Introduction

Millions of people in the United States struggle with Overactive Bladder (OAB) symptoms. The most common symptom is the ongoing urgent need to go to the bathroom. Now.

OAB can interfere with work, going out with friends, exercise and sleep. It can lead you to the bathroom many times during the day or night. Some people leak urine (pee) after this urgent "gotta go" feeling. Others feel afraid they'll leak.

Fortunately, there is help and there are treatments.

What is OAB and Who Gets It?

Overactive bladder is the name for a group of bladder symptoms. There are three main symptoms:

• A feeling that you have to go to the bathroom, urgently.
• Sometimes incontinence, which means that you leak urine with the "gotta go" feeling.
• Usually the need to go to the bathroom often (frequently), day and night.

With OAB, you feel that you need to empty your bladder – even when it's not full. This leads to the feeling that you need a bathroom quickly, right now. You can't control or ignore this feeling. (Although it may feel like your bladder muscle is squeezing to empty your bladder, in actual fact your bladder muscle may not be squeezing.) If you "gotta go" eight or more times each day and night, or fear that urine will leak out before you’re ready, you may have OAB.

OAB affects about 33 million Americans. It's not a normal part of aging. It's a health problem that can last for a long time if it's not treated. Many older men (30%) and women (40%) struggle with OAB symptoms. Often people don't know about treatments that can help, or they don't ask for help.

Stress urinary incontinence or SUI is a different bladder problem. People with SUI leak urine while sneezing, laughing or being active. It is not the same as that sudden "gotta go" feeling from OAB. To learn more about SUI, go to https://www.urologymanagement.org/sui/.

In this guide you will find clear information about how to manage OAB. Please ask for help, even if you feel embarrassed. Don't wait, because there are several treatments that work well for OAB. Your health care provider should be trained to talk with you and help you manage your symptoms without embarrassment.

For information about the other health care providers trained to help, click here.

How the Urinary Tract Works and What Happens with OAB

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

The urinary tract is the important system that removes liquid waste from our bodies:

• kidneys: two bean-shaped organs that clean waste from the blood and make urine
• ureters: two thin tubes that take urine from the kidney to the bladder
• bladder: a balloon-like sac that holds urine until it's time to go to the bathroom
• urethra: the tube that carries urine from the bladder out of the body. The urethra has muscles called sphincters that lock in urine. The sphincters open to release urine when the bladder contracts.

When your bladder is full, your brain signals the bladder. The bladder muscles then squeeze. This forces the urine out through the urethra. The sphincters in the urethra open and urine flows out. When your bladder is not full, the bladder is relaxed.

Bladder and sphincter
Image © 2003 Fairman Studios, LLC

With a healthy bladder, signals in your brain let you know that your bladder is getting full or is full, but you can wait to go to the bathroom. With OAB, you can't wait. You feel a sudden, urgent need to go. This can happen even if your bladder isn't full.

Symptoms of OAB

Urgency: This is the main symptom of OAB. It is a strong (urgent) need to urinate that can't be ignored. This "gotta go" feeling makes people afraid that they'll leak urine if they don't find a bathroom right away. OAB may also cause:

• Incontinence (urine leaks): Sometimes OAB causes urine to leak out before getting to the bathroom. This is called "urgency incontinence." Some people may leak just a few drops, while others can have a sudden gush. (for more information: https://www.urologyhealth.org/urologic-conditions/urinary-incontinence)
• Urinate frequently: OAB may also cause people to go to the bathroom many times during the day. Experts say that "frequent urination" is when you have to go to the bathroom more than eight (8) times in 24 hours.
• Wake up at night to urinate: OAB can wake a person from sleep to go to the bathroom more than once a night. This is called "nocturia" by health providers.

Some foods and drinks can bother the bladder. Caffeine, artificial sweeteners, alcohol, chocolate and very spicy foods may make OAB symptoms worse.

OAB does not cause pain. If you feel pain while urinating, you may have an infection. Please talk with your health care provider about pain.

How OAB Can Affect Your Life

Without treatment, OAB symptoms are uncomfortable. It can be hard to get through the day without many visits to the bathroom. OAB can impact relationships. You may not want to do things you enjoy because you worry about finding a bathroom in time. It can disrupt your sleep and sex life. It can leave you tired and short-tempered, or leaks can lead to a rash or infections. The whole experience can make anyone feel hopeless and very unhappy.

The good news is that OAB can be controlled. There are treatments available to help.

