Overactive bladder (OAB) is a condition recognized by symptoms such as 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 vary widely, and may include urinary tract infection, nerve damage from injury or pelvic surgery, bladder stones, diabetes, kidney disease, side effects of certain drugs, or neurologic disorders like Parkinson's disease, stroke or multiple sclerosis. In men, prostate problems may lead to OAB.
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 what foods and beverages he/she 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.
- Bladder scan: An ultrasound of the kidneys, bladder and urethra, to see if the bladder empties completely.
- 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 may be prescribed estrogen as a topical cream, vaginal rings or tablets.
- Posterior Tibial Nerve Stimulation (PTNS): A nurse 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 (InterStim Therapy): A tiny pacemaker-like device is implanted through a tiny incision in the lower back to calm the sacral nerves that control bladder function.
- Bladder augmentation: A rare surgical procedure that enlarges the bladder with a patch made from the patient’s own tissue.
To learn more about Overactive Bladder, visit WebMD's Incontinence & Overactive Bladder Health Center.
To learn more about OAB, visit our women's health section on Overactive Bladder.
To record your urination patterns click here.