Overactive Bladder

  • Overactive bladder is a collection of urinary symptoms that primarily include:

    • A sudden, urgent need to urinate that is difficult to control

    • Increased frequency of urination, including waking up multiple times during the night (nocturia)

    • Occasional involuntary leakage of urine due to urgency (urge incontinence)

    It’s important to note that overactive bladder is not a disease; rather, it is a set of symptoms which can be linked to underlying health conditions or occur independently. OAB affects people of all ages but is more common among older adults and females. Despite its prevalence, many individuals avoid seeking medical attention due to embarrassment or the belief that it’s just a natural part of ageing.

    Early evaluation can help ease symptoms and improve overall quality of life, which is why awareness and professional intervention are key.

  • To understand what causes overactive bladder, it helps to first know how the urinary system works. The bladder stores urine which is produced by the kidneys. When the bladder is full, it sends signals to the brain, triggering the sensation of needing to urinate. For most people, this cycle is smooth and controlled. However, with OAB, these signals occur too frequently or inappropriately, leading to sudden urges.

    Common Causes of Overactive Bladder

    There isn’t always one clear cause, but OAB can be linked to several factors, including:

    1. Neurological Conditions

    Damage to the nerves responsible for bladder control (due to conditions like multiple sclerosis, Parkinson’s disease, or stroke) can disrupt normal signalling.

    1. Weak Pelvic Muscles

    Weakened pelvic muscles, often due to childbirth or surgery, can impact bladder control.

    1. Urinary Tract Infections (UTIs)

    A UTI can irritate the bladder lining, mimicking OAB symptoms.

    1. Bladder Outlet Obstruction

    Issues like enlarged prostate in men can impede normal urine flow, leading to bladder overactivity.

    1. Other Factors

    • Hormonal changes (e.g., menopause)

    • Diabetes

    • Obesity

    • Excess caffeine or alcohol consumption

    It’s worth noting that in some cases, no identifiable cause is found, which is referred to as idiopathic overactive bladder.

  • If OAB symptoms are affecting daily life, consulting a healthcare professional is crucial. A proper diagnosis not only identifies the issue but also rules out other underlying conditions such as urinary tract infections, bladder stones, or even bladder cancer.

    Diagnostic Process

    1. Patient History

    The doctor will begin by reviewing the patient’s medical and lifestyle history. Key questions may include:

    • How often do you urinate?

    • Do you experience leakage or night-time urination?

    • Are there specific triggers, such as stress or certain drinks?

    1. Physical Examination

    A physical examination, particularly of the abdomen and pelvic region, is performed to check for any abnormalities.

    1. Urine Tests

    A urinalysis may be conducted to rule out infections or the presence of blood in the urine.

    1. Bladder Diary

    Patients might be asked to maintain a ‘bladder diary.’ This record includes details about fluid intake, frequency of bathroom visits, and instances of leakage.

    1. Specialised Testing

    When necessary, further tests like urodynamics (to study bladder function) or cystoscopy (to examine the inside of the bladder) may be recommended.

    These steps provide a comprehensive picture, allowing healthcare professionals to tailor a treatment plan that effectively addresses the individual’s symptoms.

  • While OAB might feel overwhelming, a variety of treatment options exist to help manage the condition. From lifestyle adjustments to advanced medical interventions, there is hope for everyone affected.

    1. Lifestyle Modifications

    Small changes can significantly reduce symptoms:

    • Bladder Training involves gradually increasing the time between bathroom visits to gain better control.

    • Dietary Changes may include reducing caffeine, alcohol, and bladder irritants like spicy foods.

    • Weight Loss can alleviate pressure on the bladder.

    2. Pelvic Floor Exercises

    Also known as Kegels, these exercises strengthen the pelvic muscles, improving bladder control. Physical therapists specialising in pelvic health can guide patients in performing these exercises correctly.

    3. Medications

    Several medications are available to relax the bladder muscles and reduce urgency. These include:

    • Anticholinergics (e.g., oxybutynin, tolterodine)

    • Beta-3 adrenergic agonists (e.g., mirabegron)

    While effective, these medications may have side effects, so consultation with a doctor is essential.

    4. Behavioural Therapies

    Techniques like biofeedback can help individuals understand and better control their bladder muscles.

    5. Medical Interventions

    For severe cases, the following options are recommended:

    • Botox (Botulinum Toxin) injections into the bladder muscle can reduce overactivity.

    • Nerve Stimulation therapies such as percutaneous tibial nerve stimulation (PTNS) or sacral neuromodulation can help regulate bladder signalling.

    • Surgery may be an option for those who do not respond to other treatments. Procedures like bladder augmentation or diversion are only considered as a last resort.

    6. Support Groups and Counselling

    Living with a chronic condition can take an emotional toll. Joining a support group or seeking counselling can provide much-needed emotional support while building coping mechanisms.