Every condition provides an opportunity to understand how our bodies works and reminds us to listen more carefully to it. The article is on overactive bladder. But first, I would like to share with you a personal experience that taught me a critical lesson about the bladder. Imagine having a health problem while traveling in another country.

In my mid-thirties, I traveled to Guatemala for a volunteer medical experience. I spent hours on a bus and then on a boat to get to my final destination. There was no bathroom on the bus, so I held my bladder longer than I knew I should have. At the rest stop, I had trouble urinating, as if my brain’s uncertainty were showing on my body.

Two days later, I was unable to control my bladder throughout the day and it accumulated urine. During the day, I became increasingly frightened. What if? During an evening meeting, I confided in a surgeon colleague, explaining to him my problem. He inserted a foley catheter to discover that my bladder was completely full, as 800 ml of urine came out. It brought me instant relief, and I realized that holding for so long made my bladder less able to relax. I ensured that I limited caffeine and did not take any medications that could cause urinary retention – I had taken benadryl the night before for an itchy rash.

In this article about overactive bladder, Julian Dollente, RN outlines the symptoms, the causes, and the treatments.

Christopher M. Cirino, DO, MPH Founder Your Health Forum

Overactive Bladder

Do you know how many times you pee in a day? Probably not. Well, it may not be a common practice to count your trips to the bathroom, but your urinary frequency does reveal a lot about your health. An average person typically urinates around 6-7 times in 24 hours. When you need to empty your bladder more than eight times a day or experience sudden urges to urinate, you may have an overactive bladder or OAB. 

Normal urinary frequency varies between people. It may depend on how much and what type of fluids you drink. Contrary to what most people may think, OAB is not a normal part of getting older or the result of drinking too much water. Its symptoms can affect your quality of life, especially without proper treatment.

With an estimated 33 million people living with OAB in the United States, it is still often underreported or misdiagnosed. This article will cover all you need to know about overactive bladder, including the different treatment options that will help manage the symptoms.

What is Overactive Bladder (OAB)?

Overactive bladder (OAB) causes a frequent and sudden urge to urinate many times throughout the day. You may feel an uncontrollable need to empty your bladder even though it is not full. OAB can also lead to urinary incontinence, where you experience leaking or involuntary loss of urine. 

Managing OAB symptoms can be difficult, which may cause you to feel embarrassed, isolate yourself, or limit your work or social life. Because of its unpredictable nature, having an overactive bladder can negatively affect your quality of life. While OAB can be a nuisance at best, it can also trigger anxiety and emotional distress or debilitate you at worst. 

What are the Symptoms of Overactive Bladder?

An overactive bladder represents a collection of symptoms and is usually determined by the frequency and urgency of urination. The typical symptoms include: 

What are the Main Causes of Overactive Bladder?

Your kidneys produce urine that drains into your bladder and stays there for storage. When your bladder is full of urine, your brain sends signals that tell your body to urinate. With a healthy bladder, you can control the urge to pee and wait to go to the bathroom. And when your bladder is empty, your bladder muscle relaxes, and there is no “urgency.”

But if your bladder muscles are too active, they will contract involuntarily. This reaction gives you a sudden, urgent need to urinate even if your bladder isn’t full. Basically, OAB is a result of improper nerve signals between your bladder and brain. 

Risk Factors for OAB

Conditions and factors that cause OAB symptoms include:

• Neurologic disorders (damage to signals between the brain and bladder)
• Drinking too much fluid
• Hormonal changes (menopause in women)
• Enlarged prostate in men
• Consumption of alcohol, caffeine, or other bladder irritants
• Urinary tract infection
• Pelvic weakness or spasms
• Side effects from medications
• Failure to completely empty the bladder
• Bladder abnormalities (bladder stones or tumors)
• Declining cognitive function due to aging

Diet-Related Factors for OAB

Certain foods and dietary habits may also interfere with urinary health, such as

• Carbonated beverages
• Irritating foods, such as citrus fruits, spicy foods, tomato products, artificial sweeteners or preservatives
• Drinking before bedtime
• Caffeine in foods such as ice cream, chocolates, and some over-the-counter medications
• Gluten sensitivity. People allergic to or sensitive to wheat-based foods may experience OAB symptoms.

Diagnosing Overactive Bladder

Your healthcare provider may refer you to a urologist, a doctor who specializes in the treatment of urinary system disorders. If you’re experiencing any of the overactive bladder symptoms, a urologist may order tests to confirm the diagnosis, including

• Physical Examination – This test allows your doctor to assess the organs around your pelvis and rectum. Tenderness around your abdomen and kidneys may indicate an underlying condition.
• Urinalysis – A urine test can help identify any abnormalities. The presence of blood or bacteria in the urine may indicate a urinary tract infection.
• Bladder Scan – a noninvasive imaging test (ultrasound) that can help measure the amount of urine left in your bladder after urinating.
• Urodynamic Testing – These tests can help assess the bladder and urethra’s ability to store, hold, and release urine.
• Cystoscopy – This test involves inserting a lighted scope into your bladder via the urethra, which allows your doctor to examine any abnormalities within your bladder and urethra.

