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OVERACTIVE BLADDER SYNDROME

Read in Hindi

Dr. Prasad Kasbekar
Oncologist

verified

Overactive bladder syndrome (OAB) signifies an uncontrolled urge to urinate without any control over the bladder. The urgency to visit the washroom strikes when the bladder is not full and has very little urine in it. In simple words, overactive bladder syndrome refers to gross urgency or incontinence of urine where one loses the power to control the urge. However, despite the feeling of urgency, one might just urinate miniscule amounts of urine at the time.

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Symptoms

Some symptoms of overactive bladder syndrome are as follows.


  • A sudden urge or desire to pass urine without the capability to control it even for a few seconds.

  • Waking up in the middle of the night more than once to pass urine.

  • Leaking of urine in cases where a person cannot immediately relieve themselves.

  • Increase in frequency of urination compared to previous intervals of urination before OAB.

Causes And Risk Factors

Causes

The exact cause for this syndrome is not totally understood. ‘People who suffer from this syndrome usually have bladder muscles that seem to become overactive and contract when there is no requirement for it. In general, the bladder muscles or detrusor remains relaxed as the bladder gradually fills up. When the bladder stretches, there is a message sent to the brain that the bladder requires to be emptied. This usually happens when the bladder is about half-filled. Sometimes, people can hold on to the urge till a convenient time. However, with people suffering from the syndrome, the bladder may feel fuller much before actually being filled and sends a wrong message to the brain. Hence, the bladder contracts too early even when it is not very full, which leads to the person visiting the restroom more often than necessary. Because of poor bladder control, it can lead to leakage in some people. In some rare cases, an overactive bladder can develop because of a complication of the nerve- or a brain-related disease such as stroke, Parkinson’s disease, multiple sclerosis or a spinal cord injury. Sometimes, similar symptoms can occur because of an infection or stone in the bladder, which does not classify as an overactive bladder syndrome as it has a known cause. Other causes of an overactive bladder may be listed below:


  • Weak pelvic muscles that may be caused post pregnancy and childbirth. This may cause urine leakage because of the sagging of the bladder.

  • Nerve damage that may be caused because of wrong signals being sent from the brain to empty the bladder at the wrong time. This may be caused because of a herniated disc, radiation, back or pelvic surgery, or other brain-related injuries.

  • Alcohol, caffeine, or medications that may rapidly fill your bladder or affect brain signals to your bladder, causing it to overflow.

  • Infections such as urinary tract infections can irritate the nerves of your bladder, causing it to prematurely squeeze and cause leakage of urine.

  • Being obese can cause an increase in pressure on your bladder, causing leakage.

  • Post-menopausal oestrogen deficiency can cause urine urgency, leading to urine leakage.[1]


Risk Factors

Risk factors for OAB may be listed below.

  • Hormonal changes

  • Urinary tract infections

  • Neurologic disorders that may interfere with signals between your bladder and brain

  • Pelvic muscle spasms or weakness

  • Medication side-effects

  • Diseases such as multiple sclerosis or stroke that affect the brain or spinal cord


Other risk factors may result from damage to the detrusor muscles that are important in contracting the bladder for expelling the urine. These factors may include bladder stones, bladder cancer, prostate cancer, or normal pressure hydrocephalus (abnormal fluid build-up in the cavities (ventricles) of the brain).[2,3]

Prevention

Overactive bladder can be prevented by improving your bladder musculature and making certain changes or following certain strategies as follows.

Diet changes - Reducing alcohol, caffeine, artificial sweeteners, carbonated beverages, chocolate, citrus fruits and tomatoes, honey, corn syrup, and spicy foods can prevent incidents of bladder leakage.

Lose weight - Aim to shed a few extra kilos because this has been proved by research to reduce the incidence of leaky bladder in women.

Bladder training - Certain exercises such as kegel exercise and the knack can help in improving your bladder control. Kegel s exercises are done by tightening the muscles of your pelvis, which help in strengthening them. The knack involves performing a Kegel exercise while coughing, sneezing or doing any other activity that initiates a bladder leak. These exercises require practice; a physical therapist can help you identify the correct method for performing them. [4]

Diagnosis

Diagnosis of an overactive bladder may be performed by a urologist (a doctor trained in the genitourinary tract).

Medical history - Your urologist will take a detailed history regarding your symptoms, any past or present health issues that you may be facing, and your diet and what fluids you have been consuming during the day and night.

Physical examination - Your doctor will perform a thorough physical examination to identify the reason for your OAB. This will involve examining your abdomen, your pelvic organs, and your rectum.

Bladder diary - Your doctor may ask you to maintain a bladder diary for a few weeks. This involves recording how often you use the bathroom and frequency of urine leakage. A bladder diary can help identify when and the quantity of fluid you consume, when and the quantity of urine you eliminate, the frequency of urgent feelings of urinating that you get, and how often you leak urine. This information can help your doctor identify the best treatment plan for you.

