Overview of Overactive Bladder
Living with an overactive bladder is tough. You never know when the sudden urge to urinate will interrupt your day. Worse yet, you may be anxious about being caught without a nearby bathroom.
You aren’t the only one with that fear. According to the National Association for Continence, 1 in 6 people have symptoms of overactive bladder (OAB). Overactive Bladder BasicsThe rates of overactive bladder are almost equal for men and women. However, women start showing signs at an earlier age.
People coping with OAB may have trouble remembering what normal bladder function should be. They may not realize that most people get plenty of warning when it’s time to find a bathroom, urinate less than eight times a day and typically awaken less than twice per night to go to the bathroom.
It’s different for people with OAB. To start with, bathroom urges are more sudden and demanding, and bathroom trips are more frequent throughout the day. And, instead of sleeping soundly, they’re up a few times every night to urinate.
If this describes you, you don’t have to live with these symptoms. Lifestyle changes and medical treatments can help you reclaim control.
How your bladder works
To understand how your bladder becomes overactive, it helps to understand what your bladder does and how it is supposed to function. Urine is produced by your kidneys and then moves to your bladder, where it is held before being released from the body. The cells lining the inside of the bladder send signals to your brain to let it know when the bladder is getting full. Eventually the signals are so strong that you realize you have to go to the bathroom.
Most people have a reasonable amount of time from the signal to the time they get to a bathroom. Those with OAB usually don’t. Instead, somewhere in the complex signaling, the bladder muscle may have spasms or start contracting earlier than it should. As a result, your bladder suddenly feels full.
Wet versus dry?
Not everyone with symptoms of OAB has the same set of symptoms. Two-thirds of people with overactive bladders have the dry form. They get the powerful urge to urinate, but are able to hold it until they get to the bathroom. Men with OAB are more likely to have the dry type.
The remaining third have wet OAB, which can also be called urge incontinence. This means that you have sudden urges to urinate and little time to find a bathroom before urine leakage. Wet overactive bladder is much more common in women than men.
Reclaiming bladder control
Worse than the sudden urges and increased frequency is when these symptoms take over your life. Have you skipped activities out of fear of a bathroom emergency or accident? Do you feel shame and guilt? Is your condition interfering with intimacy in the bedroom?
Don’t let it. By working with your doctor, you can get control through lifestyle changes, and, if necessary, medical treatments.
You may even improve your overall health—OAB can also lead to injury. Rushing to the bathroom due to a sudden urge can cause falls and possibly fractures. Plus, getting checked for OAB will rule out other potentially serious conditions that cause similar symptoms.
Many people see OAB as a natural part of aging. It’s not. You can enjoy life and have healthy, well-controlled bladder function. Even if you have been living with an overactive bladder, many options can help you regain your quality of life.
Symptoms of Overactive Bladder
Are your frequent bathroom trips making you wonder if you have an overactive bladder? Here are the symptoms your doctor will look for:
- Urinating eight or more times in a 24-hour span
- Waking two or more times at night to urinate
- Needing to urinate suddenly and feeling like you can’t hold it
Overactive Bladder Symptoms:
But diagnosing overactive bladder is not as simple as mentally checking off the above. Those symptoms are also common with other conditions, such as urinary tract infections, kidney problems, prostate problems in men, or, more rarely, bladder or prostate cancer. Your doctor will usually run tests to rule out these conditions before making a diagnosis of OAB. Be prepared to discuss any medications and supplements you are currently taking, in case your symptoms are a side effect of one of them.
Symptoms of OAB are also similar to some types of urinary incontinence. This can be confusing for patients because the conditions are often grouped together and the differences between them can be difficult to understand.
In general, OAB involves symptoms related to how urgent and frequent is the need to urinate. It may or may not involve urine leakage or dribbling, known as incontinence. So, it is easy to see how these conditions are interrelated—and often confused, even within the medical community.
In addition, there are several kinds of incontinence. The one that may overlap with OAB is called urge incontinence. With this form, you have a sudden urgency to urinate, but don’t have enough time to get to the bathroom before there is urine leakage. The same definition can be used to describe a type of overactive bladder called wet OAB, so some experts consider this the same condition. However, with OAB, you not only have an urgent need to go, but it can occur several times a day. It’s that combination of urgency and frequency that many doctors use to diagnose OAB.
