Overactive bladder (OAB) is a condition recognized by symptoms including urinary urgency, frequent urination, waking up at least twice a night to urinate or urge incontinence (leakage of urine). It is one of the leading causes of urinary incontinence. At least 30 million Americans suffer from overactive bladder.
Research shows that multiple factors can cause overactive bladder. Signals from the sacral nerves (located at the base of the spine) to the bladder may cause the muscle surrounding the bladder (detrusor) to contract, even if the bladder isn't full. This is called detrusor overactivity. But the causes of OAB in women vary widely and may include urinary tract infection, nerve damage from injury or pelvic surgery, previous pregnancies, bladder stones, diabetes, kidney disease, side effects of certain drugs, or neurologic disorders like Parkinson's disease, stroke or multiple sclerosis. Also, bladder control issues are a common complication of menopause.
Most symptoms of OAB involve a sudden, uncontrollable need to urinate:
- Frequent and immediate need to urinate
- Going to the bathroom frequently at night
- Accidents resulting from the inability to reach the bathroom in time
A urologist will perform a detailed history and physical exam to categorize the incontinence. It is helpful if the patient keeps a diary for a few days before examination to record times of urination, how much urine is passed, leakage and the foods and beverages consumed. The physician may also perform one of several tests:
- Stress test: The patient relaxes and then coughs hard as the physician watches for urine loss.
- Postvoid residual volume: A test that measures the amount of urine left in the bladder after urination.
- Urinalysis: An examination of the composition of the patient’s urine.
- Ultrasound: Sound waves used to take a picture of the kidneys, bladder and urethra.
- Cystoscopy: A thin tube with a tiny camera is inserted into the urethra to view any abnormalities in the urethra or bladder.
- Urodynamics: A special technique that measures pressure in the bladder and urine flow.
Overactive bladder can interfere with many activities so treatment is important. However, a patient can adopt lifestyle changes to help control the condition. Cutting down on caffeinated drinks, alcohol, chocolate, tomatoes, citrus and spicy foods has shown positive results. Also, a high-fiber diet can prevent constipation, which aggravates OAB. Women with OAB may experience improvement after performing pelvic floor exercises. Other treatments may include:
- Medication: Anticholinergics, the most common OAB medications, help to suppress involuntary contractions by the detrusor muscles. Women also may be prescribed estrogen as a topical cream, vaginal rings or tablets.
- Posterior Tibial Nerve Stimulation (PTNS): The physician performs periodic stimulation of the posterior tibial nerve (near the ankle) as a weekly, outpatient therapy.
- Botox injection: The physician injects Botox directly into the bladder muscle, partially paralyzing it to reduce overactivity, but leaving enough control to empty the bladder voluntarily.
- Sacral nerve stimulation: A tiny pacemaker-like device for the bladder is implanted through a tiny incision near the tailbone, to stimulate the sacral nerves.
- Tension-free vaginal tape (TVT): Mesh tape is placed under the urethra like a hammock to keep it in its normal position. The tape provides support for a sagging urethra so it remains closed when you cough or move vigorously or suddenly.
- Sling: In this procedure, support material is placed directly under the urethra and attaches it up to the connective tissue of the abdominal muscles. It is usually a small outpatient procedure.
- Bladder augmentation: A rare surgical procedure that enlarges the bladder with a patch made from the patient’s own tissue.
For more information on Overactive Bladder (in women) visit WebMD's Incontinence & Overactive Bladder Health Center.
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