Other tests to help diagnose an OAB are as follows.


  • Urine test: This is performed to identify the presence of any blood or infection in your urine via a urine sample.

  • Bladder scan: This ultrasound identifies the residual urine remaining in your bladder after you have gone to the bathroom.

  • Uroflowmetry diagnoses the amount and speed of your urination

  • Cystometry measures the bladder pressure and the bladder capacity. This is useful in identifying the functioning and contraction of the detrusor muscles, any leakage pressure and the amount of pressure required to completely empty your bladder.

  • Electromyography is performed to measure the synchronization of nerve impulses in the urinary sphincter and bladder muscles.

  • Video urodynamics helps in creating images of both filled and empty bladder post voiding by using ultrasound.

  • Cystoscopy to visualize the interior of the bladder and urethra. [2,3]

Treatment

There are various ways in which one can treat overactive bladder syndrome. Some of them are listed below:

Medications

In certain cases, medications can help get certain relief from the symptoms; however, not everyone can benefit from medication. It depends on the severity of the condition too. Prescribed antimuscarinics blocks certain nerve impulses to the bladder, thereby increasing the bladder capacity and relaxing the bladder muscles. For people with mild symptoms of overactive bladder, medications can reduce the urgency, leakage and frequent trips to the restroom. However, the flipside is that these drugs come with their set of limitations and side effects. The symptoms can return with a vengeance when medications are stopped. Nevertheless, prolonged use of these drugs can aggravate the side-effects such as dry eyes, dry mouth, and constipation to name a few.

Surgery

Going under the knife to treat an overactive bladder is not common; however, if medications and lifestyle changes fail to provide relief, surgery remains the last resort. There are various types of procedures that can treat overactive bladder syndrome. Some procedures could indicate that one might require a catheter to pass urine later. Surgery is recommended in cases where overactive bladder syndrome is hampering your quality of living to an extreme extent. Two types of surgical interventions are available for OAB. The first is to enlarge the capacity of the bladder by a procedure called augmentation cystoplasty. The second is to reroute or to divert the flow of urine.

Pelvic floor exercises

In many cases, performing pelvic floor exercises help strengthen the muscles in the area and deal with stress incontinence. In case stress incontinence is an outcome of an overactive bladder, these exercises could be of help. However, only exercise cannot reverse or completely cure the condition; however, a combination of exercise and medication can promise adequate relief.

Treatment with botulinum toxin

To date, botox has only been considered as a magical treatment to banish signs of ageing; however, now it has proved its efficiency in treating conditions such as an overactive bladder syndrome. ‘However, one should only opt for the treatment when other forms of treatment have failed to provide adequate relief. One should keep in mind that botox is not the first line of treatment for overactive bladder syndrome,’ informs Dr Pandey. Botox gives temporary relief from the symptoms improving one’s quality of life for the time being. In this form of treatment, an injection of diluted botulinum toxin is injected in the bladder that makes the muscle of the bladder relax and helps control contractions of the bladder. The effect of one injection might last for around six to nine months. ‘One might have to take the shot again once its effect wears out,’ says Dr Pandey. This is an alternative treatment to surgery if other treatments, including lifestyle modifications and medication, have not helped to control the symptoms.

Nerve Stimulation

Neuromodulation therapy or nerve stimulation sends electrical signals to nerves that share a common path with the bladder. These electrical pulses can help in proper communication between your brain and bladder, thus improving your OAB symptoms.

Nerve Stimulation

Nerve stimulation, known as neuromodulation therapy, is another treatment for people who require extra help. This type of treatment sends electrical pulses to nerves that share the same path for the bladder. In OAB, the nerve signals between your bladder and brain do not correctly communicate. These electrical pulses help the brain and nerves to the bladder communicate such that the bladder can properly function and improve OAB symptoms.

These are of two types.


  • Percutaneous tibial nerve stimulation (PTNS), which sends nerve impulses to your tibial nerve to correct your bladder contraction.

  • Sacral neuromodulation (SNS), which sends nerve impulses to your sacral nerve, which helps in holding and releasing urine.[2]

Lifestyle/management

Certain lifestyle changes can help one deal with the overactive bladder syndrome in a better manner, although it cannot cure it. Here is what you can do to control overactive bladder syndrome:

Cut down on caffeine intake: Diuretics such as tea, coffee, colas and some medications can increase the urge for urination and worsen the symptoms. It is wise to get a grip on your caffeine habit in case you suffer from overactive bladder syndrome.

Use the restroom when in need: To avoid embarrassment, use the restroom as soon as you get the urge to relieve yourself.

Don’t limit your fluid intake: Never limit your daily fluid intake to avoid incontinence. Remember it will only worsen the symptoms and make it more painful while urinating; instead, stick to consuming adequate amount of liquid throughout the day.

