Overactive Bladder

OVERACTIVE BLADDER

Overactive bladder is a medical condition caused by involuntary contractions of muscles in the bladder. These spasms create an urgency to urinate, whether the bladder is full or not. Overactive bladder (OAB) is the name for a group of urinary symptoms. It is not a disease. It occurs because the muscles of the bladder start to contract involuntarily even when the volume of urine in your bladder is low. This involuntary contraction creates the urgent need to urinate.

The urge occurs more frequently than is considered normal. If there’s urine in the bladder, it may leak at the same time the contraction occurs (known as urge incontinence). Nearly 1 in 5 Canadians of both genders over the age of 35 have overactive bladder.

If you have an overactive bladder, you may feel embarrassed, isolate yourself, or limit your work and social life. A brief evaluation can determine whether there’s a specific cause for your overactive bladder symptoms.

Without treatment, OAB symptoms can make it hard to get through the day without many trips to the bathroom. You may not want to go out with friends or go far from home because you’re afraid of being far from a bathroom. This makes many people feel lonely and isolated.

SYMPTOMS OF OVERACTIVE BLADDER

The symptoms of overactive bladder include:

• Sudden, strong urge to urinate.
• Urinating frequently, usually eight or more times in 24 hours.
• Inability to control the urge to urinate until bathroom is reached.
• Severe cases can lead to incontinence.
• Waking from sleep to urinate.

Many people mistakenly assume it is a natural part of aging and do not seek treatment that could alleviate their symptoms.

Overactive bladder can cause problems for patients in all aspects of their lives – professional, social and sexual. People with overactive bladder can struggle with depression, shame, isolation, and stress.

If your symptoms distress you or disrupt your life, talk to your doctor. Treatments are available that might help you. Discussing such a private matter with your doctor might not be easy, but it’s worthwhile to take that risk — especially if your symptoms disrupt your work schedule, social interactions and everyday activities.

RISK FACTORS

As you age, you’re at increased risk of developing overactive bladder. You’re also at higher risk of diseases and disorders, such as enlarged prostate and diabetes, which can contribute to other problems with bladder function.

Many people with cognitive decline — for instance, after a stroke or with Alzheimer’s disease — develop an overactive bladder. Incontinence that results from situations like this can be managed with fluid schedules, timed and prompted voiding, absorbent garments, and bowel programs.

Some women also may have a disorder called mixed incontinence, when both urge and stress incontinence occur. Stress incontinence is the loss of urine when you exert physical stress or pressure on your bladder, such as during activities that include running or jumping. Treatment of the stress incontinence is not likely to help the overactive bladder symptoms.

Older people may have a common combination of bladder storage problems and bladder-emptying issues. The bladder may cause a lot of urgency and even incontinence, but it doesn’t empty well. A specialist may be able to help you with this combination of bladder problems.

Life style factors

These healthy lifestyle choices may reduce your risk of overactive bladder:

• Maintain a healthy weight.
• Get regular, daily physical activity and exercise.
• Limit consumption of caffeine and alcohol.
• Quit smoking.
• Manage chronic conditions, such as diabetes, that might contribute to overactive bladder symptoms.

Learn where your pelvic floor muscles are and then strengthen them by doing Kegel exercises — tighten (contract) muscles, hold the contraction for two seconds and relax muscles for three seconds. Work up to holding the contraction for five seconds and then 10 seconds at a time. Do three sets of 10 repetitions each day.

DIAGNOSIS

Your doctor will do a physical examination. He or she will ask what kinds of fluids you drink and how much. Your doctor will also want to know how often you urinate, how much, and if you leak. It may help to write down these things in a bladder diary for 2 or 3 days before you see your doctor.

The evaluation is aimed at quantifying the symptoms and looking for potentially reversible or significant causes of the symptoms. Evaluation may include:

• A pelvic examination if you are a woman or a rectal examination if you are a man.
• Urine test: Your health care provider may ask you to leave a sample of your urine to test for infection or blood.
• Bladder scan: This type of ultrasound shows how much urine is still in the bladder after you go to the bathroom.
• Cystoscopy involves passing a thin scope through the urinary tube (urethra) into the bladder to visually inspect the lower urinary system.
• Your doctor may order a simple urodynamic test to assess the function of your bladder and its ability to empty steadily and completely.

Your doctor will review the results of any tests with you and suggest a treatment strategy.

OVERACTIVE BLADDER TREATMENTS

The symptoms of overactive bladder are treatable. The doctor may ask you to keep a voiding journal – a record of your urges, frequency, incontinence and fluid consumption.

There are many types of response to overactive bladder: