Overactive Bladder (OAB)

 What is overactive bladder?

overactive bladder diagramOveractive bladder (OAB) is a condition where a patient without a full bladder feels a strong urge, which cannot be suppressed.  One of the main causes is involuntary bladder contractions – this is called “primary” OAB.  It is important to remember that in most cases, an underlying reason for these contractions is never found.  When leakage of urine occurs with the urgency to urinate it is called “wet” OAB.

OAB caused by another condition is called “secondary” OAB.  Examples of other conditions that may cause OAB include neurologic disorders, stones, bladder infections or a bladder growth, but this last one is rare.   OAB itself is very common and affects up to 20 percent of the population over age 35.

How is overactive bladder diagnosed?

OAB is diagnosed with an evaluation that eliminates other reasons as being the cause of the symptoms.  This is called a “diagnosis of exclusion”.  The evaluation can include the following:

  • Questionnaires
  • A clinical interview and examination
  • Urine and or Imaging testing
  • Cystoscopy – an internal examination of the bladder and urethra using a cystoscope
  • Urodynamics – a test of bladder function
  • Bladder diary – a take home activity where you measure and record the time and amount of urine passed over 3 days.

What treatment is there for overactive bladder?

Primary OAB is most often treated with lifestyle and behavioral changes.  If those don’t work, medication can be prescribed.  Finally, there are other options for severe cases if neither the lifestyle modification nor the medication works.   Each is discussed here:

Lifestyle and behavioral changes include pelvic floor exercises, pelvic floor physiotherapy, dietary changes and behavioral therapy for the bladder.

  • Pelvic floor exercises – Commonly known as Kegel exercises, this involves the contraction of the pelvic floor muscles, which strengthens and tightens them.
  • Pelvic floor physiotherapy – Exercises other than Kegels that are taught by specialized physiotherapists using internal examination.
  • Dietary Changes – Basically avoiding foods that irritate the bladder.  Some common bladder irritants include caffeinated drinks, carbonated drinks or alcoholic drinks, spicy foods and artificial sweeteners.
  • Behavioral therapy for the bladder – regulating fluid intake, avoiding constipation and retraining the bladder to void every 3-4 hours.

      Medication

When behavior changes and exercises are not successful in treating OAB, medication may be prescribed.  These medications block the involuntary actions of the muscle (detrusor). There are two types:

  • Anticholinergics (many different brands available)
  • Beta Adrenergic Agonists (recently developed)

They can cause side effects ranging from dry eyes and constipation to confusion, which your doctor will discuss with you.

Both of these medications take at least 6 weeks to work and therefore should not be judged as effective or not until that time.

Other options

In severe cases of OAB where lifestyle changes and medications are not working, other options may be tried. These include catheterization, surgery, neuromodulation techniques and Botox injections into the bladder.  Botox injections into the bladder wall are a very effective, outpatient treatment that can provide relief without the side effects of anticholinergic medications.

 

Michelle Strovski, Maple Ridge Urology, Serving Maple Ridge, Coquitlam, Mission, Abbotsford, Langley, and Vancouver.