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
- Neurological Disorders: Stroke, multiple sclerosis, or Parkinson’s disease disrupt bladder nerve signalling.
- Bladder Dysfunction: Involuntary detrusor muscle contractions.
- Infections: UTIs cause temporary bladder irritation.
- Medications: Diuretics increase urine production.
- Lifestyle Factors: Excess caffeine, alcohol, or acidic foods.
- Obesity: Excess weight pressures the bladder.
- Pelvic Floor Weakness: Childbirth, hysterectomy, or ageing weakens pelvic muscles.
- 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
- Clinical Evaluation:
- Medical History: Symptom patterns, fluid intake, medications.
- Physical Exam: Assess pelvic floor strength, and check for abdominal tenderness.
- Urinalysis: Rule out infection or hematuria.
- Bladder Diary: Track voiding habits over 3–7 days.
- 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.