Overactive bladder, also called OAB, causes a frequent and sudden urge to urinate that may be difficult to control. You may feel like you need to pass urine many times during the day and night, and may also experience unintentional loss of urine (urgency incontinence).
If you have an overactive bladder, you may feel embarrassed, isolate yourself, or limit your work and social life. The good news is that a brief evaluation can determine whether there's a specific cause for your overactive bladder symptoms.
You may be able to manage symptoms of an overactive bladder with simple behavioral strategies, such as dietary changes, timed voiding and bladder-holding techniques using your pelvic floor muscles. If these initial efforts don't help enough with your overactive bladder symptoms, additional treatments are available.
If you have an overactive bladder, you may:
Even if you are able to get to the toilet in time when you sense an urge to urinate, unexpected frequent urination and nighttime urination can disrupt your life.
Although it's not uncommon among older adults, overactive bladder isn't a normal part of aging. It might not be easy to discuss your symptoms, but if they are distressing you or disrupting your life, talk to your doctor. Treatments are available that might help you.
The kidneys produce urine, which drains into your bladder. When you urinate, urine passes from your bladder through a tube called the urethra (u-REE-thruh). A muscle in the urethra called the sphincter opens to release urine out of the body.
In women, the urethral opening is located just above the vaginal opening. In men, the urethral opening is at the tip of the penis.
As your bladder fills, nerve signals sent to your brain eventually trigger the need to urinate. When you urinate, these nerve signals coordinate the relaxation of the pelvic floor muscles and the muscles of the urethra (urinary sphincter muscles). The muscles of the bladder tighten (contract), pushing the urine out.
Overactive bladder occurs because the muscles of the bladder start to contract involuntarily even when the volume of urine in your bladder is low. These involuntary contractions create an urgent need to urinate.
Several conditions may contribute to signs and symptoms of overactive bladder, including:
Other factors that may be associated with your symptoms include:
The specific cause of an overactive bladder may be unknown.
As you age, you're at increased risk of developing overactive bladder. You're also at higher risk of diseases and disorders, such as enlarged prostate and diabetes, which can contribute to other problems with bladder function.
Many people with cognitive decline — for instance, those who have had a stroke or have Alzheimer's disease — develop an overactive bladder. Incontinence that results from situations like this can be managed with fluid schedules, timed and prompted voiding, absorbent garments, and bowel programs.
Some people with an overactive bladder also have bowel control problems; tell your doctor if this is a problem for you.
Any type of incontinence can affect your overall quality of life. If your overactive bladder symptoms cause disruption to your life, you might also have:
In some cases, treatment of these associated conditions may help with your urinary symptoms.
Women who have an overactive bladder may also have a disorder called mixed incontinence, when both urgency and stress incontinence occur. Stress incontinence is the unintentional loss of urine prompted by physical movement or activity that puts pressure on your bladder, such as coughing, sneezing, laughing or exercising. Treatment of stress incontinence is not likely to help overactive bladder symptoms. Similarly, treatment of overactive bladder is not likely to improve stress incontinence symptoms.
Some people may have a common combination of bladder storage problems and bladder-emptying issues. The bladder may cause a lot of urgency and even incontinence, but it doesn't empty well. A specialist may be able to help you with this combination of bladder problems.
These healthy lifestyle choices may reduce your risk of overactive bladder:
If you have an abnormal urge to urinate, your doctor will check to make sure that you don't have an infection or blood in your urine. Your doctor may also want to make sure that you're emptying your bladder completely when you urinate.
Your doctor will look for clues that might also indicate contributing factors. Your appointment will likely include a:
Your doctor may order tests to assess how well your bladder is functioning and its ability to empty steadily and completely (urodynamic tests). These tests usually require a referral to a specialist and may not be necessary to make a diagnosis or begin treatment. Urodynamic tests include:
Measuring urine left in the bladder. This test is important if there's concern about your ability to empty your bladder completely when you urinate. Remaining urine in the bladder (post-void residual urine) may cause symptoms identical to those of an overactive bladder.
To measure residual urine after you have voided, your doctor may request an ultrasound scan of your bladder. The ultrasound scan translates sound waves into an image, showing how much urine is left in your bladder after you urinate. In some cases, a thin tube (catheter) is passed through the urethra and into your bladder to drain the remaining urine, which can then be measured.
Testing bladder pressures. Cystometry is a test that measures pressure in your bladder and in the surrounding region as your bladder fills. During this test, your doctor uses a thin tube (catheter) to fill your bladder slowly with warm fluid. Another catheter with a pressure-measuring sensor is placed in the rectum or, for women, inthe vagina. The sensor tells how much pressure your bladder has to exert to empty completely.
