Overactive bladder – Diagnosis and treatment

What is Overactive Bladder (OAB)?

Overactive bladder (OAB) leads to sudden and frequent urges to urinate. Overactive bladder is a urinary symptom and not a disease. The urge to urinate increases, and there will be an unintentional leak of urine too.

The affected person will pass urine many times during the day and night. There will always be a feeling “to use the washroom”. The unintentional urge to leak urine is called incontinence.

An overactive bladder can interfere with work and social life. Without proper treatment, an overactive bladder can be difficult to manage. Overactive bladder is common between the age of 45-60.

Incontinence can lead to skin problems or infections. Overactive bladder can be controlled with certain dietary changes and proper treatment.

Symptoms of Overactive Bladder

An overactive bladder represents itself as a collection of symptoms. Some of the common symptoms include

• Incontinence
• Frequent peeing
• Nocturia
• Sudden urge to urinate that is difficult to control

Causes of Overactive Bladder

Overactive bladder usually occurs due to an underlying health condition. Detrusor is a collection of smooth muscle fibres that surrounds the bladder wall. Injury or damage to the detrusor muscle can lead to an overactive bladder. Other causes of overactive bladder are listed below.

• Abdominal trauma

Pregnancy is the main cause of abdominal trauma. Pelvic muscles support the organs in the lower abdomen. Childbirth can lead to stretching and weakening of pelvic muscles. If the pelvic muscles weaken, the bladder can sag out of its normal position.

• Nerve damage

Damaged nerves can sometimes send wrong signals to the body. This can lead to peeing at the wrong time. Nerve damage can be caused due to certain diseases like herniated discs, Parkinson’s disease, multiple sclerosis and stroke.

• Medications, alcohol and caffeine

Overconsumption of alcohol and caffeine, and certain medication can lead to nerve damage. These can affect the signals that the brain sends to the body. This can lead to an overflow of the bladder. Caffeine consumption can cause the bladder to fill rapidly and potentially leak.

• Infection

Urinary tract infection can irritate your bladder nerves. This can squeeze the bladder and lead to urine leakage without warning.

• Extra weight

Being overweight or obese can exert extra pressure on the bladder and lead to urine leakage.

• Oestrogen deficiency after menopause

Hormonal changes can lead to an overactive bladder. It increases the urge to urinate often.

Diagnosis of Overactive Bladder

If there is an unusual urge to urinate, the healthcare professional will first check for an infection or blood in the urine. Additionally, they will also check if a person’s  bladder is fully emptying or not.

The doctor will also ask for your

• Medical history
• Physical exam
• Urine sample to check for the presence of any infection
• A neurological exam that identifies reflex problems or sensory issues.

A urologist will additionally ask for all the below-listed tests.

Urinalysis

Urinalysis examines the chemical, visual and microscopic aspects of the urine. The technical person will look for the presence of white blood cells, red blood cells and bacteria.

The presence of any of the three can lead to an overactive bladder. This can also increase the urge to urinate and incontinence.

Urodynamic tests

Urodynamic tests determine how much urine is left over after you pee. The test also determines how fast you pee and how much pressure is exerted on the bladder as it fills with urine.

Ultrasound

An ultrasound test will give a detailed image of the bladder.

Cystoscope

Cytoscope is a special instrument that helps look inside the bladder from the urethra. The technical person will use a numbing agent so that you will not feel any pain.

Tests of bladder function

The bladder function test will determine the bladder’s ability to empty completely.

The urine flow rate will be measured with the help of a device called a uroflowmeter. You will be asked to pee in the device, and the urine flow rate will be measured as you pee. The device will translate the data into a graph.

Cystometry measures the pressure in the bladder and the surrounding region as the bladder fills. The technical person will use a thin tube to fill the bladder slowly with a warm liquid. Another thin tube with a pressure measuring sensor will be placed in the rectum or the vagina. The sensor will measure how much pressure the bladder has to exert to empty completely.

