What is Overactive Bladder (OAB)?

Overactive bladder (OAB) is a common condition that affects millions of Americans. Overactive bladder isn't a disease. It's the name of a group of urinary symptoms. The most common symptom of OAB is a sudden urge to urinate that you can't control. Some people will leak urine when they feel the urge. Leaking urine is called "incontinence." Having to go to the bathroom many times during the day and night is another symptom of OAB.

There is another common bladder problem called stress urinary incontinence (SUI), which is different from OAB. People with SUI leak urine while sneezing, laughing or doing other physical activities. More information on SUI can be found at www.urologyhealth.org/SUI/.

Key Statistics

About 33 million Americans have overactive bladder. As many as 30% of men and 40% of women in the United States live with OAB symptoms. But the real number of people with OAB is most likely much larger. That's because many people living with OAB don't ask for help. Some are embarrassed. They don't know how to talk to their health care provider about their symptoms. Other people don't ask for help because they think there aren't any treatments for OAB.

How OAB Can Affect Your Life

OAB can get in the way of your work, social life, exercise and sleep. Without treatment, OAB symptoms may make it hard to get through your day without lots of trips to the bathroom. You may feel nervous about going out with friends or doing everyday activities because you're afraid you may not find a bathroom when you need one. Some people begin to shy away from social events. This can make them feel lonely and isolated.

OAB may affect your relationships with your spouse and your family. It can also rob you of a good night's sleep. Too little sleep will leave you tired and depressed. In addition, if you leak urine, you may develop skin problems or infections.

You don't have to let OAB symptoms change your life. There are treatments available to help. If you think you have OAB, see your health care provider.

The Truth About OAB

Don't let myths about OAB prevent you from getting the help you need.

OAB is not "just part of being a woman."
OAB is not "just having an ‘enlarged' prostate (BPH)."
OAB is not "just a normal part of getting older."
OAB is not caused by something you did.
Surgery is not the only treatment for OAB.
There are treatments for OAB that can help with symptoms.
There are treatments that many people with OAB find helpful.
There are treatments that can help, even if your symptoms aren't severe or if you don't have urine leaks.



What are the Symptoms of OAB?

Urgency: The major symptom of OAB is a sudden, strong urge to urinate that you can't ignore. This "gotta go" feeling makes you afraid you will leak urine if you don't get to a bathroom right away. You may or may not leak urine after feeling this urge to go.

If you live with OAB, you may also:

Leak urine (incontinence): Some­times people with OAB also have "urgency incontinence." This means that urine leaks after you feel the sudden urge to go.  Some people may leak just a few drops of urine.  Other people experience a sudden gushing of a large amount of urine.   

Urinate frequently: You may also need to go to the bathroom many times during the day. The number of times someone urinates differs from person to person. But many experts agree that going to the bathroom more than 8 times in 24 hours is "frequent urination."

Wake up at night to urinate: Having to wake from sleep to go to the bathroom more than once a night may be another symptom of OAB.

What Should You Do if You Think You Have OAB?

If you think you may have OAB, talk with your health care provider. Sometimes OAB symptoms can be the result of a urinary tract infection, an illness, damage to nerves, or a side effect of a medication. So it's important to go to a health care provider to find out if you have any of these problems. If you do have OAB, there are treatments to help. Together, you and your health care provider can choose what's best for you.



What Are the Causes of OAB?

How the Urinary Tract Works

Female Urinary Tract
Female urinary tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

Male Urinary Tract
Male urinary tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

Normal vs. Overactive Bladder
Normal vs. overactive bladder
Image © 2003 Fairman Studios, LLC.

The bladder and kidneys are part of the urinary system the organs in our bodies that produce, store and pass urine. You have 2 kidneys that produce urine. Then urine is stored in the bladder. The muscles in the lower part of your abdomen hold your bladder in place.