Other forms of incontinence are unrelated to OAB. With the stress form, you may find yourself leaking when you lift something, sneeze or laugh. With overflow incontinence, you have frequent or constant feeling that you have to urinate, along with small urine leaks, but when you do go to the bathroom, your urine flow is weak and it never feels like your bladder empties. While it’s possible to have more than one condition, such as wet OAB and stress incontinence, they are different conditions.
The below chart highlights which bladder symptoms are associated with the two kinds of OAB, and the urge form of incontinence that is often linked with OAB:
Whether your symptoms indicate overactive bladder, incontinence or a combination, what matters is that you can reduce them. Talk to your doctor and get diagnosed. You may be surprised by how much you can do to minimize the impact OAB has on your life.
Overactive Bladder Risk Factors
Both men and women stand a good chance of one day facing overactive bladder (OAB). The sudden and frequent urgency to urinate occurs when a muscle in the bladder malfunctions, yet the causes of these malfunctions are largely unknown. However, in some cases, OAB can be linked to a variety of risk factors, including age, chronic disease and medications.
Age and gender
Age is the single most common risk factor for overactive bladder, which is why some people assume their symptoms are a normal part of aging. They’re not. OAB, like many other medical conditions, is treatable.
While men and women are equally as likely to develop OAB, gender-specific factors increase risk (see Women’s Factors).
Your urge to urinate could have its roots in your medicine cabinet. A variety of medications can cause bladder-related symptoms. Examples include:
- Diuretics. Used to treat high blood pressure, edema, glaucoma and other conditions.
- Antidepressants. Prescribed for people with depression, anxiety and obsessive behavior.
- Sedatives. Used to treat anxiety.
- Anticholinergics. Medicines that help control muscle spasms and tremors.
- Alpha blockers. Prescribed to help lower blood pressure and treat vascular disease.
- Beta-adrenergic agonists. Used in the treatment of asthma attacks.
These medicines can impact bladder function in various ways. For example, diuretics and certain antidepressants affect your kidneys and lead to increased production of urine. In many cases, larger amounts of urine mean more frequent urination. Other medications, such as some anticholinergics, interfere with the communication among nerves that would normally help monitor the fullness of your bladder. (However, not everyone taking these drugs will have an overactive bladder as a side effect.)
Talk to your doctor about your prescriptions. You may be able to change the medication or dose and regain your bladder control.
Healthy bladder function requires complex communication between many parts of your nervous system. If you have a condition that affects the nerves, communication throughout your body can be disrupted, putting you at a higher risk of developing overactive bladder. Such conditions include:
- Parkinson’s disease
- Multiple sclerosis
- Spinal cord injury
Other chronic diseases are also risk factors for an overactive bladder. Examples of such conditions include fibromyalgia, irritable bowel syndrome (IBS) and depression. One theory is that these conditions are all linked through disruptions in the normal creation and use of serotonin and other chemicals involved in nerve communication.
Medical researchers continue to find factors that can increase the risk of developing an overactive bladder. There’s some evidence that risk may be tied to smoking or consuming carbonated drinks, such as sodas. Some studies have also found that you’re more likely to show temporary signs of OAB a few weeks after a urinary tract infection. More risk factors will probably be identified as research into the cause of OAB progresses.
As a woman, you have an almost equal chance of developing overactive bladder (OAB) as men do. But that doesn’t mean your risk factors are the same. So what do you have to worry about that men don’t? The main factors are:
Your experience while you were pregnant may affect your risk of developing OAB afterwards. Carrying a child puts pressure on the bladder, which can contribute to OAB. For most women, pregnancy-related bladder problems will resolve themselves within a few months of giving birth. However, some cases continue long after you’ve given birth, and require treatment before any improvement is seen. (Hysterectomy, removing the uterus for medical reasons, may also put women at a higher risk of developing overactive bladder.)
