Overactive bladder (OAB) facts
What is an overactive bladder?
Overactive bladder (OAB) is a condition that is characterized by sudden, involuntary contraction of the muscle in the wall of the urinary bladder. This results in a sudden and unstoppable need to urinate (urinary urgency), even though the bladder may only contain a small amount of urine. Key features are the sudden urge to void along with urinary frequency (voiding < 2 hour intervals). Irritating fluids, such as caffeinated beverages (coffee, tea), spicy foods, and alcohol can worsen the symptoms. It is common for those affected to compensate for OAB by toilet mapping, fluid restriction, and timed voiding. There is no pain, burning, or blood in the urine with OAB.
Overactive bladder coupled with urinary leakage (inability to suppress the urge to void) is also referred to as urge incontinence and is a form of urinary incontinence (unintentional loss of urine). Another common type of urinary incontinence is called stress incontinence, which is caused by anatomic weakness in the structures that prevent the bladder from leaking. Such patients will leak with coughing, straining, jumping, or other physical activity that contracts the abdominal muscles. Treatment for stress incontinence is very different than urge incontinence. Stress incontinence is treated with methods that support the weakened support structures, including Kegel exercises, urethral bulking agents, and urethral mesh surgery to strengthen the pelvic floor muscles. In some, there can be a combination of urge and stress incontinence (mixed incontinence). In general, urinary incontinence is more common in women compared to men.
SymptomsOABStress Urinary IncontinenceUrgency (Strong, Sudden Desire to Void)YesNoFrequency With Urgency (≥ 8 Times/24 Hours)YesNoLeaking During Physical Activity (For Example, Coughing, Sneezing, Lifting)NoYesAmounts of Urinary Leakage With Each Episode of IncontinenceLarge (If Present)SmallAbility to Reach the Toilet in Time Following Urge to VoidOften NoYesNocturia (Waking to Pass Urine at Night)UsuallySeldomThe overall prevalence of overactive bladder is 13.9%, affecting men and women with equal frequency. Although it can happen at any age, overactive bladder is especially common in older adults. Overactive bladder should not be considered a normal part of aging. The prevalence under the age of 50 is < 10%. After age 60, the prevalence increases to 20%-30%. It is estimated that 60% of patients have dry OAB (no leakage) while 40% have wet OAB.
What are the causes of overactive bladder?
Overactive bladder is typically caused by early, uncontrolled contraction (spasms) of the bladder muscle (detrusor muscle), resulting in an urge to urinate. Overactive bladder is primarily a problem of the nerves and muscles of the bladder that allow for early contraction during the normal relaxation phase of bladder filling. The bladder's contraction in response to filling with urine is one the steps in the normal process of urination. The contraction and relaxation of the detrusor muscle is regulated by the nervous system. Approximately 300 cc of urine in the bladder can signal the nervous to trigger muscles of the bladder to coordinate urination. Voluntary control of the sphincter muscles at the opening of the bladder can hold the urine in the bladder for longer. Up to 600 cc of urine can be contained in a normal adult bladder. For those with OAB, the bladder capacity is typically low (< 200cc).
Overactive bladder typically results from inappropriate contraction of the detrusor muscle regardless of the amount of urine. This could result from problems of the nervous system or other causes.
The common abnormalities of the nervous system that cause overactive bladder are
Other causes include urinary tract infection, bladder stones, urethral strictures, benign prostatic enlargement (BPH), or bladder tumors.
Frequently, no apparent cause of overactive bladder can be determined (idiopathic overactive bladder).
Are there any risk factors for overactive bladder?
Some of the common risk factors for overactive bladder include
Race is not a risk factor for overactive bladder as it can affect people of all races.
What are overactive bladder symptoms?
The symptoms of an overactive bladder include frequent urination, urgency of urination, and nocturia (urinating in the middle of the night), with or without urge incontinence. Overactive bladder may cause significant social, psychological, occupational, domestic, physical, and sexual problems. Again, these symptoms should not be considered a normal part of aging.
How is overactive bladder diagnosed?
Careful medical history and diligent review of symptoms related to overactive bladder are very important. Getting up to urinate at least three times in the middle of the night, increased urinary frequency (urinating at least eight times daily), urinary urgency, and urinary incontinence are all important clues in evaluating someone suspected of having overactive bladder.
