Overactive Bladder (OAB)

Causes of overactive bladder

Overactive bladder typically occurs when the muscles of the bladder involuntarily contract when there is minimal urine in the bladder.

Conditions that can contribute to overactive bladder include:

• Diabetes
• Acute UTIs
• Tumors in the bladder or bladder stones
• Strokes or multiple sclerosis
• Enlarged prostate
• Excessive alcohol or caffeine consumption
• Declining cognitive function

Risk factors for overactive bladder

More people will experience overactive bladder as they age. More than 20 percent of people ages 70 and older have symptoms of OAB.

Other risk factors for overactive bladder include:

• Obesity
• Previous prostate surgery
• Multiple pregnancies
• Parkinson’s disease
• Previous stroke
• Multiple sclerosis
• Dementia

Symptoms of overactive bladder

Symptoms of an overactive bladder include:

• Urge to urinate that comes on suddenly and hard to control
• Frequent urination (more than eight times in 24 hours)
• Waking at night to urinate (more than two times)
• Unable to urinate after an urge

Although symptoms are not debilitating, they decrease quality of life for people who suffer from overactive bladder.

Diagnosis of overactive bladder

Overactive bladder can be diagnosed during a physical exam with your doctor. Your physician will take a full medical history, review symptoms and perform either a pelvic exam or a prostate exam depending on your sex.

Other diagnostic tests that your doctor may order include:

• Urinalysis — can help diagnose other conditions that need to be treated.
• Post-void residual (PVR) — measures the amount of urine in the bladder after you urinate.
• Urine flow rate measurement — data can show how your urine flow rate has changed.
• Bladder pressure testing — can determine the cause of the contractions by measuring the pressure in the bladder and surrounding area as the bladder fills.

Treatment for overactive bladder

Overactive bladder treatments fall into three categories:

• Nonmedical therapy or behavioral therapy
• Medical therapy
• Surgical therapy

Most patients can find symptom relief from a combination of behavioral and medical therapies.

Behavioral therapy

Behavioral therapy can be done at home and includes education, lifestyle modifications, bladder training, pelvic floor muscle therapy and voiding logs.

Medical therapy

There are a variety of prescription medications (mainly anticholinergic drugs) that can help the bladder relax in order to alleviate the symptoms associated with overactive bladder. Ditropan, Oxytrol, Detrol, VESIcare, Enablex and Toviaz are the most commonly used medications to treat OAB.

Surgical therapy

If all other therapies fail, surgical therapy can be performed to alleviate the symptoms of OAB. 

Minimally invasive or surgical treatments for overactive bladder include:

• Nerve stimulation — regulates the nerve impulses to the bladder to relieve OAB symptoms. If effective, a wire is placed permanently under the skin.
• Surgery that increases bladder capacity — replaces a portion of the bladder with a piece from the bowel. This surgery may result in the long-term need for a catheter.
• Bladder removal — the bladder is removed and replaced with a neobladder, a last resort to treat overactive bladder.

Recovery from overactive bladder

Recovery from overactive bladder depends on the severity of your condition and treatment protocol you followed.

Many patients completely alleviate symptoms after successfully modifying their behaviors, while others who have surgery may need lifelong support and treatment for the condition.