Overactive Bladder (OAB) is a common condition that affects millions of women worldwide. Its symptoms, causes, and treatments are often misunderstood. In this blog post, we will explore the essential questions and answers concerning OAB, including its definition, causes, diagnosis, and various treatment options. The objective is to demystify this prevalent condition and provide readers with practical insights that could help manage or alleviate symptoms.

Q: What is Overactive Bladder (OAB)?

Overactive Bladder (OAB) is a syndrome diagnosed by its symptoms, chiefly characterized by urinary frequency. Patients with OAB often experience the need to urinate 8 or more times per day. But what determines this frequency? While drinking excessive fluids can lead to more frequent urination, in patients with OAB, it's more about the bladder's capacity. Most people can comfortably hold between 10 and 20 ounces, but those with Overactive Bladder may feel an urgent need to urinate with as little as 2-3 ounces. This urgency leads to more frequent bathroom visits, even if you reduce your fluid intake.

Another hallmark of OAB is urinary urgency, an uncomfortable and often pressing need to urinate that is difficult to postpone. This urgency can foster a feeling of being tethered to the bathroom, with the "warning time" for urination varying greatly. For a normal bladder, this time can range from minutes to hours, but those with OAB may have mere seconds. A key treatment goal for OAB is extending this warning time, helping patients regain control over their lives.

Closely connected to warning time and urinary urgency is Urgency Incontinence (often abbreviated as UUI - the extra “U” is for urinary). This common type of bladder leakage in patients with OAB can result in significant incontinence. It's often described as losing control of the bladder or unintentional urination, so the term "leakage" may seem confusing. Some may not recognize it as a strong urge due to familiarity, but if incontinence occurs during non-strenuous activities like sleeping, watching TV, washing dishes, or walking to the bathroom, it is typically classified as Urgency Incontinence.

While OAB is, by far, the most prevalent cause of these symptoms, other bladder diseases may produce similar effects. It's crucial to be aware of certain warning signs that might point to an underlying issue. If these signs are present, a visit to a bladder health specialist is highly recommended.

Q: What Causes OAB in Women?

A: Several factors can contribute to OAB in women, making it a complex condition with multifaceted origins. These include:

• Aging: While not a normal part of aging, age-related changes in the bladder and pelvic muscles may increase susceptibility.

• Obesity: Excess weight puts pressure on the bladder, potentially leading to symptoms.

• Neurological disorders: Diseases such as multiple sclerosis or Parkinson's might disrupt the nerves that control bladder function.

• Lifestyle factors: Consumption of known irritants like caffeine, alcohol, spicy, and acidic foods might exacerbate symptoms.

• Menopause and childbirth: Hormonal changes during menopause and physical changes after childbirth can affect the urinary tract and contribute to OAB.

• Medications: Some medications may have side effects that contribute to OAB.

These factors may interact, making each case unique, thus requiring individualized evaluation and treatment.

Q: What Are the Treatment Options for OAB?

A: While there is, unfortunately, no definitive cure for Overactive Bladder (OAB), various treatment options are available, ranging from conservative to more advanced approaches. These therapies fall into three main categories: behavioral, second-line, and advanced therapies.

Behavioral Therapies (First-Line Therapies)

Behavioral therapies, also known as first-line therapies, are conservative in nature. They are non-invasive and are unlikely to cause significant side effects. Since they do not involve medication or medical procedures, they can be mostly self-managed, granting you control over your therapy. Although sometimes perceived as less effective, research shows that, when applied diligently, these therapies can be as successful as medication in treating bladder symptoms. The key to success is the effort and dedication you invest in these therapies. Explore more in this detailed guide that outlines behavioral therapies for OAB, including downloadable handouts.

Second-Line Therapies

The next tier of treatments, known as second-line therapies, are medications specifically designed to treat OAB. Most OAB medications work by blocking receptors in the bladder's wall that sense when the bladder is full. In Overactive Bladder, these receptors may send premature signals, resulting in frequent and urgent urination or even leakage. Common side effects of these medications include dry mouth, dry eyes, constipation, and memory or thinking impairment. An exception is the medication mirabegron (Myrbetriq), which stimulates a different receptor to calm the bladder without the usual side effects. However, it may raise blood pressure. View a more comprehensive guide to OAB medications here.

Third-Line or Advanced Therapies

The final category of treatments, known as advanced or third-line therapies, is typically reserved for refractory OAB cases or for patients who cannot take medications due to side effects or other medical issues. These therapies are usually considered for moderate to severe symptoms.

Neuromodulation

Two advanced therapies involve neuromodulation, where a nerve is stimulated to change how the bladder communicates its fullness to the brain.

• Peripheral Tibial Nerve Stimulation (PTNS or Percutaneous Tibial Neuromodulation): PTNS stimulates a branch of the bladder's nerve near the ankle to control symptoms. It's delivered in-office with a tiny needle under the skin, making it suitable for those with other medical complications.

• Sacral Neuromodulation (SNM): SNM works similarly to PTNS but stimulates the nerve before it reaches the bladder. Unlike PTNS, SNM is implanted permanently under the skin, so patients do not need regular office visits.

Botox for Bladder

Botulinum toxin (Botox): Botox is the final advanced therapy for OAB. It blocks nerve endings in the bladder wall, reducing urgency signals to the brain. Unlike medications, Botox is injected directly into the bladder, minimizing side effects outside the bladder. Treatments occur roughly every six months and require a cystoscopy (a small scope to look into the bladder). Anesthesia or light sedation can be used for patient comfort.

Understanding the wide array of treatments for Overactive Bladder can empower you to find the best solution for your unique symptoms and lifestyle. Consultation with a bladder health specialist will provide personalized guidance in selecting the most suitable therapy for your condition.

Q: Is a Specialist Required for OAB Treatment?

A: Initial treatment of OAB usually does not require a specialist, as techniques like bladder training and dietary changes can often be started independently or with primary care guidance. However, if symptoms persist, escalate, or become burdensome, seeing a urologist or other specialists in urinary disorders is beneficial. Specialists offer more advanced treatments, deeper insights, and an accurate diagnosis, thus optimizing the treatment approach.

Q: Is OAB Just a Part of Getting Older?

A: Because OAB (like many other diseases) becomes more common as we get older, it is tempting for some patients and even health providers to think of it as “just a normal part of aging”. But the symptoms of OAB are never normal and if they are bothersome, you deserve to have them diagnosed and treated. It is not uncommon for younger men and women to experience symptoms of urinary frequency, urgency and incontinence associated with an Overactive Bladder and this is certainly not “a disease of older people”. However, as we age, the rates of OAB do increase (especially in men) and it can seem like these symptoms are something to be expected and just tolerated. This can lead to frustration on the part of people who are tired of suffering with these bladder symptoms but may not feel like they are being taken seriously. If this is the case, it may be helpful to meet with a provider who has a focus or an interest in bladder health.

Q: What Testing Is Needed for OAB?

A: Many people are concerned that being evaluated for OAB means expensive or invasive tests. In fact, most of the diagnosis is obtained simply by asking questions about your symptoms and taking a history to rule out other potential causes. An office test of your urine and a physical exam are often all that is required. It may be appropriate to perform a painless ultrasound scan of your bladder to see if it is empty. Unless there are complicating factors, it is not necessary to perform more in-depth testing to first diagnose OAB. Only patients who have concerning bladder warning signs or who do not see improvement with therapy need to have a more extensive evaluation.

Q: What's the Difference Between OAB and Interstitial Cystitis?

A: Though OAB and Interstitial Cystitis (IC) may share some symptoms like frequent urination, there are distinct differences:

• Pain and discomfort: IC often involves persistent pain and discomfort in the bladder and pelvic region, whereas OAB primarily centers on urgency.

• Causes: The causes of IC are less well understood and may involve autoimmune factors, whereas OAB has more defined and varied causes.

• Treatments: Medications used to treat the two syndromes are also quite different. Overactive Bladder is often treated with medications that attempt to block the nerve endings responsible for sending messages about bladder fullness. These medications are called antimuscarinics. Another type of OAB medication stimulates a different nerve receptor that helps to relax the bladder. Neither of these OAB medications is indicated for use in IC/BPS. I have even noted that some patients with BPS/IC who report that their symptoms became worse with OAB medications, possibly because their bladders were able to hold more urine (which can increase pain with IC/BPS). Medications to treat Interstitial Cystitis/Bladder Pain Syndrome target different nerves of the bladder, attempt to decrease inflammation in the bladder or try to restore the normal lining of the bladder.

• Diagnosis: The diagnosis of IC is more complex, often being a process of exclusion to rule out other urinary tract conditions, and may include specific tests such as the Potassium Sensitivity Test. Like OAB, neither a biopsy nor cystoscopy is necessarily required for the diagnosis of IC. Despite the overlap in urinary urgency and frequency, these two conditions differ fundamentally in their underlying causes and diagnostic criteria, making accurate differentiation essential for effective treatment planning.

Understanding OAB in women is essential for effective management and treatment. The condition affects many aspects of daily life but can be addressed with proper care, lifestyle changes, medication, or advanced therapies. It's vital to consult healthcare providers if symptoms persist to explore the best treatment options tailored to individual needs.

This post is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition.