Over Active Bladder - What Is It?

Over Active Bladder (OAB) is a condition in which an individual has a sudden involuntary contraction of the muscles present in the urinary bladder wall. This leads the patient to feel a sudden urge to urinate and one which is usually difficult to control. This, in turn, may lead to urinary incontinence, which is the involuntary leakage of urine.

Patients with an overactive bladder may become socially withdrawn due to embarrassment related to the condition. It also affects them psychologically. Isolation and avoidance from social life may frequently be seen.

Overactive bladder is not a hopeless case. Proper management of it can help control this condition and enable you to lead a very normal life.

Risk Factors of OAB

Part of controlling OAB is knowing what are the risk factors associated with it. These include:

• Age: Risk of OAB increases with age.
• Gender: Women are affected more than men.
• Obesity: The greater the weight, the greater the risk of OAB.

Triggers of OAB

So, what is it that triggers OAB? Possible OAB triggers include:

• Consuming acidic foods like tomatoes, citrus fruits, etc.
• Consuming too much alcohol or caffeine.
• Eating a diet which is deficient in fiber.
• Not drinking enough water.
• Constipation.

Prevention of OAB

Risk and triggers of OAB can be reduced by adhering to healthy lifestyle choices. Factors that help in preventing OAB are:

• Maintaining a healthy and ideal weight.
• Maintaining a regular daily exercise regime.
• Limiting the intake of alcohol and caffeine.
• Quitting smoking.
• Managing and controlling chronic conditions like diabetes.
• Learning about your pelvic floor muscles and doing strengthening exercises called Kegels that will keep them strong and flexible.

What are the causes of Overactive Bladder?

Overactive bladder may be caused by any number of different conditions. Some of these conditions directly affect the urinary bladder wall, while others have an indirect effect on the urinary bladder wall due to some other primary cause. The causes include:

• Neurological disorders
• Stroke
• Spinal cord injury
• Back problems like herniated disc
• Parkinson’s disease
• Dementia
• Multiple sclerosis
• Diabetic neuropathy
• Brain and spinal cord infections

Causes of Urinary Tract Infections

• Drug side effects
• Water pills
• Caffeine pills
• Bladder stones
• Bladder tumors
• Enlarged prostate
• Constipation
• Any previous surgery causing incontinence
• Excessive consumption of alcohol or caffeine
• Decline in cognitive functions related to aging
• Difficulty walking that makes it difficult to reach the bathroom in time
• Incomplete emptying of the urinary bladder
• Idiopathic OAB

Signs and Symptoms

Overactive bladder shows its typical sign and symptoms, which are in many cases accompanied by bladder infection symptoms.

Overactive Bladder Symptoms

Sign and symptoms as seen in OAB include the following:

• Urinary urgency: There is an urgent need to urinate, even though there is a small amount of urine present in the bladder.
• Urinary incontinence: There might be leakage of the urine. This may be seen with or without urgency.
• Increased frequency: Trips to the bathroom increase with OAB. Usually, urinary frequency is seen as voiding 8 or more times per day.
• Nocturia: This means getting up at night while you are asleep to urinate. Usually one gets up one or more times at night to void.

Stress incontinence: This is a type of urinary leakage where there is a weakness in the supporting muscles of the urinary bladder and urethra. Pelvic floor muscles also show subsequent weakness. Whenever intra-abdominal pressure rises as it does when coughing or jumping, there is urinary incontinence.

Bladder Infection Symptoms

Symptoms of a bladder infection include:

• Burning feeling while urinating.
• Frequent intense urge to urinate with little or no urine coming out.
• Feeling pain or pressure in the lower abdomen or the back.
• Passing urine that is cloudy, dark, bloody or smells strange.
• Feeling of tiredness or shakiness.
• Fever and chills.

Treatment

The different types of treatment strategies are often most successful when combined to get the most effective result for an overactive bladder.

Behavioral Interventions

These are the first choice in OAB management. They come with no side effects and are found to be very effective. These include;

• Pelvic floor muscle exercises (Kegels)
• Maintaining a healthy weight
• Scheduled toilet trips
• Intermittent catheterization
• Absorbent pads
• Bladder training

Tablets for Overactive Bladder

Certain drugs which have a relaxing effect on the urinary bladder wall help in reducing the signs and symptoms of OAB and urinary incontinence. The different medicines used include:

• Tolterodine (Detrol, Detrol LA))
• Oxybutynin (Ditropan XL)
• Oxybutynin skin patch (Oxytrol)
• Oxybutynin gel (Gelnique, Gelnique 3%)
• Trospium (Sanctura)
• Solifenacin (Vesicare)
• Darifenacin (Enablex)
• Fesoterodine (Toviaz)
• Mirabegron (Myrbetriq)
• Onabotulinumtoxin A (Botox), used in small doses and injected into the urinary bladder tissue, paralyzes the muscles and relieves the contraction.

Nerve Stimulation

Sacral nerves, which carry signals to the bladder, are stimulated by placing a thin wire close to them. It works similarly to the way a pacemaker does for the heart and helps reduce the symptoms of OAB.

Surgery

After all other treatments fail, only then we turn to surgery. Surgical interventions are of 2 types:

Surgery to increase bladder capacity; used for cases of OAB with severe urinary incontinence that has not responded to any other treatment.

Bladder removal: This is the last resort. If all fails, then either the bladder is removed and replaced with a neobladder, or an opening (stoma) is formed in the body. A bag is attached to this stoma that collects the urine.

UTI Treatment

As urinary tract infection is a very common occurrence associated with OAB, invariably it must be treated along with OAB. Commonly recommended antibiotics for UTI treatment are Trimethoprim/sulfamethoxazole, Fosfomycin, Cephalexin, Ceftriaxone, etc.

References:

1. Healthline – Tips for Limiting Acidic Foods
2. Continence Foundation of Australia – Pelvic floor muscles