What are the other Names for this Condition? (Also known as/Synonyms)

• OAB (Overactive Bladder)

What is Overactive Bladder? (Definition/Background Information)

• Overactive Bladder (OAB) is a urological condition that results in a sudden frequent urge to urinate, resulting in the involuntary spillage of urine. It is commonly seen in adults
• It is believed that the condition occurs when there is loss of control over urination due to damage to the brain, spinal cord, or the nerves regulating the bladder and urination
• The underlying factors that may result in an Overactive Bladder may include aging causing the gradual loss of pelvic muscle control, uncontrolled diabetes, neurodegenerative disorders such as Parkinson’s and Alzheimer’s disease, and benign prostatic hyperplasia (BPH) in men
• In many, Overactive Bladder can result in a decreased quality of life, due to disturbed sleep and emotional stress from involuntary loss of urine (wetting) causing embarrassment
• The treatment for Overactive Bladder may include both passive and active measures, such as behavioral interventions and therapy, use of medications, and surgical procedures, if necessary
• The prognosis of Overactive Bladder is generally good in a majority of individuals with adequate treatment. However, the overall prognosis depends on the underlying condition causing OAB and the severity of the symptoms

Who gets Overactive Bladder? (Age and Sex Distribution)

• Overactive Bladder is commonly seen in adults. Some reports indicate that between 30-40% of the adults may have OAB to some extent
• According to research studies, the prevalence rate among the general population is about 12-17%
• Both males and females are affected, although the condition is more commonly reported in women
• No predilection for any particular racial or ethnic group is observed

What are the Risk Factors for Overactive Bladder? (Predisposing Factors)

The following are the risk factors for Overactive Bladder:

• Aging: Older individuals have a higher risk for OAB; normally, post-menopausal women have an increased risk
• Uncontrolled diabetes can cause damage to the nerves controlling the urinary bladder
• Individuals who are overweight or obese
• Enlarged prostate gland in men causing benign prostatic hyperplasia (BPH), can increase the risk
• Damage to the area of the brain regulating urination during a stroke or a neurological disorder, such as Alzheimer’s disease or Parkinson’s disease
• Having a lot of caffeinated drinks; increased alcohol consumption
• Longstanding constipation

The following factors may also aggravate the condition, thereby increasing the severity of the symptoms:

• Diabetic neuropathy due to injury of the blood vessels supplying the nerves
• Neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disorder, and Shy-Drager syndrome, due to the degeneration of neurons controlling urination function
• Stroke due to poor blood supply causing neuronal cell death
• Demyelinating disorders, such as multiple sclerosis, where there is damage to the insulating cover of the nerve cells in the brain and spinal cord, affecting their ability to communicate
• Use of certain medications
• Presence of urinary bladder stones or benign/malignant tumors, causing obstruction of the bladder
• Nerve damage due to certain procedures, such as pelvic surgery or surgery to treat urinary incontinence
• Nerve damage due to herniated disc and spinal stenosis
• Cognitive decline caused by factors such as aging or certain neurological conditions
• Any condition that impedes the smooth passage of urine within the urinary bladder including swollen prostate gland in men or constipation
• Unable to empty the urinary bladder completely

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Overactive Bladder? (Etiology)

The exact cause of Overactive Bladder is currently unknown.

• It is reported that an Overactive Bladder is caused by damage to certain areas of the brain, spinal cord, or the nerves regulating urination
• When the nerve signals to the bladder muscles are impaired, the bladder muscles may be triggered to become overactive, resulting in its contraction
• This tightening of the muscles brings about a sudden urge to urinate, even though the urinary bladder may not be completely filled with urine

What are the Signs and Symptoms of Overactive Bladder?

The signs and symptoms of Overactive Bladder may include:

• Urinary urgency: The need to urinate frequently, during day and/or during nights
• Increased frequency of urination; usually over 8 times per day
• Unable to control the sudden urge to urinate resulting in the accidental loss/spillage of urine (urinary urge incontinence); the urge to urinate is also unexpected and uncontrollable
• Dribbling of urine

How is Overactive Bladder Diagnosed?

The diagnosis of Overactive Bladder may involve:

• A complete medical history and a thorough physical examination, which may include abdominal, genital, and rectal examination (checking for bladder enlargement) and a neurological examination
• Maintaining a voiding diary containing a 24 hour record of urination, fluid intake, and episodes of leakage
• Urine cytology
• Blood urea and serum creatine levels to examine kidney function
• Imaging tests of the kidneys, urinary bladder, spine, and the nervous system using x-rays, ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) scans
• Urodynamic studies to measure the pressure and amount of urine in full, empty, or contracting bladder
• Cystoscopy (visualization of the urinary tract using a fiber-optic camera)
• Tests and exams to diagnose the underlying cause of an Overactive Bladder
• Neurological examination, if required

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Overactive Bladder?

The complications of Overactive Bladder may include:

• Decreased quality of life
• Disturbed sleep, due to regularly waking up two or more times to use the bathroom
• Embarrassment and emotional stress
• Urinary tract infection (UTI)
• In some individuals, bowel incontinence may accompany urinary incontinence (a condition known as mixed incontinence)

How is Overactive Bladder Treated?

The treatment of Overactive Bladder is based on the cause, severity, and type of symptoms present. The treatment may include a combination of the following measures:

• Use of behavioral interventions that may include:
  • Pelvic floor muscle exercises (Kegel exercises)
  • Usage of absorbent undergarments such as diapers and pads
  • Intermittent catheterization to empty the bladder
  • Avoidance of spicy food and caffeinated beverages such as coffee and tea
  • Diet and weight control for individuals who are overweight/obese
  • Practicing to time schedule urination (trips to the restroom)
  • Maintenance of optimum level of fluid intake
  • Exercise and delayed voiding to prevent premature contraction of the bladder muscles
• Administration of medication to relax or contract the bladder muscles
• Botox injections for Overactive Bladder, in case of severe urge incontinence
• Additionally, treatment of the underlying condition, if any present, is undertaken

Surgical intervention may be needed in some cases depending on the underlying cause of Overactive Bladder. This may include:

• Stimulation of nerves using electricity
• The bladder capacity is increased by using graft tissue from the intestine
• Surgical bladder reconstruction after removal of the urinary bladder, in severe cases that do not respond to any of the aforementioned therapeutic measures

How can Overactive Bladder be Prevented?

In most cases, Overactive Bladder is a condition that cannot be prevented. However, the following factors may be considered to lower one’s risk for OAB:

• Lifestyle modification to maintain a healthy weight; including physical activities and regular exercising
• Avoiding smoking; minimizing coffee and alcohol intake
• Individuals with diabetes can help prevent the condition by maintaining their blood sugar levels under constant control
• Undertake early and appropriate treatment for any underlying condition that increases the risk for OAB

What is the Prognosis of Overactive Bladder? (Outcomes/Resolutions)

• The prognosis of Overactive Bladder depends on the underlying cause of the condition
• Most individuals are able to lead a good quality of life with appropriate treatment measures

Additional and Relevant Useful Information for Overactive Bladder:

• Neurogenic bladder is a condition where there is loss of control over urination due to damage to the brain, spinal cord, or the nerves regulating the bladder and urination. It is classified into 2 types depending on the site of injury: Hypertonic bladder and hypotonic bladder

The following link can help you understand nephrogenic bladder:

https://www.dovemed.com/diseases-conditions/neurogenic-bladder/