Learn About Overactive Bladder (OAB)

Bladder control problems are actually very common, and almost half of all women leak urine at some point in their lives.1 It can have a significant impact on a woman’s quality of life, causing emotional distress, discomfort and preventing her from living her life to the fullest.

There are different types of urinary incontinence. The most common types are stress urinary incontinence (SUI), when coughing, sneezing or physical activity causes urine to leak, and urge incontinence or overactive bladder (OAB), when someone has a strong need to urinate and may leak before making it to the bathroom.1 In many cases, women will experience both OAB and SUI at the same time, known as “mixed incontinence.” The causes of OAB vary and there are often risk factors that make women more or less likely to experience bladder leakage.2

Causes:2

  • Neurological disorders, such as stroke and multiple sclerosis
  • Diabetes
  • Medications that require large fluid intake, causing rapid urine production
  • Acute urinary tract infections
  • Tumors or bladder stones
  • Incomplete bladder emptying during trips to the bathroom

There may be other causes of OAB that your doctor could discuss with you.

Risk Factors:1,2

  • Age: your risk of experiencing OAB increases as you get older. This is sometimes due to a person’s risk of developing other conditions that affect the bladder, or declining cognitive function which makes it more difficult to recognize the urge to urinate.
  • Childbirth: weak pelvic floor muscles caused by pregnancy and childbirth make OAB more common in women
  • Menopause: like childbirth, menopause can also be accompanied by weakening of the pelvic floor muscles, making women more susceptible to bladder leaks
  • Obesity: being overweight can make increase your risk of developing OAB and other diseases like diabetes that can exacerbate bladder control issues

OAB can be recognized by the following symptoms:1,2

  • Sudden urge to urinate that is difficult to control
  • Urge incontinence – the involuntary loss of urine immediately following the urgent need to urinate
  • Frequent urination – urinating more than eight times in a day
  • Nocturia – awaking two or more times during the night to urinate

It is common for women with OAB to have mixed incontinence, which means they also experience symptoms of stress urinary incontinence (SUI). For these women, leakage is also a result of coughing, sneezing, or exert pressure on abdominal muscles, which are symptoms specific to SUI.

OAB may be common, but that doesn’t mean you have to live with it.  If your bladder habits are impacting your daily life, ask your doctor about diagnostic testing and treatment options. Some diagnostic tests may include:1,2

  • Physical exam focusing on abdomen and genitals
  • Urine sample: a test for infection or traces of blood
  • Neurological exam: a test for sensory issues or abnormal refluxes
  • Urodynamic test: a doctor will use an ultrasound scan of the bladder or a thin tube catheter through the urethra to assess the function of your bladder and its ability to empty.
 

Overactive Bladder (OAB) Treatment Options

The daily challenges of this condition are compounded by shame and embarrassment, causing many women to suffer silently before seeking medical treatment. Fortunately for women suffering from OAB, there are many treatment options that can be discussed with your doctor before invasive surgeries, ranging from lifestyle changes and drug therapy to muscle and nerve therapy.

Women experiencing mixed incontinence (symptoms of SUI and OAB) should consult a doctor about which symptoms are most bothersome, and as result, which treatment option would be most effective. For a full list of SUI treatment options, click here.

DRUG THERAPY

There are quite a few medications that your doctor can prescribe to help alleviate symptoms of OAB, including:

  • Tolterodine (Detrol, Detrol LA)
  • Oxybutynin (Ditropan XL)
  • Oxybutynin as a skin patch (Oxytrol)
  • Oxybutynin gel (Gelnique, Gelnique 3%)
  • Trospium (Sanctura)
  • Solifenacin (Vesicare)
  • Darifenacin (Enablex)
  • Mirabegron (Myrbetriq)
  • Fesoterodine (Toviaz)

As with many medications, there is a potential for side effects that you should discuss with your doctor.  Many medications come in extended-release forms, like a skin patch or gel, which may decrease the occurrence of side effects.

MINIMALLY INVASIVE THERAPIES

For women who have tried medication and lifestyle changes to no avail, your doctor may recommend sacral nerve stimulation or posterior tibial nerve stimulation.