This test will determine whether you have a stiff bladder or involuntary muscle contractions.  

Treatment of overactive bladder

Overactive bladder can be treated with a combination of treatment strategies.

Behavioural therapies

Behavioural therapies are the first choice of treatment to manage overactive bladder. In most cases, behavioural therapies are effective and contain no side effects. Some of the common behavioural therapies include

• Pelvic floor muscle exercise

Kegel exercises help strengthen the urinary sphincter and pelvic floor muscles. Weakened urinary muscles can lead to urine incontinence. If the muscles are strengthened, urine leakage and involuntary muscle contraction can be stopped.

A professional will teach Kegel exercises, and you have to follow the routine. The effectiveness of the exercise can be found only if you work out regularly.

• Biofeedback

During the biofeedback session, you will be connected to electrical sensors. These sensors will receive and measure the information about the body.

The biofeedback will teach you how to make changes in such a way that strengthens the pelvic muscle so that the urgency to urinate will reduce.

• Healthy weight

Being overweight or obese can lead to urine incontinence. Losing some weight can help reduce the pressure and ease symptoms.

• Absorbent pads

Absorbent pads can protect the clothes from getting wet and avoid embarrassing incidents in public. You need not limit your activities, and absorbent pads come in different sizes and absorbency levels.

• Bladder training

Bladder training is to train yourself in such a way as to delay emptying when you have the urge to urinate. You can start the delays by 15-30 minutes and gradually work up to urinating once in three hours. However, bladder training will not work for all, and to do that, you have to be able to tighten your pelvic floor muscles.

• Intermittent catheterisation

Intermittent catheterisation is using a catheter or a small tube which helps to empty the bladder fully, as the bladder cannot do by itself.

• Scheduled toilet trips

Try to schedule your toilet usage— for example, every three hours. Try to get to the toilet usage at the same time every day. Don’t rush to the toilet. When it’s time, just use the bladder.

Medications

Medication can help strengthen muscles and tissues in the vaginal area. Women during menopause get affected by an overactive bladder. Vaginal oestrogen therapy can help with urine incontinence.

Vaginal oestrogen is available in the form of tablets, creams, suppositories and rings. It can significantly improve the symptoms of an overactive bladder.

Vaginal oestrogen can cause certain side effects like dry mouth and eyes. However, drinking water to quench your thirst can aggravate the symptoms. Constipation is another symptom of using vaginal oestrogen.

Extended-release forms of these medications are available in the form of gel and skin patches. These extended releases will help reduce the side effects. Sipping on small amounts of water can help with a dry mouth.

Bladder injections

Bladder injection uses small doses of a protein from the bacteria Clostridium botulinum. Botox is a protein that is extracted from bacteria. 

The protein will help relax the muscle and reduce the severity of the symptoms of incontinence.

Nerve stimulation

Nerve stimulation regulates the nerve impulses to the bladder and improves the symptoms of an overactive bladder.

Percutaneous tibial nerve stimulation (PTNS)

Percutaneous tibial nerve stimulation uses a small needle that sends electrical stimulation from a nerve in the leg to the spine, connecting with the nerve that controls the bladder.

The needle will be inserted in the ankle, and the treatment will be delivered once a week for 12 weeks.

Surgery

Surgery is for people who have severe overactive bladder symptoms. Surgery will be recommended when other treatments do not respond and will help to improve the bladder’s ability to store urine and reduce the pressure in the bladder.

When to consult a doctor?

Overactive bladder is common in people aged between 40-60. However, it is not a typical sign of ageing. If the symptoms are severe, consult your doctor.

Conclusion

Overactive bladder is not a disease and a urinary symptom. It can lead to changes in bathroom usage. People with overactive bladder may have a hard time controlling their urine, and in severe cases, urine leakage can occur.

This can lead to infection and other health issues. It is important to treat the underlying health condition to reduce the symptoms. With proper treatment, quality of life can improve.