A high body-mass index (BMI), a ratio of weight to height, is a measure of body fatness, that is, obesity. Depending on your BMI, your doctor may classify you as at a healthy weight, underweight, overweight or obese. If you are overweight or obese, those extra pounds are putting extra pressure on your bladder. This puts you at greater risk of developing an overactive bladder, especially “wet” OAB (involving leakage or incontinence).
Do you have one of these risk factors? Even if you do, it doesn’t mean your bladder will become overactive. And if it does, talk to your doctor about ways to manage symptoms and get back to normal bladder function.
Managing Overactive Bladder
Managing overactive bladder (OAB) often begins with diet and other lifestyle changes. But these steps are not always enough to resolve bladder symptoms. Don’t give up too quickly, though. Many treatments options can help, including behavioral techniques, medications and procedures.
When OAB causes leakage, many people turn to products such as pads and disposable undergarments. Incontinence products can help lessen the immediate impact of symptoms but are not a solution to overactive bladder. In most cases, OAB will not go away on its own and most treatments improve symptoms gradually over time. So, you’ll need a long-term game plan.
There are three main treatment options:
This approach involves training yourself and your body to gain control over your overactive bladder by changing your actions or habits. These methods include keeping a bladder diary, bladder training, Kegel exercises to strengthen the pelvic muscles, and biofeedback, which increases the mind’s control over bodily functions and is sometimes used as part of Kegel training.Behavioral techniques are usually the first line of treatment for OAB. They are very effective, pose little or no risks and are inexpensive. However, behavioral techniques take practice and time. It may take weeks or months to see improvement so staying motivated is crucial for success. For more information, see Behavioral Techniques.
Anticholinergics, the primary group of drugs used for overactive bladder, relax the bladder muscles and prevent spasms. Your doctor may prescribe other kinds of drugs as well, including, for some women, hormone replacement therapy. There are also drugs that treat conditions that lead to OAB, including obesity and prostate enlargement.The risks associated with medications for overactive bladder vary by the drug and patient, but are generally much lower than procedures or surgeries. For more information, see Medications.
These are usually reserved for severe cases of overactive bladder that do not respond to other treatments. Behavioral treatment and/or medications work for most people and surgeries and procedures carry additional risks.Electrical nerve stimulation is sometimes used to treat the hyperactive nerves that cause bladder symptoms. There is also surgery to reconstruct the bladder. For women, a device called a pessary may be considered. This latex ring is inserted into the vagina by a doctor to put pressure on the urethra and reduce leakage. For more information, see Surgeries & Procedures.
Check with your doctor about your options. Each one has its advantages and disadvantages, and individuals respond differently to treatments. Often a combination of treatments is prescribed.
It might take a while to find out what works best for you. In the meantime, take comfort in the fact that there are many medical treatments available for OAB.
Knowing the facts can not only help you better understand overactive bladder, it may make it easier to talk about your condition with family, friends and coworkers—even with your doctor:
- An estimated 33 million people in the United States have OAB, according to the National Association for Continence (NAFC).
- Women are more likely to be younger when symptoms start, according to the National Overactive Bladder Evaluation (NOBLE) Program.
- Overactive bladder can occur with pregnancy or be a sign of other illness such as a urinary tract infection, kidney infection or bladder cancer, or, in men, enlarged prostate (benign prostatic hyperplasia) or prostate cancer. Tell your doctor about your symptoms so you can get tested.
- A third of people with OAB have the wet form, which means they suffer some leakage with their condition. Wet OAB is more common in women and increases greatly among women in their mid-40s.
- More than $12 billion is spent treating OAB each year (NAFC).
- OAB accounts for 9 to 12 percent of the medical expenses of people with the condition, according to the American Urological Association.
- Left untreated, overactive bladder can interfere with work, social activities and relationships.
- About 9 out of 10 doctor-patient conversations about OAB start because the patient brings it up (NAFC). So if you think you might have the condition, don’t wait for your doctor to ask about it.
- You don’t have to live with an overactive bladder. Lifestyle changes, medications and treatment options can reduce symptoms.
- Overactive bladder is not a normal part of aging.
Now that you’ve got the facts, speak up for yourself. Talk to your doctor and get treated. When you decide that you’re ready to share with close family and friends, use these talking points.
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