This procedure can identify whether you have involuntary muscle contractions or a stiff bladder that's not able to store urine under low pressure.
Your doctor will review the results of any tests with you and suggest a treatment strategy.
A combination of treatment strategies may be the best approach to relieve overactive bladder symptoms.
Behavioral interventions are the first choice in helping manage an overactive bladder. They're often effective, and they carry no side effects. Behavioral interventions may include:
Pelvic floor muscle exercises. Kegel exercises strengthen your pelvic floor muscles and urinary sphincter. These strengthened muscles can help you stop the bladder's involuntary contractions.
Your doctor or a physical therapist can help you learn how to do Kegel exercises correctly. Just like any other exercise routine, how well Kegel exercises work for you depends on whether you perform them regularly.
After menopause, vaginal estrogen therapy can help strengthen the muscles and tissues in the urethra and vaginal area. Vaginal estrogen comes in the form of cream, suppository, tablet, or ring, and can significantly improve symptoms of overactive bladder.
Medications that relax the bladder can be helpful for relieving symptoms of overactive bladder and reducing episodes of urge incontinence. These drugs include:
Common side effects of most of these drugs include dry eyes and dry mouth, but drinking water to quench thirst can aggravate symptoms of overactive bladder. Constipation — another potential side effect — can aggravate your bladder symptoms. Extended-release forms of these medications, including the skin patch or gel, may cause fewer side effects.
Your doctor may recommend that you sip small amounts of water or suck on a piece of sugar-free candy or chew sugar-free gum to relieve dry mouth, and use eyedrops to keep your eyes moist. Over-the-counter preparations, such as Biotene products, can be helpful for long-term dry mouth. To avoid constipation, your doctor might recommend a fiber-rich diet or use of stool softeners.
OnabotulinumtoxinA (ON-ah-boch-yoo-lih-num-tox-in-A), also called Botox, is a protein from the bacteria that cause botulism illness. Used in small doses directly injected into bladder tissues, this protein relaxes the muscles.
Studies show that it may be useful for severe urge incontinence. The temporary effects generally last six months or more, but repeat injections are necessary.
Side effects from these injections include urinary tract infections and urinary retention. If you're considering Botox treatments, you should be willing and able to catheterize yourself if urinary retention occurs.
Regulating the nerve impulses to your bladder can improve overactive bladder symptoms.
One procedure uses a thin wire placed close to the sacral nerves — which carry signals to your bladder — where they pass near your tailbone.
This minimally invasive procedure is often done with a trial of a temporary wire implanted under the skin in your lower back. Sometimes it may be done as an advanced procedure in which the permanent electrode is implanted and a longer trial is performed. Your doctor then uses a hand-held device connected to the wire to deliver electrical impulses to your bladder, similar to what a pacemaker does for the heart. If it helps with your symptoms, a permanent, battery-powered pulse generator is surgically implanted to help regulate the nerve rhythm.
This procedure uses a thin needle that is placed through the skin near your ankle to send electrical stimulation from a nerve in your leg (tibial nerve) to your spine, where it connects with the nerves that control the bladder.
PTNS treatments are delivered once a week for 12 weeks to help treat symptoms of overactive bladder. You will likely need maintenance treatments every three to four weeks to keep symptoms under control.
Surgery to treat overactive bladder is reserved for people with severe symptoms who don't respond to other treatments. The goal is to improve the bladder's ability to store urine and reduce pressure in the bladder. However, these procedures won't help relieve bladder pain. These procedures include:
These lifestyle strategies may reduce overactive bladder symptoms:
No complementary or alternative therapies have been proved to successfully treat overactive bladder.
Research has suggested that acupuncture might help ease the symptoms of overactive bladder. Acupuncture practitioners treat you using extremely thin, disposable needles.
Complementary treatments may not be covered by insurance, so check with your insurance company first.
Living with overactive bladder can be difficult. Consumer education and advocacy support groups such as the National Association for Continence can provide you with online resources and information, connecting you with people who experience overactive bladder and urge incontinence. Support groups offer the opportunity to voice concerns, learn new coping strategies and stay motivated to maintain self-care strategies.
Educating your family and friends about overactive bladder and your experiences with it may help you establish your own support network and reduce feelings of embarrassment. Once you start talking about it, you may be surprised to learn how common this condition really is.
For overactive bladder, you're likely to start by seeing your primary doctor. After your initial appointment, you may be referred to a specialist in urinary disorders in men and women (urologist), a specialist in urinary disorders in women (urogynecologist), or a specialist in physical therapy for diagnosis and treatment.
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
For overactive bladder, basic questions might include:
Your doctor may use an overactive bladder questionnaire to make an assessment of your symptoms, asking questions such as:
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