Overactive Bladder (OAB): Symptoms, Causes, and Treatment

Introduction

Anyone who frequently wakes up at night to use the bathroom or has to make multiple stops during a road trip knows how inconvenient and frustrating it can be to constantly feel the need to urinate. This could be a symptom of overactive bladder syndrome (OAB), which is more common than many people realize. According to the Urology Care Foundation, up to 30% of men and 40% of women in the United States experience symptoms of OAB [^1]. In this article, we will explore what overactive bladder is, its symptoms, causes, and available treatment options.

What Is an Overactive Bladder?

An overactive bladder is not a disease itself but rather a collection of urinary symptoms, with the most common being a sudden and frequent urge to urinate. The bladder has two functions: storing urine by relaxing and expelling urine by contracting. In individuals with OAB, the bladder muscle, known as the detrusor muscle, involuntarily contracts, leading to bothersome urinary symptoms. OAB can significantly disrupt daily life if left untreated.

Causes of Overactive Bladder

There are several possible causes of overactive bladder. One cause is bladder spasms, where the bladder contracts as if the person were attempting to urinate, even when they do not intend to. Another common cause is sensory urgency, where the person feels the need to urinate frequently but without bladder spasms. OAB can also be a symptom of underlying conditions such as diabetes, multiple sclerosis, rare neurological diseases, or the presence of bladder-obstructing masses like uterine fibroids. Certain medications, such as diuretics used for hypertension, may also contribute to OAB symptoms.

Symptoms of Overactive Bladder

The primary symptom of overactive bladder is a sudden and urgent need to urinate. This urge can occur with or without urinary incontinence (unintentional leakage of urine). Other accompanying symptoms include daytime urinary frequency (feeling the need to urinate too often during the day) and nocturia (interrupted sleep due to the need to urinate). The "normal" frequency of urination varies among individuals, but typically, people urinate around six to seven times within a 24-hour period. However, anywhere between four and ten times can still be considered normal .

Diagnosing Overactive Bladder

Diagnosing overactive bladder involves a clinical assessment based on reported symptoms. Doctors diagnose OAB when patients describe being bothered by urinary urgency, with or without urinary incontinence, and often accompanied by frequency and nocturia. It is important for doctors to rule out any underlying conditions or obvious pathology that could contribute to frequent urination before confirming an OAB diagnosis.

Who Is at Risk for Overactive Bladder?

While anyone can develop overactive bladder, it is more prevalent in women, particularly post-menopausal women. The decline in estrogen levels after menopause affects the bladder's ability to stretch, leading to increased susceptibility to OAB symptoms. However, OAB can also occur in younger women without a clear explanation. In older men, OAB is often associated with prostate issues, such as benign prostatic enlargement, which can cause bladder outlet obstruction. Other risk factors for OAB include constipation, higher body mass index (BMI), metabolic syndrome, and certain medical conditions like diabetes, hyperlipidemia, cardiovascular disease, and renal disease [^3].

Treatment Options for Overactive Bladder

The initial approach to treating overactive bladder involves implementing behavioral changes. One common strategy is fluid restriction, especially later in the evening to minimize nighttime awakenings. If behavioral changes alone do not provide relief, medications designed to decrease bladder spasms, such as tolterodine (Detrol), oxybutynin chloride (Ditropan), or darifenacin (Enablex), may be prescribed. It is worth noting that some individuals experience symptom improvement with a placebo, suggesting the power of psychological factors in symptom management.

Additional treatment options for OAB include pelvic floor physical therapy with electrical stimulation, posterior tibial nerve stimulation, Botox injections in the bladder, and sacral nerve stimulation via an implantable pacemaker. The choice of treatment depends on individual circumstances and the severity of symptoms.

Prevention of Overactive Bladder

There is no guaranteed method to prevent overactive bladder. However, certain lifestyle modifications can help manage and limit the severity of OAB symptoms. Maintaining a healthy lifestyle, including weight management (if necessary), regular exercise, proper bowel management to address constipation, and optimizing any other coexisting medical conditions, may contribute to preventing or alleviating OAB symptoms. For individuals with diabetes, managing blood sugar levels may help reduce urgency incontinence, although some individuals may experience this symptom regardless of blood sugar control.

When to See a Doctor

If you find yourself urinating more frequently than usual and it disrupts your daily life, it is advisable to consult a doctor. Many people with overactive bladder symptoms avoid discussing them with their doctors, which can be risky if the symptoms are related to an underlying medical issue. Healthcare professionals can provide appropriate guidance and treatment options to alleviate suffering and improve quality of life.

Conclusion

Overactive bladder is a common condition characterized by frequent and urgent urination, which can significantly impact daily life if left untreated. While it affects both men and women, it is more prevalent in women, especially post-menopausal individuals. The causes of overactive bladder can vary, including bladder spasms, sensory urgency, underlying medical conditions, and certain medications. Treatment options range from behavioral changes to medications and various interventions. While prevention may not be possible, adopting a healthy lifestyle and managing modifiable risk factors can help manage and limit the severity of symptoms.

References:

( Forbes Health - [https://www.forbes.com/health/body/overactive-bladder/)