Avoid constipation: Maintain bowel regularity by consuming a high-fibre diet such as fresh fruits and vegetables. Exercising daily can avoid constipation.

Maintain a healthy weight: Lose weight if you are overweight to reduce pressure on your bladder.

Stop smoking: Cigarette smoke can be irritating to the bladder and so avoid smoking.

Maintain a Bladder Diary: This diary can help you understand your body and bladder better. It will help to identify what makes your symptoms worse and what treatment plan can be initiated for you.

Double Voiding: This is useful for those individuals who face difficulty in emptying their bladder. After voiding, you need to wait for a few seconds and then try voiding again. This is known as double voiding.

Delayed Voiding: Delaying going to the bathroom even when you feel the urge is called delayed voiding. You can begin with holding it for a few minutes, and then slowly increase the waiting period to 2–3 h. However, this should be done only if advised by your healthcare professional.

Timed Urination: This involves following a regular schedule for bathroom use. This schedule can be made along with your healthcare provider. This schedule will involve trying to urinate every 2–4 h to ultimately help regain control of your bladder muscles and prevent the urgent feeling.

Bladder Exercises: Bladder exercises to help relax your bladder muscles can be done such as Kegel exercise and quick flicks. Kegel exercise involves strengthening your pelvic floor muscles by making your pelvic muscles tight and holding it for some time. Quick flicks involves squeezing and relaxing your pelvic floor muscles again and again repeatedly.

Biofeedback: This uses sounds and computer graphs to monitor your bladder muscle movement. This will help you to learn about your bladder, how strong your pelvic muscles are, and how they move.[1,2]

Do's & Don’ts

Do’s


  • Drink adequate fluid at least 6 to 8 glasses in a day, especially water

  • Include more fibre-rich foods such as fresh vegetables and fruits to avoid constipation

  • Do exercise regularly

  • Do pelvic floor muscle exercises

  • Do requently use the bathroom for when required


Don’ts

  • Limit or reduce the intake of caffeine, sodas, chocolate, alcohol, coffee, and tea

  • Don’t smoke

  • Avoid constipation[5]

Prognosis And Complications

Prognosis

Though overactive bladder can be challenging, with adequate treatment, your quality of life can be improved. Your healthcare professional will be the best judge to guide you in the best treatment options for your overactive bladder.[1]

Complications

Complications associated with OAB are urinary tract infections, increased visits to the doctor and increased risks of falls and injuries because of urgency in emptying the bladder.[6]

Alternative Treatments

Before attempting any alternative treatments, it is best to consult with your healthcare provider to identify whether any of the alternative medication may interfere with your treatment. Following are some of the alternative treatments for OAB.


  • Gosha-jinki-gan: This is an herbal remedy to improve urinary urgency, nighttime urination and frequency of urination. It is found to improve the quality of life for patients with OAB. It is found to be useful in increasing the capacity of your bladder and reducing the number of bladder contractions.

  • Buchu: Buchu tea helps alleviate symptoms of OAB and bladder control issues.

  • Cleavers: Cleaver tea coats the inner part of your bladder wall, reducing the symptoms of OAB by protecting it against irritation.

  • Cornsilk: Cornsilk, which are the strands that you remove before consuming the corn, is consumed as cornsilk tea. This helps in easing symptoms of OAB.[7]

References


  1. Overactive Bladder. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/14248--overactive-bladder-.


(https://my.clevelandclinic.org/health/diseases/14248--overactive-bladder-)

  1. Overactive Bladder. Urology Care Foundation. Available at: https://www.urologyhealth.org/urology-a-z/o/overactive-bladder-(oab). (https://www.urologyhealth.org/urology-a-z/o/overactive-bladder-(oab))

  2. Overactive Bladder. Cedars Sinai. Available at: https://www.cedars-sinai.org/health-library/diseases-and-conditions/o/overactive-bladder.html. (https://www.cedars-sinai.org/health-library/diseases-and-conditions/o/overactive-bladder.html)

  3. Solutions for a Leaky Bladder. John Hopkins Medicine. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/urinary-incontinence/solutions-for-a-leaky-bladder. (https://www.hopkinsmedicine.org/health/conditions-and-diseases/urinary-incontinence/solutions-for-a-leaky-bladder)

  4. 13 Tips to Keep your Bladder Healthy. NIH. Available at: https://www.nia.nih.gov/health/13-tips-keep-your-bladder-healthy


(https://www.nia.nih.gov/health/13-tips-keep-your-bladder-healthy)

  1. Wagner TH, et al. Am J Manag Care. 2002;8(19 Suppl):S598-607.

  2. Treating Bladder Control Problems. Beaumont. Available at: https://www.beaumont.org/treatments/bladder-control-problems-treatment(https://www.beaumont.org/treatments/bladder-control-problems-treatment)


 

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