Overactive Bladder (OAB)
An overactive bladder (OAB) is the sensation to urgently need to empty your bladder, and often occurs with urge and frequency incontinence, and nocturia. An OAB does not always lead to incontinence however, and in this circumstance it is known as OAB dry rather than OAB wet. OAB dry is diagnosed where you have the frequent urge to empty your bladder, but have the control to make it to a bathroom before leaking.
Suffering from an OAB always has a negative effect on quality of life, with 10-20% of adult men and women suffering and older individuals suffering from more extreme symptoms.
There are many treatments available to improve the health of the bladder and, as a result, the quality of life of those suffering. Therefore its important that you do not consider suffering with an OAB as an inevitable part of ageing, and seek treatment as soon as possible. Do not avoid treatment due to embarrassment as this will put you at risk of developing further associated conditions. Such as; vaginal dryness (atrophy), urge incontinence and nocturia.
Symptoms of an Overactive Bladder (OAB)
You may be suffering from an OAB if you:
- frequently have the sudden urge to urinate
- experience urge incontinence where you immediately urinate following the urge
- suffer from nocturia
Getting a formal diagnosis from your GP can determine whether your OAB is a symptom of another condition. There are several conditions with similar symptoms, these include; bladder cancer (tumours); vaginal dryness (atrophy); vaginal yeast infection; bladder infection (cystitis); diabetes mellitus and insipidus; and congestive heart failure.
Causes of an Overactive Bladder (OAB)
There are many events that can lead to you developing an overactive bladder. It can occur at any age, with your risk increasing as you get older.
- Behaviour - In a healthy individual the pelvic floor and bladder muscles coordinate, to retain urine until the individual is in a position to empty the bladder. This psychological control is developed in childhood, and issues can arise if during this period you were encouraged to empty your bladder more often than required. Or in adulthood, you may not be able to access a toilet when required, due to restrictions in your job or other responsibilities, and therefore always take advantage of having access even when you do not need to go. This can result in detrusor over activity or instability - when the detrusor muscle, responsible for contracting the bladder in order for it to empty normally, contracts involuntarily and cannot be relaxed. It can also result in emptying your bladder turning from an unconscious coordination of the pelvic floor and bladder muscles, to an overactive pelvic floor preventing your bladder from fully emptying when you do get to a toilet.
- Urinary tract infection - An OAB can be caused by a lower urinary tract infection consistently causing the urge to go, and if so, can be treated by treating that condition.
Conditions that affect the spinal cord or nervous system - Multiple sclerosis, a stroke and a herniated disc are just three of the conditions which can affect normal bladder functionality.
Bladder pelvic organ prolapse (cystocele) - If you suffer from a cystocele, your bladder is more vulnerable to developing conditions such as OAB.
- Bladder tumour (cancer) - If you have a tumour on your bladder, the pressure can feel like you need to urinate.
Anxiety - An OAB may occur due to anxiety about being caught short with an empty bladder. There may have been sexual or psychological trauma that causes the individual to be unable to relax and fully empty their bladder, which may not immediately be obvious. Even to the individual suffering.
To read more about these causes, and the events that can lead to you developing any form of urinary incontinence, visit the Causes and Diagnosis page.
How to Stop an Overactive Bladder (OAB)
The cause of your OAB, and what specifically is not functioning correctly, determines which treatment you will benefit from. Speak to your GP before beginning treatment to ensure you have correctly self-diagnosed and are not going to make your OAB worse.
Conservative therapy's - Conservative therapy's, such as lifestyle changes and non-surgical medical treatments, resolve 25% of incontinence cases, and are the first course of treatment.
- Oestrogen therapy for women - Oestrogen therapy can be prescribed as a short term treatment by your GP, it is locally administered as a cream to your vagina. There are ongoing studies looking at the benefit of oestrogen therapy once the cream is no longer applied.
- Prescription of antimuscarinics - This group of medications may be useful due to their effect on the muscles, reducing involuntary contractions and increasing the bladders capacity. They are only prescribed in extreme cases of OAB, and where other treatments have not worked.
- Bladder training - In a bladder training programme you will postpone going to the toilet until you are urgent. This will show you how long you are able to go, and cause normal function to resume. The success of a programme reduces over time, and therefore should be considered a life long behaviour change for you to continue to see the benefits.