Overactive Bladder in Men

In the United States, overactive bladder is more common in women (40%), but men are not too far behind, with at least 30% of them living with OAB symptoms. However, that number could be much higher, considering that many people living with OAB do not always ask for help. 

In many cases, an enlarged prostate is responsible for an overactive bladder among men. As the prostate becomes enlarged, it puts pressure on the bladder and urethra, making urine incontinence or frequent urination more common. Since the prostate gland grows more prominent with age, OAB is also more common in older men. Treating prostate issues may help relieve overactive bladder symptoms.

Overactive Bladder in Women

Women are more likely to report their OAB symptoms to doctors than men, even though many more American women with overactive bladder — apart from the 40% who do — may not seek professional help. While OAB can occur at any age, it seems to become more common in women after menopause. It’s not yet clear what causes overactive bladder during this stage in a woman’s life, but it may be due to estrogen deficiency. 

Treatment and Management Options

There are several approaches to fixing your overactive bladder. Treatments may vary from natural remedies and exercises to surgery and botox injections. Sometimes you’ll need to apply lifestyle changes and avoid certain foods that may trigger OAB symptoms. Here are some management options that your healthcare provider may recommend.

1. Natural Treatment

• Vitamins and supplements are both excellent alternative treatments for OAB. A 2011 study suggests that taking vitamins and minerals, such as vitamin C and beta-cryptoxanthin, can help relieve symptoms of OAB. However, you should check with your doctor before taking any vitamins or supplements. 

• Not only is Acupuncture effective in restoring the flow of energy (“qi”), but it can also help ease OAB symptoms, according to some research. And while there’s still insufficient evidence, acupuncture shows promise as overactive bladder symptom relief. 

• Essential oils such as lavender, clary sage, or pumpkin seed oil can help calm nerves and muscles and relieve OAB symptoms. 

2. Behavior and Exercise Recommendations

• Bladder training – This exercise can help you control your urge and hold your urine longer. It involves training your bladder to urinate at specific times of the day. The purpose of this exercise is to improve bladder function and learn to empty your bladder voluntarily.

• Pelvic floor exercises – These exercises, also known as Kegels, require contracting and relaxing the muscles in your pelvic floor, reducing unwanted or unintended urination. Try to stop your urine each time you urinate. Start with a couple of minutes, then slowly build up.

• Vaginal cones – A vaginal cone is inserted into your vagina like a tampon to help strengthen your pelvic floor. This device offers a safe and non-surgical solution to regain bladder control. 

3. Surgery

Surgery is often the last resort and is only recommended when all the other treatments don’t relieve OAB symptoms. 

• Sacral nerve stimulation – This surgical procedure involves placing a small electrode under the skin of your buttocks or lower abdomen. The electrode will send pulses that help regulate the signals between your brain and bladder, reducing urinary frequency or incontinence. 

• Urinary diversion – When other options do not ease OAB symptoms, creating a new way for urine to exit your body may be necessary. Bypassing your bladder and rerouting the urine flow to your abdominal wall (where urine can empty into an ostomy bag) can help reduce urinary frequency and urgency. 

• Cystoplasty –  If you have a small bladder, your doctor may suggest cystoplasty or bladder augmentation — a surgery that makes your bladder larger so you can hold more urine. 

• Bladder removal – This surgical procedure is rarely recommended. Your doctor will only suggest removing your bladder when your OAB symptoms persist after going through all the other treatment options.

4. Botox & Medication

In some cases, medications can be an effective remedy for OAB symptoms. Your doctor may prescribe drugs such as Tolterodine, Oxybutynin, Solifenacine, and others to help calm your bladder nerves and muscles.

If those medications don’t work, your doctor may consider using Botox injection. It’s a new therapy for bladder control that can help calm the muscles and reduce OAB symptoms by injecting Botox into your bladder muscles. This procedure is proven effective, long-lasting (six to eight months), repeatable, and has fewer side effects. 

Overactive Bladder and Quality of Life

Studies have shown that OAB significantly affects one’s quality of life. When someone has to take frequent, urgent trips to the bathroom, it can get in the way of their work, social life, sleep, travel goals, and even sex life. They may not want to go out with friends because they fear incontinence and embarrassment. 

The frequent urge to urinate can become frustrating and worrisome. Sometimes it may affect relationships with friends and family, making someone feel lonely and isolated. Moreover, they may also develop skin problems or infections from urine leakage.

Conclusion

While it’s true that living with OAB can present challenges in everyday life, there are also several effective treatment options available that can help. However, before a doctor prescribes the appropriate treatments, a person must report and talk about their OAB symptoms first. They may need medication or lifestyle changes to help reduce the frequency of urges.

Ultimately, OAB is manageable, so it doesn’t have to rule someone’s life. For people that have to go to the bathroom more than eight times a day or more than two times at night, consult your doctor as soon as possible. OAB will not go away on its own. But with proper treatment, you can still have a more productive and comfortable life.

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