Take charge of your bladder health. Meri Sehat offers expert advice and strategies for managing overactive bladder effectively.

Overactive Bladder

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Overactive bladder is a syndrome characterized by frequent and sudden urinary urgency. 
&nbsp;

Approximately 455 million people worldwide (almost 11%) experience overactive bladder (OAB), with the regional burden greatest in Asia. According to a large survey in China, the prevalence of OAB in the country alone was 6%.<a href="#accordion">[1]</a> In contrast, nearly 33 million people in the US have OAB.<a href="#accordion">[2]</a>

However, it is believed that the number reported does not reflect the actual number because a lot of people don&rsquo;t seek help due to embarrassment. 
&nbsp;

There are two types of OAB:<a href="#accordion">[3]</a>

<ul>
	<li>Wet &ndash; With urge incontinence, i.e., involuntary bladder voiding or leaking</li>
	<li>Dry &ndash; Without urge incontinence; more common, affecting 2/3 of the patients</li>
</ul>

Both types can occur without any underlying health conditions. 
&nbsp;

Sign and Symptoms

The characteristic sign of OAB is the sudden urge to urinate right away. Other symptoms include:

<ul>
	<li>Involuntary peeing immediately after an urgent need to urinate</li>
	<li>Urinate more than 8 times a day</li>
	<li>Wake up more than once in the night to urinate 
	&nbsp;</li>
</ul>

Causes

The exact cause of an OAB is unknown. However, some factors that cause symptoms of OAB include:

<ul>
	<li>Bladder abnormalities, such as bladder stones or tumors</li>
	<li>Underlying conditions, such as <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">diabetes</a>, urinary tract infections, or neurological diseases like stroke</li>
	<li>Certain medications 
	&nbsp;</li>
</ul>

Diagnosis

The doctor begins with a complete health history of the patient, reviewing their symptoms and previous urinary conditions. They may also perform a physical examination to check for an enlarged prostate or tenderness around the kidneys or abdomen. 
&nbsp;

They may further order tests, including:

<ul>
	<li>Bladder stress test to determine whether the patient is leaking urine.</li>
	<li>Urinalysis to rule out infection or other urinary tract problems.</li>
	<li>Imaging tests like ultrasound and CT scan for a detailed look at the bladder.</li>
	<li>Urodynamic testing, including cystoscopy and uroflowmetry, to assess the bladder&rsquo;s ability to store or hold urine. 
	&nbsp;</li>
</ul>

Treatment

Behavioral interventions are the first choice to manage OAB, given that they are usually effective and have no side effects.

These include pelvic floor muscle exercises, biofeedback, scheduled toilet trips and bladder training, and using a catheter periodically to empty the bladder. Patients are also encouraged to keep a bladder diary and wear absorbent pads to avoid embarrassment due to accidental leakage.

Some doctors also prescribe medications to relax the bladder and reduce episodes of urge incontinence. These include solifenacin, tolterodine, mirabegron, oxybutynin, fesoterodine, and trospium.<a href="#accordion">[4]</a> 
&nbsp;

In cases where the patient presents with severe urge incontinence, Botox is injected in small doses directly into the bladder tissues. However, repeat injections are necessary because the effect generally lasts for around 6 months.

Surgery is usually considered for patients who don&rsquo;t respond to other treatments. It may involve bladder removal, cystoplasty, urinary diversion, and percutaneous tibial nerve stimulation.

Note: Alternative treatments, including herbal supplements, acupuncture, and essential oils, are sometimes used to calm the nerves for OAB symptom relief. However, more research is needed to validate these claims. 
&nbsp;

OAB affects the overall quality of life. The condition causes emotional distress, anxiety, or depression, especially in children with this disorder. It may also lead to sleep disturbances and an increased risk of falls and injuries. The individual even struggles with daily tasks and avoids socializing due to unpredictable needs to go to the bathroom. 
&nbsp;

The common risk factors for developing OAB include:

<ul>
	<li>Age, especially those with age-related cognitive decline</li>
	<li>Gender, especially women experiencing postmenopausal hormonal changes</li>
	<li>Abdominal trauma, such as pregnancy and childbirth, pelvic surgery</li>
	<li>Underlying issues, such as obesity, constipation, and arthritis 
	&nbsp;</li>
</ul>

Common preventive measures for reducing the risk of OAB include the following:

<ul>
	<li>Maintain a healthy weight</li>
	<li>Manage comorbid conditions such as diabetes and hypertension</li>
	<li>Exercise regularly, especially Kegel exercises, to strengthen the pelvic floor muscles.</li>
	<li>Limit caffeine intake and foods like chocolate or spicy foods that may irritate the bladder</li>
	<li>Quit smoking 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Overactive bladder (OAB) is a syndrome characterized by frequent and sudden urinary urgency.</li>
	<li>The diagnosis of OAB involves urodynamic testing, cystoscopy, and urinalysis.</li>
	<li>The treatment options for OAB include medications, behavioral therapies, and surgery.</li>
	<li>The risk factors for OAB include age, gender, and abdominal trauma.</li>
	<li>Individuals can prevent OAB by quitting smoking, maintaining a healthy weight, and eating a healthy diet.</li>
</ul>

[1] Xu D, Cheng R, Ma A, Zhao M, Wang K. Toileting behaviors and overactive bladder in patients with type 2 diabetes: a cross-sectional study in China. BMC Urol. 2017;17(1):42. Published 2017 Jun 13. doi:10.1186/s12894-017-0234-2