When it isn't full of urine, the bladder is relaxed. When nerve signals in your brain let you know that your bladder is getting full, you feel the need to urinate. If your urinary system is normal, you can delay urination for some time.

Once you are ready to urinate, the brain sends a signal to the bladder. Then the bladder muscles squeeze (or "contract"). This forces the urine out through the urethra, the tube that carries urine from your body. The urethra has muscles called sphincters. They help keep the urethra closed so urine doesn't leak before you're ready to go to the bathroom. These sphincters open up when the bladder contracts.

OAB can be caused by the nerve signals between your bladder and brain telling your bladder to empty even when it isn't full. OAB can also be the result of your bladder muscles being too active. Then your bladder muscles contract to pass urine before your bladder is full, and that causes a sudden, strong need to urinate. We call this "urgency."

Risk Factors for OAB

  • As you grow older, the risk of OAB symptoms increases. But not all people will have signs OAB as they age. No matter what your age, there are treatments that can help.
  • Overactive bladder and urine leakage are not “normal” or expected parts of the aging process.
  • Just because you are getting older doesn't mean your OAB symptoms can't respond to treatment
  • Both men and women are at risk for OAB. Women who have gone through menopause and men who have had prostate problems seem to be at greater risk for OAB.
  • People with diseases that affect the brain or spinal cord, such as stroke and multiple sclerosis, are at high risk for OAB.



How is OAB Diagnosed?

After you talk about your symptoms, your health care provider may do an exam right away. He or she may also schedule a separate exam to see if you have OAB. Your health care provider may refer you to a specialist, such as a urologist, who can perform the exam. Some urologists specialize in incontinence and OAB.

Medical History

Your health care provider will ask you a number of questions to understand your medical history. This should include information about the symptoms you are having, how long you have had them, and how they are changing your life. A medical history will also include information about your past and current health problems. You should bring a list of over-the-counter and prescription drugs you take. Your health care provider should also ask you about your diet, and about how much and what kinds of liquids you drink during the day.

Physical Exam

Your health care provider will examine you to look for something that may be causing your symptoms. In women, the physical exam will likely include your abdomen, the organs in your pelvis, and your rectum. In men, a physical exam will include your abdomen, prostate, and rectum.   

Bladder Diary

You may be asked to keep a bladder diary, where you will note how often you go to the bathroom and any time you leak urine. This will help your health care provider learn more about your day-to-day symptoms.   

Other Tests

  • Urine culture: Your health care provider may ask you to leave a sample of your urine to test for infection or blood.
  • Bladder scan: This type of ultrasound shows how much urine is still in the bladder after you go to the bathroom.
  • Cystoscopy:  During this test, the doctor inserts a narrow tube with a tiny lens into the bladder. This can be used to rule out other causes of your symptoms.
  • Urodynamic testing: These tests check to see how well your lower urinary tract stores and releases urine.
  • Symptom Questionnaire: Many doctors use a written quiz to ask questions about your bladder problems and what causes you the most bother. 


What Treatments are Available for OAB?

There are a number of treatments to help manage OAB. Your health care provider may prescribe treatment to help you manage your symptoms, or you may be referred to a specialist, such as a urologist, for treatment.

Treatment choices for OAB include:

No single treatment is right for everyone. Your health care provider may use 1 treatment alone, or several at the same time. You and your health care provider should talk about what you want from treatment and about each treatment choice.



Lifestyle Changes

Lifestyle changes known as "behavioral therapy" are often the first treatments used to manage OAB. In behavioral therapy, you make some changes in the way you live day-to-day. Most patients don't get rid of all their symptoms with lifestyle changes. But many do have fewer symptoms using this type of treatment.

Limit food and drinks that you find "bladder irritating"

Some people have fewer symptoms when they eat and drink less "bladder irritating" food. Foods and drinks that bother some people include coffee, tea, artificial sweeteners, caffeine, alcohol, soda, and other fizzy drinks, citrus fruit, food made with tomatoes, chocolate and spicy foods. You can try taking all "bladder irritating" foods out of your diet and adding them back one at a time. Once you figure out which foods and drinks make your symptoms worse, you can avoid them.