In addition to a general physical examination, a pelvic exam in women (to assess for dryness, atrophy, inflammation, and/or infection) and a prostate examination in men (to assess for size, tenderness, texture, and/or masses) are helpful in excluding other contributing conditions.
Urine analysis (UA) to assess for infections and occasionally urine cytology (to look for cancer cells in the bladder) are sometimes advised in individuals undergoing evaluation of urinary incontinence and overactive bladder. Ultrasound measurement of the amount of urine left in the bladder after urination (called post-void residual) may also provide additional information about the cause of urinary incontinence (obstruction to urine flow or weak bladder muscle).
What are the treatments for an overactive bladder?
The treatment for overactive bladder depends on the capabilities of the patient. Generally, treatment can be behavioral retraining, pharmacological (medications), and surgical.
Here are commonly recommended treatments.
Pelvic muscle rehabilitation to improve pelvic muscle tone and prevent leakageWhat is the role of medications in treating overactive bladder?
There are several medications recommended for the treatment of overactive bladder. Using these medications in conjunction with behavioral therapies has shown to increase the success rate for the treatment of overactive bladder.
The main goals of OAB treatment are to
Typically, the medications for overactive bladder start to work within one to two weeks, and optimal relief of OAB symptoms is achieved by 12 weeks. The most common medications (anticholinergics) target to decrease the overactivity of the detrusor muscle. Anticholinergics should be used under the direction of the physician prescribing them. They may have some common side effects, including dry mouth, constipation, blurry vision, and confusion (in the elderly). Here is a list of the most commonly recommended medications for overactive bladder.
Anticholinergic classLearn more about: Ditropan | Ditropan XL | Oxytrol | Detrol | Detrol LA | Vesicare | Enablex | Toviaz
B3-Agonist classLearn more about: Myrbetriq
Botox injection classNeuromodulation is a newer method of treating overactive bladder with electrical stimulation that results in reorganization of the spinal reflexes involved in bladder control. There are two types of neuromodulation available: percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation (Interstim).
Surgery is rarely necessary in treating overactive bladder unless symptoms are debilitating and unresponsive to other treatments. Reconstructive bladder surgery (cystoplasty) is the most common surgical procedure. This surgery involves enlarging the size of the bladder by using part of the intestine.
What are treatments for the chronically incontinent?
Although many people will improve their continence through medications, pelvic-muscle exercises, and bladder training, some will never achieve complete dryness. Sometimes treatment failures are due to concurrent use of other necessary medications, such as diuretics (water pills that increase urination), that actually can cause incontinence. Others may have dementia or other physical impairments that keep them from being able to perform pelvic-muscle exercises or retrain their bladders. Many will be cared for in long-term care facilities or at home. The following recommendations can help keep the chronically incontinent drier and reduce their cost of care:
What measures can be taken at home to prevent overactive bladder symptoms?
There are simple steps that can reduce symptoms of overactive bladder. For example, caffeine may exacerbate urinary urgency and it is potentially an irritant to the bladder. Eliminating caffeine intake can diminish some of the symptoms of overactive bladder.
Some experts suggest that avoidance of certain foods, such as chocolate, spicy foods, alcohol, carbonated beverages, and nuts, can be beneficial in preventing symptoms of overactive bladder. Others encourage increasing the amount of dietary fiber for people with overactive bladder. Limiting fluid intake can also help to reduce urinary frequency.
Excess weight can put more pressure on the bladder, causing urinary incontinence. Therefore, weight loss can also help with urinary incontinence in general.
Are there any risk factors for overactive bladder?
Some of the common risk factors for overactive bladder include
Race is not a risk factor for overactive bladder as it can affect people of all races.
What are overactive bladder symptoms?
The symptoms of an overactive bladder include frequent urination, urgency of urination, and nocturia (urinating in the middle of the night), with or without urge incontinence. Overactive bladder may cause significant social, psychological, occupational, domestic, physical, and sexual problems. Again, these symptoms should not be considered a normal part of aging.
How is overactive bladder diagnosed?