Finding the Words

It's normal to feel uncomfortable when talking about OAB symptoms. Who wants to talk about bathroom problems or incontinence?! Still, knowing more about OAB is the best way to take control of the problem. A little planning will give you confidence. Here are some tips to help:

• Be prepared: Before your appointment, gather useful information to help the health care provider learn what's going on. Also be ready to take notes about what you learn. Bring:
  • A list of the prescription drugs, over-the-counter medicines, vitamins and/or herbs you take.
  • A list of your past and current illnesses or injuries.
  • Results from the Think You Have Overactive Bladder? Quiz, to help you discuss your symptoms.
  • A pad of paper and pen to take notes about treatments
• Bring a friend: Ask a close friend or relative to go with you to the doctor, if you don't mind sharing what's going on. An "appointment buddy" can help remind you of things you may forget to ask, or remind you of things the health care provider said.
• Bring up the topic: If your health care provider doesn't ask about your OAB symptoms, bring up the topic yourself. Don't wait until the end of your visit. Make sure you have time for questions. If a nurse meets with you first, tell the nurse about your symptoms.
• Speak freely: Share everything you're experiencing. Your health care provider hears about problems every day. They've heard it all! It's OK to tell them about your symptoms and how they impact your daily life. Let your health care provider know your answers to these questions:
  • Do my symptoms make me stop doing the things I enjoy, or prevent me from going to events?
  • Am I afraid to be too far away from a bathroom?
  • Have my symptoms changed my relationships with friends or family?
  • Do my symptoms make it hard to get a good night's sleep?
• Ask questions: A visit to your health care provider is the right time to ask questions. It is best to bring your list of questions with you so you don't forget. We offer some good question to ask in each section of this guide to help you.
• Follow-up care: Ask your health care provider when you should visit again, and what you should bring with you.

How to Diagnose OAB

When you tell your health care provider about your symptoms, s/he will ask more questions and do some tests. This is done to diagnose the problem. OR, your provider will tell you the name of a specialist who can diagnose and treat you.

To learn what's happening, a health care provider will likely:

• Ask about your health history: You will be asked about how you feel, how long you've had symptoms, and how they impact you. You will be asked about medicine you take (over-the-counter and prescribed). You should also talk about what you eat and drink during the day. This lets your provider learn about your health now and in the past.
   
• Do a physical exam: Your health care provider will look for things that could cause symptoms. In men and women, they will feel your organs in and below your belly, in your pelvic area. They will also check your rectum.
   
• Ask you to keep a "Bladder Diary:" A Bladder Diary helps you, and your doctor, learn about daily events and patterns. In this diary you write down how often you go to the bathroom and if/when you leak urine. You can use this Bladder Diary sample to start. You can also download an electronic bladder diary for your mobile device like The Bladder Pal. This app was developed by AUA Member, Dr. Ronald Yap, through the support of the LeBaron Foundation and the Concord Hospital Trust.
  • Bladder Pal app for Android
  • Bladder Pal app for Apple
• Do other tests if you need them:
  • Urine test: a sample of your urine may be tested for infection or blood.
  • Bladder scan: This test shows how much urine is left in your bladder after you go to the bathroom.
  • Cystoscopy: Your health care provider inserts a thin tube with a tiny camera into the bladder to see if it looks normal or not.
  • Urodynamic testing: These tests check to see how well your lower urinary tract holds and lets-go of urine. One of these tests is call CMG (cystometrogram ).
  • Symptom quiz: Many doctors use a written quiz to ask questions about your bladder problems and what causes you the most bother. Take our OAB Quiz

There are a number of things you can do to help manage OAB. Everyone has a different experience with what works best. You may try one 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 option.

OAB treatments include:

Lifestyle Changes

To manage OAB, health care providers first ask a patient to make "lifestyle changes". Sometimes these changes are called "behavioral therapy". This could mean that you eat different foods, change how much, when or what you drink, and pre-plan bathroom visits to feel better. Many people find that these changes help. Other people need to do more.

1. Limit food and drinks that bother your bladder: Many people feel better when they change the way they eat and drink. There are certain foods known to bother the bladder. You can try taking all of these things out of your diet, then add them back one at a time. Once you learn which foods and drinks make your symptoms worse, you can avoid them. Common foods to avoid:
   • Coffee / caffeine
   • Tea
   • Artificial sweeteners
   • Alcohol
   • Soda and other fizzy drinks
   • Citrus fruit
   • Food made with tomatoes
   • Chocolate (not white chocolate)
   • Spicy foods
2. Keep a bladder diary: Writing down when you make trips to the bathroom for a few days can help you understand your body better. This diary may show you things that make 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?
3. Double voiding (emptying your bladder twice): This may be helpful for people who have trouble fully emptying their bladders. After you go to the bathroom, you wait a few seconds and then try to go again.
4. Delayed voiding: This means that you practice waiting before you go to the bathroom, even when you have to go. At first, you wait just a few minutes. Gradually you may be able to wait two to three hours at a time. Only try this if your health care provider tells you to. Some people feel worse or have urine leaks when they wait too long to go to the bathroom.
5. Timed urination: This means that you follow a daily bathroom schedule. Instead of going when you feel the urge, you go at set times during the day. You and your health care provider will create a reasonable schedule. You may try to urinate every two to four hours, whether you feel you have to go or not. The goal is to prevent that "urgent" feeling and to gain control.
6. Exercises to relax your bladder muscle: You may be familiar with exercises to strengthen your pelvic floor muscles, also called Kegel exercises. A special exercise using those same pelvic floor muscles may help relax your bladder during those "gotta go" moments. To do "quick flicks," you quickly squeeze and relax your pelvic floor muscles repeatedly. When you feel the urge to go, try a number of "quick flicks" instead. These exercises can help control that "gotta go" feeling. It helps to be still, relax and focus on just the exercise. Your health care provider or a physical therapist can help you learn these exercises. Biofeedback may also help. Biofeedback uses computer graphs and sounds to monitor muscle movement. It can help teach you how your pelvic muscles move and how strong they are.

Prescription Drugs

When lifestyle changes aren't enough, the next step may be to take medicine. Your health care provider can tell you about special drugs for OAB.

There are several types that can relax the bladder muscle. These drugs (for example: Anti-muscarenics and Beta-3 agonists) can help stop your bladder from squeezing when it's not full. Some are taken as pills, by mouth. Others are gels or a sticky patch to give you the drug through your skin.

Your health care provider will want to know if the medicine works for you. They will check to see if you get relief or if the drug causes problems, known as "side-effects". Some people get dry mouth and dry eyes, constipation, or blurred vision.

To help relieve symptoms, your health care provider may ask you to take different amounts of the drug. Or, give you a different one to try. You may be asked to make lifestyle changes and take medicine at the same time for better results.

Injections

If lifestyle changes and medicine aren't working, there are other options. A trained urologist or FPMRS specialist can help. They may offer bladder injections (shots) of Botox® (botulinum toxin).

Small amounts of Botox® can stop the bladder muscles from squeezing too much. Many tiny injections are used. It gently paralyzes the muscles. Additional treatments are given when this treatment wears off, anywhere from six to twelve months later. Your doctor will watch how you're doing to make sure you aren't retaining (holding in) too much urine. If urine is not draining well, you may need to catheterize temporarily.

Nerve Stimulation (Neuromodulation Therapy)

Another treatment for people who need extra help is nerve stimulation, also called neuromodulation [pronounced: NER-oh-mahd-yoo-LAY-shun] therapy.

This type of treatment sends electrical pulses to nerves in your bladder. In OAB, the nerve signals between your bladder and brain don't work the right way. These electrical pulses interrupt the nerve signals, set them right, and improve OAB symptoms.

There are two types:

• 
  

  Sacral neuromodulation (SNS)
  National Institute of Diabetes and Digestive and Kidney Diseases,
  National Institutes of Health
  Sacral neuromodulation (SNS) changes how the sacral nerve works. This nerve carries signals between the spinal cord and the bladder. Its job is to help hold and release urine. In OAB, these nerve signals aren't doing what they should. SNS uses a "bladder pacemaker" to control these signals to stop OAB symptoms. SNS is a two-step surgical process. The first step is to implant an electrical wire under the skin in your lower back. This wire is first connected to a handheld "pacemaker" to send pulses to the sacral nerve. You and your doctor will test whether or not this pacemaker can help you. If it helps, the second step is to implant a permanent pacemaker that can regulate the nerve rhythm.
• 
  

  Percutaneous tibial nerve stimulation (PTNS)
  (c)2012 The University of Texas M.D. Anderson Cancer
  Percutaneous tibial nerve stimulation (PTNS) is another way to correct the nerves in your bladder. For this type of nerve stimulation you will not have to have surgery. PTNS is performed during an office visit that takes about 30 minutes. PTNS is done by placing a small electrode in your lower leg near your ankle. It sends pulses to the tibial nerve. The tibial nerve runs along your knee to the sacral nerves in your lower back. The pulses help control the signals that aren't working right. Often, patients receive 12 treatments, depending on how it's working. [This therapy is pronounced: PER-cyoo-TAY-nee-uhs TI-bee-ahl NERV STIM-yoo-LAY-shun.]

Other Resources

Here are a few more organizations that offer useful information to help people living with OAB and incontinence.

Urology Care Foundation
1-800-828-7866
The official foundation of the American Urological Association, the Urology Care Foundation is committed to advancing urologic research and education. We collaborate with researchers, health care providers, patients and caregivers to improve patients' lives.

American Urological Association
The American Urological Association promotes the highest standards of urological clinical care through education, research and health care policy.

It's Time to Talk about OAB
Get the facts. Get diagnosed. Take control.
Order printed materials about OAB, take our "Overactive Bladder Quiz," and download a "Bladder Diary" to track your symptoms.

It's Time to Talk about SUI
Find out more about Stress Urinary Incontinence, order printed materials and take the SUI quiz.

National Kidney and Urologic Diseases Clearinghouse:
The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that provides information on kidney and urologic diseases. The NIDDK is part of the U.S. National Institutes of Health (NIH).

National Association for Continence
The National Association for Continence is a national, private, non-profit organization dedicated to improving the quality of life of people with incontinence, voiding dysfunction, and related pelvic floor disorders. NAFC's purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence.

Simon Foundation for Continence
The mission of the Simon Foundation is to bring the topic of incontinence out into the open, remove the stigma surrounding incontinence, and provide help and hope to people with incontinence, their families and the health professionals who provide their care.

Patient resources provided through the generous support of: