Affecting an estimated 33 million Americans, overactive bladder (OAB), sometimes called urge incontinence, is the abrupt, strong need to urinate. It's different from stress incontinence, which occurs when movement—like sneezing or coughing—places stress on your bladder, causing you to pee. Some people have a combination of the two conditions, called mixed incontinence.
OAB symptoms are defined by four main characteristics:
- Urgency, or how badly you have to urinate
- Frequency, or how often you have to urinate; eight-plus times in 24 hours is considered a sign of OAB
- Nocturia, or urination at night; going more than once per evening could be a sign of OAB
- Incontinence, or the leakage of urine
Though it's not usually a serious health problem, OAB symptoms can be messy, inconvenient and emotionally taxing. People with the condition often report feeling embarrassed, stressed, lonely and depressed. Many have problems with social activities, work, intimacy and even sleep—often torpedoed by bathroom emergencies and leakage.
While OAB symptoms occasionally recede within in a few months, they often take years to get under control. Still, with proper diagnosis and OAB treatment, most people with the condition can lead a fulfilling life.
Who's at risk?
Though OAB can happen to anyone, some people are more prone than others, and the chances increase for all of us as we age. Women, have a slightly higher risk than men, thanks to bladder changes after menopause.
Other factors contributing to OAB include obesity, smoking and diabetes, as well as:
- Certain medications
- An enlarged prostate or similar blockages
- Excessive caffeine and alcohol intake
- Neurological conditions like Parkinson's disease, multiple sclerosis or stroke
- Mobility issues, including arthritis
To properly diagnose your OAB—and eliminate other possible causes of incontinence—your healthcare provider will need an accurate medical history. Physical and neurological exams may be performed, as will a urine test and possibly a bladder scan. Among other diagnostic tools, your doctor may also use a uroflowmeter to measure your urine volume, or cystometry, which figures out how your urine flow relates to your bladder pressure.
OAB treatment: What you can do
Once your OAB has been diagnosed, the first line of treatment will most likely be exercises and behavioral changes—things you can do by yourself, at home. You may be asked to cut back on coffee and alcohol, or to drop a few pounds. The doctor might tell you to drink fewer fluids, especially close to bedtime. You may be assigned one or more of the following exercises:
- Kegels, during which you flex and hold your pelvic floor muscles to improve bladder control
- Bladder training, during which you practice being able to hold your urine for longer and longer durations
- Scheduled voiding, during which you set certain times of the day for bathroom trips, until you don't feel the urge to urinate at other times
Keeping a bladder diary, where you record when and how much you pee, can also be helpful in pinpointing your triggers.
OAB treatment: What doctors can do
If behavioral changes don't quite work, or your healthcare provider decides that additional steps should be taken, he or she might prescribe medication as part of your OAB treatment. Side effects may include dry mouth or constipation.
Another option is Botox, which a doctor injects into your bladder to paralyze its muscles. The results can last for months—and even up to a year—though side effects are common; some people must use a catheter to help empty their bladders, at least initially.
Finally, for more severe cases of OAB, surgery may be the right choice. Nerve stimulation, in which an implanted wire transmits electrical impulses to stop your bladder from contracting, is one option. The most severe cases may necessitate suprapubic catheterization, during which a catheter tube is actually placed in your body to help remove urine. Other last-line treatments include surgery to make your bladder larger or the removal of the entire bladder, though these are very rare.
Ultimately, if you believe you might have OAB, contact your healthcare provider before beginning any treatment. They will diagnose you and help steer you in the right direction.