Keep a daily "bladder diary"

Writing down when you make trips to the bathroom for a few days can help you and your health care provider understand your symptoms better. A diary may help show you some things that make your symptoms worse. For example, are your symptoms worse after eating or drinking a certain kind of food? Are they worse when you don't drink enough liquids?

Double voiding (emptying your bladder twice)

This may be helpful if you have trouble emptying your bladder completely. After you go to the bathroom, wait a few seconds and then try again to pass urine.

Delayed voiding

In this method of urinating, you teach yourself to put off going to the bathroom, even when you feel an urge. At first, you wait just a few minutes. Gradually you will be able to wait much longer between bathroom visits. But it is important to try this only if your health care provider tells you to. Some people have worse symptoms or have urine leaks when they wait too long to go to the bathroom.

Scheduled voiding

With this method, you follow a daily schedule of going to the bathroom. Instead of going when you feel the urge, you go to the bathroom at set times during the day. Depending on how often you go to the bathroom now, your health care provider may ask you to urinate every 2 to 4 hours, whether you feel you have to go or not.

Exercises to relax your bladder muscle

These can help decrease that "gotta go" feeling when it hits. Some call these exercises "quick flicks" because you quickly squeeze and release the muscles in your pelvis several times. When you get that "gotta go" feeling, squeeze and then relax your pelvic floor muscles as quickly as you can. Do "quick flicks" several times in a row when you feel the urge to go. This sends a message to your nervous system and back to your bladder to stop squeezing. As your bladder stops squeezing and starts relaxing, your "gotta go" feeling should lessen. When you do this exercise, it helps to be still, relax and concentrate just on the "quick flicks." Your health care provider can explain this exercise in more detail.



Medical and Surgical Treatments

Drugs

When lifestyle changes don't help enough, your health care provider may ask you to try a prescription drug. You may take the drug alone or along with behavioral therapy.

There are several prescription drugs available to relax the bladder muscle. These drugs can help stop your bladder from contracting when it isn't full. You take some of these medicines by mouth. With other drugs you may use a gel or adhesive patch to deliver the drug through the skin.

Your health care provider should follow you closely to look for changes in your symptoms and any problems while you are taking the medicine. Common side effects include dry mouth and eyes, constipation, and blurred vision.

To get the best results, your health care provider may ask you to take different doses of the drug. Your health care provider may also give you a different drug to try.

Injections

If lifestyle changes and prescription drugs don't work for you, or the drug side effects are too serious, more advanced therapies may be the right choice. You will most likely be referred to a specialist who treats patients with incontinence and OAB, such as a urologist. After reviewing your problem, the specialist may recommend injections. With this treatment, botulinum toxin, better known as Botox®, is injected into your bladder muscle.

Small doses of this drug can paralyze muscles. When injected into the bladder muscle, this drug may help keep it from contracting too often. Over time, this treatment wears off in some people. It may need to be repeated in 6 months or a year. The specialist should follow you closely to watch for side effects, including urinary retention (not emptying your bladder completely). If you do have problems emptying your bladder completely after injections, you may need to use a catheter (a thin, hollow tube) to empty your bladder, at least for a short time.

Stimulating Nerves (Neuromodulation Therapy)

Another treatment when drugs or lifestyle changes don't work is neuromodulation therapy. Neuromodulation therapy is the name given to a group of treatments that deliver electrical pulses to nerves to change how they work. There are 2 types of neuromodulation therapy:

Sacral neuromodulation (SNS)

A device can be placed under your skin to deliver mild electrical pulses to the nerves that control bladder function
A device can be placed under your skin to deliver mild
electrical pulses to the nerves that control bladder function
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

This therapy works by stimulating the sacral nerve (near the base of the spine). This nerve carries signals between the spinal cord and the bladder. In OAB, these nerve signals don't work the right way. SNS uses a "bladder pacemaker" to interrupt these signals, which can improve OAB symptoms.

During the placement of a "bladder pacemaker," a surgeon makes a small cut and places a thin wire close to the sacral nerves. The device is then tested to see how well it works for you. In a second procedure, the surgeon connects the wire to a small battery operated device placed under the skin. This device delivers electrical impulses to the bladder to stop the signals that can cause OAB.

Percutaneous tibial nerve stimulation (PTNS)

Percutaneous tibial nerve stimulation (PTNS)
Percutaneous tibial nerve stimulation (PTNS)
(c)2012 The University of Texas M.D. Anderson Cancer

This therapy stimulates the tibial nerve. For this type of neuromodulation you will not have to have surgery. PTNS is performed during an office visit that takes about 30 minutes. Your health care provider places a needle electrode near your ankle. It sends electrical pulses to the tibial nerve which runs along your knee to the sacral nerves. The electrical pulses help block the nerve signals that aren't working correctly. Often, patients receive 12 weekly treatments, depending on how well they are doing.



Lifestyle Changes

Lifestyle changes known as "behavioral therapy" are often the first treatments used to manage OAB. In behavioral therapy, you make some changes in the way you live day-to-day. Most patients don't get rid of all their symptoms with lifestyle changes. But many do have fewer symptoms using this type of treatment.

Limit food and drinks that you find "bladder irritating"

Some people have fewer symptoms when they eat and drink less "bladder irritating" food. Foods and drinks that bother some people include coffee, tea, artificial sweeteners, caffeine, alcohol, soda, and other fizzy drinks, citrus fruit, food made with tomatoes, chocolate and spicy foods. You can try taking all "bladder irritating" foods out of your diet and adding them back one at a time. Once you figure out which foods and drinks make your symptoms worse, you can avoid them.

Keep a daily "bladder diary"

Writing down when you make trips to the bathroom for a few days can help you and your health care provider understand your symptoms better. A diary may help show you some things that make your symptoms worse. For example, are your symptoms worse after eating or drinking a certain kind of food? Are they worse when you don't drink enough liquids?

Double voiding (emptying your bladder twice)

This may be helpful if you have trouble emptying your bladder completely. After you go to the bathroom, wait a few seconds and then try again to pass urine.

Delayed voiding

In this method of urinating, you teach yourself to put off going to the bathroom, even when you feel an urge. At first, you wait just a few minutes. Gradually you will be able to wait much longer between bathroom visits. But it is important to try this only if your health care provider tells you to. Some people have worse symptoms or have urine leaks when they wait too long to go to the bathroom.

Scheduled voiding

With this method, you follow a daily schedule of going to the bathroom. Instead of going when you feel the urge, you go to the bathroom at set times during the day. Depending on how often you go to the bathroom now, your health care provider may ask you to urinate every 2 to 4 hours, whether you feel you have to go or not.

Exercises to relax your bladder muscle

These can help decrease that "gotta go" feeling when it hits. Some call these exercises "quick flicks" because you quickly squeeze and release the muscles in your pelvis several times. When you get that "gotta go" feeling, squeeze and then relax your pelvic floor muscles as quickly as you can. Do "quick flicks" several times in a row when you feel the urge to go. This sends a message to your nervous system and back to your bladder to stop squeezing. As your bladder stops squeezing and starts relaxing, your "gotta go" feeling should lessen. When you do this exercise, it helps to be still, relax and concentrate just on the "quick flicks." Your health care provider can explain this exercise in more detail.



Medical and Surgical Treatments

Drugs

When lifestyle changes don't help enough, your health care provider may ask you to try a prescription drug. You may take the drug alone or along with behavioral therapy.

There are several prescription drugs available to relax the bladder muscle. These drugs can help stop your bladder from contracting when it isn't full. You take some of these medicines by mouth. With other drugs you may use a gel or adhesive patch to deliver the drug through the skin.

