Overactive Bladder (OAB): Symptoms, Causes, Diagnosis, and Management

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By Dr Humna

Overactive bladder (OAB) is a condition marked by a sudden, uncontrollable urge to urinate, frequent daytime and nighttime voiding, and, in some cases, urgency incontinence (unintended urine loss). Affecting an estimated 16.5% of adults, it disproportionately impacts older individuals and significantly diminishes quality of life. Despite its prevalence, OAB remains underdiagnosed due to patient hesitancy and limited clinician awareness.


Prevalence

  • Age: Most common in older adults, but can occur in children and young adults.
  • Gender: Women often experience symptoms earlier (around age 45), while men are more likely to develop OAB later in life, often due to prostate issues.

Symptoms of OAB

  • Urinary Urgency: Sudden, intense urge to urinate that is difficult to delay.
  • Frequency: Urinating eight or more times daily.
  • Nocturia: Waking ≥2 times nightly to void.
  • Urgency Incontinence: Accidental urine loss following an urgent need to urinate.

Causes and Contributing Factors

  1. Neurological Disorders: Stroke, multiple sclerosis, or Parkinson’s disease disrupt bladder nerve signalling.
  2. Bladder Dysfunction: Involuntary detrusor muscle contractions.
  3. Infections: UTIs cause temporary bladder irritation.
  4. Medications: Diuretics increase urine production.
  5. Lifestyle Factors: Excess caffeine, alcohol, or acidic foods.
  6. Obesity: Excess weight pressures the bladder.
  7. Pelvic Floor Weakness: Childbirth, hysterectomy, or ageing weakens pelvic muscles.
  8. Hormonal Changes: Menopause reduces estrogen, thinning urethral/bladder tissues.

Impact on Quality of Life

  • Social/Emotional: Embarrassment leads to isolation.
  • Daily Disruptions: Interference with work, travel, or exercise.
  • Sleep Disturbances: Nocturia fragments sleep, causing fatigue.

Diagnosis

  1. Clinical Evaluation:
    • Medical History: Symptom patterns, fluid intake, medications.
    • Physical Exam: Assess pelvic floor strength, and check for abdominal tenderness.
  2. Urinalysis: Rule out infection or hematuria.
  3. Bladder Diary: Track voiding habits over 3–7 days.
  4. Specialized Tests (if needed):
    • Urodynamics: Measures bladder pressure and flow.
    • Cystoscopy: Visualizes bladder lining for abnormalities.

Treatment Options

1. Lifestyle Modifications

  • Dietary Adjustments: Limit caffeine, alcohol, and spicy foods; moderate hydration.
  • Weight Management: Even 5–10% weight loss reduces symptoms.
  • Smoking Cessation: Smoking aggravates bladder irritation.
  • Bowel Regulation: Prevent constipation to avoid pelvic pressure.

2. Behavioral Therapies

  • Bladder Training: Gradually extend the time between voids (start at 30 minutes).
  • Kegel Exercises: Strengthen pelvic floor muscles to control urgency.
  • Biofeedback: Sensors teach pelvic muscle coordination.

3. Pharmacological Treatments

  • Antimuscarinics:
    • Oxybutynin/Tolterodine: Reduce contractions (side effects: dry mouth, constipation).
    • Trospium/Solifenacin: Fewer cognitive side effects.
  • Beta-3 Agonists:
    • Mirabegron: Relaxes bladder muscle without dry mouth.

4. Advanced Therapies

  • Botulinum Toxin (Botox): Injected into bladder muscle for refractory cases.
  • Neuromodulation:
    • Sacral Nerve Stimulation: Implanted device regulates bladder nerves.
    • Percutaneous Tibial Nerve Stimulation: Non-invasive electrical therapy.

When to Seek Medical Advice

Consult a healthcare provider if:

  • Symptoms disrupt daily life or sleep.
  • You experience pain, recurrent UTIs, or blood in the urine.
  • Lifestyle changes fail to improve symptoms.

Conclusion

OAB is a treatable condition, yet many suffer silently due to stigma or misinformation. A tailored approach combining lifestyle changes, behavioral strategies, and medical therapies can restore bladder control and improve well-being. Early intervention is key—seek evaluation to explore personalized solutions.

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