Sacral nerve stimulation (SNS):During this procedure, a thin wire will be placed close to the sacral nerves that carry signals to your bladder. Once tested, patients will undergo a final procedure to implant a battery-powered pulse generator device that connects to the wire to deliver impulses to the bladder.

Posterior tibial nerve stimulation (PTNS): This is a good option for patients looking for a low risk, non-surgical option. During this procedure, a thin needle is placed near the ankle nerve and connected to a device that sends mild electrical pulses to the base of the spine that is responsible for bladder function. Stimulating these nerves can help regulate bladder urgency caused by OAB.

Another minimally invasive approach to treating OAB involves injecting Botox® into the bladder tissues. In this case, instead of stimulating the bladder, the Botox is partially paralyzing the muscles and preventing muscle spasms that lead to leakage.

SURGERY

For women who have tried medication and lifestyle changes to no avail, your doctor may recommend electrical nerve stimulation as known as sacral nerve stimulation(SNS).  During this procedure, a thin wire will be placed close to the nerves that carry signals to your bladder. Once tested, a battery-powered pulse generator device will be connected to the wire to deliver impulses to your bladder.

Doctors will usually hold off on recommending surgery for OAB until you are experiencing severe symptoms that have not responded to other treatments. Surgical options to treat OAB can have a lasting negative impact on quality of life, so it is recommended that women consider less invasive options first before exploring surgery.

Surgery to increase bladder capacity: This procedure uses pieces of your bowel to replace a portion of your bladder. If you have this surgery, you may need to use a catheter intermittently for the rest of your life to empty your bladder.

Bladder removal: a procedure that involves full removal of the bladder and constructions of replacement bladder or an opening in the body (stoma) to attach a bag on the skin to collect urine.

LIFESTYLE CHANGES

Lifestyle has a tremendous impact on pelvic health, and simple changes can make a difference in the management of OAB. This starts with water consumption. Women should ask their doctor how much liquid they should be drinking without sacrificing hydration. To help with this, drinks with caffeine or alcohol should be avoided, especially before bedtime.

Maintaining a healthy weight plays a significant role in bladder control as an increase in BMI can contribute to bladder leakage. That’s why staying physically active is a simple first step you can take in managing bladder control issues.

Lastly, here’s one more reason to quit smoking.  Smoking raises your chances of developing stress incontinence as it often causes chronic cough. So put down the cigarettes for good - not only for your bladder health, but your overall health. 

Exercises

Doctors will often recommend therapies or exercises designed to improve bladder control and help patients become more aware of their urge to go to the bathroom. Women can either perform exercises on their own or see a physical therapist who specializes in pelvic floor health. These therapists can teach you various mental and physical exercises like pelvic floor contractions, practicing distractive thoughts to fight the urge associated with OAB, and breathing exercises that relax the bladder. Some exercises you can do on your own include:

Kegel exercises, which strengthen the pelvic floor muscles that support the bladder and bowels. To perform Kegel exercises, contract the muscles that you would normally use to stop the flow of urine, hold the contraction for three seconds, then relax for three seconds. Repeat this pattern 10 times. As your muscles strengthen, hold the contraction longer, gradually working your way up to three sets of 10 contractions every day.

You can also train your body to suppress the urge to urinate by delaying urination when the urge arises; starting with 30-minute and slowly working your way up to urinate every three to four hours.  The same training can also be achieved through scheduled bathroom trips to get yourself on a schedule rather than waiting until you feel the urge.

REFERENCES

  1. National Institutes of Health. Bladder Control Problems. Symptoms and Causes. https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems/symptoms-causes. Accessed January 2019.
  2. Mayo Clinic. Overactive Bladder. Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/overactive-bladder/symptoms-causes/syc-20355715. Accessed January 2019
  3. Mayo Clinic. Overactive Bladder. Diagnosis and Treatment. https://www.mayoclinic.org/diseases-conditions/overactive-bladder/symptoms-causes/syc-20355715. Accessed January 2019
  4. National Institutes of Health. Bladder Control Problems. Treatment. https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems/treatment. Accessed January 2019.
  5. The Simon Foundation. PTNS. https://simonfoundation.org/ptns/. Accessed April 2019
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