Your health care provider should follow you closely to look for changes in your symptoms and any problems while you are taking the medicine. Common side effects include dry mouth and eyes, constipation, and blurred vision.

To get the best results, your health care provider may ask you to take different doses of the drug. Your health care provider may also give you a different drug to try.

Injections

If lifestyle changes and prescription drugs don't work for you, or the drug side effects are too serious, more advanced therapies may be the right choice. You will most likely be referred to a specialist who treats patients with incontinence and OAB, such as a urologist. After reviewing your problem, the specialist may recommend injections. With this treatment, botulinum toxin, better known as Botox®, is injected into your bladder muscle.

Small doses of this drug can paralyze muscles. When injected into the bladder muscle, this drug may help keep it from contracting too often. Over time, this treatment wears off in some people. It may need to be repeated in 6 months or a year. The specialist should follow you closely to watch for side effects, including urinary retention (not emptying your bladder completely). If you do have problems emptying your bladder completely after injections, you may need to use a catheter (a thin, hollow tube) to empty your bladder, at least for a short time.

Stimulating Nerves (Neuromodulation Therapy)

Another treatment when drugs or lifestyle changes don't work is neuromodulation therapy. Neuromodulation therapy is the name given to a group of treatments that deliver electrical pulses to nerves to change how they work. There are 2 types of neuromodulation therapy:

Sacral neuromodulation (SNS)

A device can be placed under your skin to deliver mild electrical pulses to the nerves that control bladder function
A device can be placed under your skin to deliver mild
electrical pulses to the nerves that control bladder function
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

This therapy works by stimulating the sacral nerve (near the base of the spine). This nerve carries signals between the spinal cord and the bladder. In OAB, these nerve signals don't work the right way. SNS uses a "bladder pacemaker" to interrupt these signals, which can improve OAB symptoms.

During the placement of a "bladder pacemaker," a surgeon makes a small cut and places a thin wire close to the sacral nerves. The device is then tested to see how well it works for you. In a second procedure, the surgeon connects the wire to a small battery operated device placed under the skin. This device delivers electrical impulses to the bladder to stop the signals that can cause OAB.

Percutaneous tibial nerve stimulation (PTNS)

Percutaneous tibial nerve stimulation (PTNS)
Percutaneous tibial nerve stimulation (PTNS)
(c)2012 The University of Texas M.D. Anderson Cancer

This therapy stimulates the tibial nerve. For this type of neuromodulation you will not have to have surgery. PTNS is performed during an office visit that takes about 30 minutes. Your health care provider places a needle electrode near your ankle. It sends electrical pulses to the tibial nerve which runs along your knee to the sacral nerves. The electrical pulses help block the nerve signals that aren't working correctly. Often, patients receive 12 weekly treatments, depending on how well they are doing.



More Information

General Questions to Ask Your Health Care Provider

  • Can you prevent OAB?
  • Can you cure OAB?

Questions About Diagnosis

  • Can you help me or do I need to see a specialist?
  • If I need a specialist, how can I find the right one for me?
  • Will I need to have tests to find out if I have OAB?
  • Would you explain each test, and why you think I need them?
  • Are there any dangers of hav­ing these tests?
  • If I don't have OAB, what other problem could be causing my symptoms, and why?

Questions About Treatment

  • What types of treatment are there for OAB?
  • Are there problems that can come from treatment?
  • What are the pros and cons of each type of treatment?
  • What treatment do you think is right for me and why?
  • How soon after treatment will I feel better?
  • After I start treatment, are there problems I should I watch out for?
  • When should I call you?
  • What happens if the first treatment doesn't help?
  • Will I need treatment for the rest of my life?
  • Are there any exercises I can do to help my symptoms?
  • Do I need to see a physical therapist?
  • Are there any lifestyle changes I can make that could help my symptoms?
  • What would happen if I didn't treat OAB?
  • What's my next step?