It’s natural to have the urge of going to the toilet— after all, we are human beings with actual physiologic needs and wastes to be expelled from the body. However, the inability to resist the urge of urinating, especially if happening frequently, can affect one’s quality of life. The medical condition is known as overactive bladder (OAB).
Overview of overactive bladder (OAB)
Overactive bladder (OAB) is a condition in which the bladder squeezes urine out at the wrong time. You may have overactive bladder if you have two or more of these symptoms:
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You urinate eight or more times a day or two or more times at night (called nocturia)
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You have the sudden, strong need to urinate immediately
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You leak urine after a sudden, strong urge to urinate
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You also may have urinary incontinence, a loss of bladder control. Nerve problems, too much fluid, or too much caffeine can cause it.
U.S. National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program, Public domain, via Wikimedia Commons
OAB affects 12.8% women and 10.8% men worldwide, and the older one gets the more common to have urinary incontinence.
Many people living with OAB don't ask for help. They may feel embarrassed. Many people either don't know how to talk with their health care provider about their symptoms, or they think there aren't treatments that can help. Some even think that urine leakage is part of a normal aging process, which is not true.
The truth is there are many treatments that can help. Asking your health care provider about it is the first step.
Treatment of OAB
Non-pharmacotherapy treatment (without medications)
Many doctors encourage pelvic floor exercises, bladder training and behavioural modification as the primary therapy for patients with OAB, especially females. These approaches can include:
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Altering fluid intake – Decreasing fluids to reduce incontinence and frequency and increasing fluids to improve urine concentration.
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Quit smoking
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Dietary modification to eliminate possible bladder irritants (eg. reducing caffeine, alcohol and carbonated beverages). Caffeine is a mild diuretic (makes you pee more often) and bladder irritant, and reducing intake can reduce both urge and stress incontinence
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Weight reduction – Study has found that central obesity places pressure on the bladder and may worsen urinary incontinence.
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Regulating bowel function to avoid constipation and straining during bowel movements
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Behavioral training that teaches patients to inhibit or interrupt bladder contractions (called detrusor contractions). This is done through pelvic floor muscle training:
Image credit: https://www.pelvicfloorfirst.org.au/pages/pelvic-floor-muscle-exercises-for-women.html
For more information, check with your healthcare provider or read this simple guide on how to carry out the exercise.
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Doctors may also prescribe bladder training: Patients are instructed to empty the bladder on waking and then each time during the day when the interval is reached, and again before going to bed. If the patient feels the urge to void during the interval, patients are instructed to use urge suppression techniques, such as distraction or relaxation techniques or self affirming statements, to get them through to the scheduled voiding time. As the patient improves, the time interval between voids can be increased.
Pharmacotherapy (medications)
If the non-pharmacotherapy treatment mentioned above is not sufficient, doctors may also prescribe medications for OAB. There are various options of medications for treating OAB:
Antimuscarinics
Antimuscarinics, also known as anticholinergics, are a group of medications that can reduce contraction of bladder muscle, thereby decreasing the urge of urination. They are widely used due to their low-cost generic options, ease to access and availability of sustained-release formulations. However, antimuscarinics are known to cause a wide range of side effects, including dry mouth, dry eye, constipation and cognitive impairment in elderly. They should not be used in patients with close-angle glaucoma and with a history of impaired gastric emptying or urinary retention.
Examples of antimuscarinics used in treating OAB: oxybutynin, tolterodine, solifenacin, trospium
Beta-3 adrenergic agonist
This group of medications, although work differently than antimuscarinics, also relaxes the bladder muscle. Beta-3 adrenergic agonists are gaining more popularity over antimuscarinics nowadays due to the same efficacy but fewer side effects. Examples of beta-3 adrenergic agonists are mirabegron and vibegron.
Other treatments
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Duloxetine, a serotonin noradrenaline reuptake inhibitor that is commonly used as an antidepressant, can be effective in both stress and mixed stress and urge incontinence.
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Botox injection into the bladder muscle (turns out that botox is more than just restoring youthful image!)
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Some male patients struggle with OAB should also be examined and treated for benign prostate hyperplasia
A word from DOC2US
If you have any questions related to OAB, you can consult our professional doctors and healthcare professionals on DOC2US. DOC2US is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.
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References
Cover image credit: Photo by Jan Antonin Kolar on Unsplash