Careful medical history and diligent review of symptoms related to overactive bladder are very important. Getting up to urinate at least three times in the middle of the night, increased urinary frequency (urinating at least eight times daily), urinary urgency, and urinary incontinence are all important clues in evaluating someone suspected of having overactive bladder.
In addition to a general physical examination, a pelvic exam in women (to assess for dryness, atrophy, inflammation, and/or infection) and a prostate examination in men (to assess for size, tenderness, texture, and/or masses) are helpful in excluding other contributing conditions.
Urine analysis (UA) to assess for infections and occasionally urine cytology (to look for cancer cells in the bladder) are sometimes advised in individuals undergoing evaluation of urinary incontinence and overactive bladder. Ultrasound measurement of the amount of urine left in the bladder after urination (called post-void residual) may also provide additional information about the cause of urinary incontinence (obstruction to urine flow or weak bladder muscle).
What are the treatments for an overactive bladder?
The treatment for overactive bladder depends on the capabilities of the patient. Generally, treatment can be behavioral retraining, pharmacological (medications), and surgical.
Here are commonly recommended treatments.
Pelvic muscle rehabilitation to improve pelvic muscle tone and prevent leakageWhat is the role of medications in treating overactive bladder?
There are several medications recommended for the treatment of overactive bladder. Using these medications in conjunction with behavioral therapies has shown to increase the success rate for the treatment of overactive bladder.
The main goals of OAB treatment are to
Typically, the medications for overactive bladder start to work within one to two weeks, and optimal relief of OAB symptoms is achieved by 12 weeks. The most common medications (anticholinergics) target to decrease the overactivity of the detrusor muscle. Anticholinergics should be used under the direction of the physician prescribing them. They may have some common side effects, including dry mouth, constipation, blurry vision, and confusion (in the elderly). Here is a list of the most commonly recommended medications for overactive bladder.
Anticholinergic classLearn more about: Ditropan | Ditropan XL | Oxytrol | Detrol | Detrol LA | Vesicare | Enablex | Toviaz
B3-Agonist classLearn more about: Myrbetriq
Botox injection classNeuromodulation is a newer method of treating overactive bladder with electrical stimulation that results in reorganization of the spinal reflexes involved in bladder control. There are two types of neuromodulation available: percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation (Interstim).
Surgery is rarely necessary in treating overactive bladder unless symptoms are debilitating and unresponsive to other treatments. Reconstructive bladder surgery (cystoplasty) is the most common surgical procedure. This surgery involves enlarging the size of the bladder by using part of the intestine.
What are treatments for the chronically incontinent?
Although many people will improve their continence through medications, pelvic-muscle exercises, and bladder training, some will never achieve complete dryness. Sometimes treatment failures are due to concurrent use of other necessary medications, such as diuretics (water pills that increase urination), that actually can cause incontinence. Others may have dementia or other physical impairments that keep them from being able to perform pelvic-muscle exercises or retrain their bladders. Many will be cared for in long-term care facilities or at home. The following recommendations can help keep the chronically incontinent drier and reduce their cost of care:
What measures can be taken at home to prevent overactive bladder symptoms?
There are simple steps that can reduce symptoms of overactive bladder. For example, caffeine may exacerbate urinary urgency and it is potentially an irritant to the bladder. Eliminating caffeine intake can diminish some of the symptoms of overactive bladder.
Some experts suggest that avoidance of certain foods, such as chocolate, spicy foods, alcohol, carbonated beverages, and nuts, can be beneficial in preventing symptoms of overactive bladder. Others encourage increasing the amount of dietary fiber for people with overactive bladder. Limiting fluid intake can also help to reduce urinary frequency.
Excess weight can put more pressure on the bladder, causing urinary incontinence. Therefore, weight loss can also help with urinary incontinence in general.
Source: http://www.rxlist.com
Overactive bladder typically results from inappropriate contraction of the detrusor muscle regardless of the amount of urine. This could result from problems of the nervous system or other causes.
The common abnormalities of the nervous system that cause overactive bladder are
Other causes include urinary tract infection, bladder stones, urethral strictures, benign prostatic enlargement (BPH), or bladder tumors.
Frequently, no apparent cause of overactive bladder can be determined (idiopathic overactive bladder).
Source: http://www.rxlist.com
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