- Counselling for anxiety - An OAB may occur due to anxiety about being caught short with an empty bladder. There may have been sexual or psychological trauma that needs to be resolved before looking at the physical functionality of the bladder - the link may not immediately be obvious to the individual suffering.
- Pelvic floor muscle (Kegel) exercises - If you have some voluntary control over when you go to the toilet, then concentrate on exercising your pelvic floor muscles. If you have an overactive pelvic floor, avoid completing pelvic floor exercises until that is resolved.
- Neuromuscular electrical stimulation (NMES) - NMES can exercise both the fast and slow twitch fibres in your pelvic floor muscles to strengthen them. At lower levels they can also relax the detrusor muscle and prevent it from contracting involuntarily. To learn more about NMES and how it is used, visit our page on Manual Exercises Vs Electronic Pelvic Toners.
- Biofeedback training - If you have no voluntary control over when you go to the toilet, completing biofeedback training will show you how to relax and contract the muscles voluntarily, and how this can effect your urination.
To read about the other treatments available for general urinary incontinence, visit our incontinence treatment page.
Anger, J. T. Le, T. X. Nissim, H. A. Rogo-Gupta, L. Rashid, R. Behniwal, A. Smith, A. L. Litwin, M. S. Rodriguez, L. V. Wein, A. J. Maliski, S. L. (2012). The Journal of Urology.How Dry is “OAB-Dry”?: Perspectives from Patients and Physician Experts. [online] 188(5), p1811-1815. [viewed 18/04/18] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571660/#!po=75.0000
Athanasopoulos, A. Giannitsas, K. (2011). Advances in Urology. Review Article: An Overview of the Clinical Use of Antimuscarinics in the Treatment of Overactive Bladder. [online] Article ID 820816, 8 pages. [viewed 18/04/18] Available from: https://www.hindawi.com/journals/au/2011/820816/
Cardozo, L. Lose, G. McClish, D. Versi, E. (2004). Acta Obstetricia et Gynecologica Scandinavica. A systematic review of the effects of estrogens for symptoms suggestive of overactive bladder. [online] 83(10), p892-897. [viewed 18/04/18] Available from: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.0001-6349.2004.00581.x
Chughtai, B. Levin, R. De, E. (2008). Clinical Interventions in Aging. Choice of antimuscarinic agents for overactive bladder int he older patient: focus on darifenacin. [online] 3(30, p503-509. [viewed 18/04/18] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682382/#__ffn_sectitle
Cody, J. D. Jacobs, M. L. Richardson, K. Moehrer, B. Hextall, A. (2012). Oestrogens for urinary incontinence in women. [online] Cochrane, 2012. [viewed 18/04/18] Available from: http://www.cochrane.org/CD001405/INCONT_oestrogens-for-urinary-incontinence-in-women
Fitz, F. Sartori, M. Girão, M. J. Castro, R. (1992). Revista da Associação Médica Brasileira. Pelvic floor muscle training for overactive bladder symptoms – A prospective study. [online] 63(12), p1032-1038. [viewed 18/04/18] Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302017001201032&lng=en&nrm=iso&tlng=en
Gonçalves Correia, S. (2008) Urinary incontinence and overactive bladder in the non-institutionalized Portuguese population: national survey and methodological issues. [online] Faculdade de Medicina da Universidade do Porto [viewed 19/04/18] Available from: https://repositorio-aberto.up.pt/bitstream/10216/21944/5/MEpiscorreia200811Tese.pdf
Messelink, E. J. (1999). BJU International. The overactive bladder and the role of the pelvic floor muscles. [online] 83, p31-35. [viewed 19/04/18] Available from: https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1464-410X.83.s2.7.x
NICE, (2013). Urinary incontinence in women: management. National Institute for Health and Care Excellence, 2015. [viewed 18/04/18] Available from: https://www.nice.org.uk/guidance/cg171/resources/urinary-incontinence-in-women-management-pdf-35109747194821
Ostle, Z. British Journal of Nursing. Vaginal oestrogen for overactive bladder in post-menopausal women. [online] 24(11), p582-585. [viewed 18/04/18] Available from: https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2015.24.11.582?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed