Overactive Bladder (OAB)

What Is Overactive Bladder?

Overactive bladder (OAB) is a “gotta go now” feeling. You have the urge to pee even though your bladder isn’t full. OAB can lead to a condition called urinary incontinence where you leak urine.

Overactive Bladder Symptoms

A hallmark sign of an overactive bladder is the sudden need to urinate right away. Other symptoms may include:

  • Bladder spasms
  • Involuntary peeing
  • Need to go the bathroom more often or at night

There are two types of overactive bladder:

  • Dry. You have a sudden, urgent need to urinate many times during the day.
  • Wet. This is when you get a sudden urge to go to the bathroom but you pee before you can get there. It’s also called urge incontinence.

Both can happen without any underlying health condition.

Overactive Bladder Causes

OAB happens when the nerves that tell your brain to empty your bladder don’t work right. The faulty signal causes the bladder muscles to contract and make you dash for the toilet.

Normally, nerve signals trigger your bladder to squeeze out urine when it gets full. But damaged nerves can tell your bladder to squeeze when it isn’t full. Nerve damage can also cause the muscles around the urethra (the tube that takes urine out of your bladder) to be too loose. That leads to leaks. Such damage can come from:

Other health problems, the things you drink, or the medications you take also can trigger your OAB symptoms. When you figure out the cause of your OAB, you can take better control of it.

What else causes OAB symptoms?

Several risk factors that can raise your chances for overactive bladder. They include:

Weak pelvic muscles. A woman’s pelvic floor muscles are like a sling that holds up her uterus and bladder. The strain of pregnancy and childbirth can stretch them and make them weak. When that happens, your bladder can sag out of its normal place. The opening of the urethra stretches, too, and urine leaks out.

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Diuretic medications. Sometimes called water pills, they’re often prescribed for high blood pressure. They help your body get rid of salt and water, so your bladder can fill up fast and may even leak.

Aging and menopause. Your bladder changes after menopause. Doctors aren’t sure if it’s due to a lack of estrogen, which makes up bladder tissue, aging, or a bit of each.

Extra weight. Added pounds are linked to OAB and urine leaks (your doctor will call this urinary incontinence). We know excess weight puts more pressure on your bladder. Doctors are looking into other reasons.

Overactive Bladder Treatment

For many people, lifestyle changes and exercises can improve symptoms.

  • Avoid foods and drinks that make your bladder problems worse, such as citrus, caffeine, soda, and tomatoes.
  • After you pee, wait a few seconds and try to go again.
  • Set a schedule, and try to go whether you have to or not.
  • Do Kegel exercises: Tighten and relax the muscles you use to stop urine midstream. Try to hold your pee when you have the urge to pee. Overtime you can retrain your bladder to go less often and urgently.
  • Keep a healthy weight

Your doctor also may prescribe other treatments. They include:

Medication. Some drugs can help relax your bladder to ease the urge to go. In more serious cases, your doctor might try botulinum toxin (Botox) injections to calm the muscles in your bladder.

Nerve stimulation. This includes some of the latest treatment options for OAB. They sometimes may help if you’ve not had improvements with medications.

  • Sacral nerve stimulation. An implant above your buttocks sends electrical signals to calm your bladder. This therapy has been in use for decades.
  • Tibial nerve stimulation. This works the nerve in your ankles. It can be done with a needle inserted under your skin (percutaneous) or with an implantable device that connects to a transmitter and an electrode patch you wear on the outside.

Surgery. This is rarely done and only for serious cases if other treatments haven’t helped. The two main surgeries are to enlarge your bladder (augmentation cystoplasty) or to reroute your urine (urinary diversion).

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Behavior modification. Your doctor may first ask you to make lifestyle changes to help with OAB. They might include:

  • Limiting coffee, alcohol, chocolate, and other foods
  • Double voiding: After you pee, wait a few seconds and pee again.
  • Delayed voiding: This is when you train yourself to wait a few minutes before you go, and gradually working up to several hours.
  • Timed voiding: You work with your doctor create a schedule to pee at set times.
  • Keeping a bladder diary to help tease out problem foods and activities that worsen your symptoms

Alternative treatments. No herbs, supplements, or other natural or complementary therapies have proven effective for OAB.

Overactive Bladder Diagnosis

The main symptoms of OAB can also happen in other conditions:

If you’re living with what seems to be overactive bladder, but don’t have an official diagnosis, it’s time to see your doctor. Tests that can check for overactive bladder commonly include:

  • Physical exam. Your doctor will ask about your symptoms and your medical history.
  • Urinalysis. This checks your pee for infections, blood, or other signs of problems.
  • Neurological exam. Your doctor will check for evidence of problems with reflexes.
  • Bladder scan. This imaging test can measure how much urine is left in your bladder after you pee.

Overactive Bladder Complications

Untreated OAB may affect many parts of your life. You might feel embarrassed by your condition or avoid socializing. Unpredictable and frequent needs to go to the bathroom can make it hard to carry on with your daily activities. Waking up often at night to pee may keep you from getting enough sleep.

Overactive Bladder Prevention

Here are some things you can do that may help avoid OAB:

  • Make sure that your bladder is completely empty each time you go
  • Limit alcohol and caffeine
  • Ask if any medications you take make your body produce more urine or make you drink more water.
WebMD Medical Reference Reviewed by Neha Pathak, MD on September 21, 2020

Sources

SOURCES:

National Association for Continence: “Nocturia,” “Overactive Bladder.”

The Journal of Urology: “How dry is ‘OAB-dry’? Perspectives from patients and physician experts.”

Canadian Urological Association Journal: “Symptom-based diagnosis of overactive bladder: an overview.”

Mayo Clinic: “Overactive bladder: Causes.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Nerve Disease and Bladder Control.”

Cleveland Clinic: “Overactive Bladder,” “Calming the Overactive Bladder: An Update on New Devices and Technologies Emerging.”

Menopause International: “The postmenopausal bladder.”

Current Bladder Dysfunction Reports: “Obesity and the Overactive Bladder.”

Urology Care Foundation: “Lifestyle Changes,” “Medical and Surgical Treatments,” “What is Overactive Bladder (OAB)?”

American Urological Association.

Harvard Health: “Overcoming an overactive bladder.”

Medscape: “Overactive Bladder.”

Reviews in Urology: “Use of Herbal Supplements for Overactive Bladder.”

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