What is Overactive Bladder (OAB)?

Symptoms

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 fear you will leak if you don't get to a bathroom right away. You may or may not actually leak with this urge to go.

If you live with OAB, you may also:

Leak urine or have “urge incontinence.” This means urine leaks when you feel the sudden urge to go. This isn’t the same as stress urinary incontinence or SUI . People with SUI leak urine when sneezing, laughing or doing other physical activities.

Urinate frequently. You may need to go to the bathroom many times during the day. The number of times someone urinates varies from person to person. Many experts agree that going to the bathroom more than eight times in 24 hours is “frequent urination.”

Wake up at night to pass urine. If you have to wake from sleep to go to the bathroom more than once a night, it’s a symptom of OAB or nocturia.

Causes

What Are the Causes of OAB?

How the Urinary Tract Works Normally, and What Causes OAB

The urinary tract   is the important system in our bodies that removes liquid waste (urine). It includes the organs that produce, store and pass urine. These are:

  • 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 muscular 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 a muscle called a sphincter that locks in urine.

  • The sphincter muscle opens to release urine when the bladder contracts.

Overactive Bladder
Overactive Bladder

Normally, when your bladder is full of urine waste, your brain signals the bladder. The bladder muscles then squeeze. This forces the urine out through the urethra. The sphincter in the urethra opens and urine flows out. When your bladder is not full, the bladder is relaxed.

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.

If the nerve signals between your bladder and brain don’t work properly, OAB can result. The signals might tell your bladder to empty, even when it isn't full. OAB can also be caused when muscles in your bladder are too active. This means that the bladder muscles contract to pass urine before your bladder is full. In turn, this causes a sudden, strong need to urinate. We call this "urgency."

Risk Factors for OAB

  • Neurologic disorders or damage to the signals between your brain and bladder
  • Hormone changes
  • Pelvic muscle weakness or spasms
  • A urinary tract infection
  • Side effects from a medication
  • Diseases that affect the brain or spinal cord, like stroke and multiple sclerosis

If you think you have OAB, talk with your health care provider. It’s important to learn why it’s happening so you can manage your symptoms.

Diagnosis

How is OAB Diagnosed?

After you talk about your symptoms, your health care provider may do an exam right away. Or, they may refer you to a specialist, such as a urologist who can diagnose and treat OAB. Some urologists specialize in incontinence and OAB.

Medical History

Your exam will begin with questions. Your provider will want to understand your health history and experiences. You should tell them about the symptoms you have, how long you’ve had them, and how they’re changing your life. A medical history will include questions about your past and current health problems. You should bring a list of over-the-counter and prescription drugs you take. You should also tell your provider about your diet and about how much and what kinds of liquids you drink during the day and night.

Physical Exam

Your provider will examine you to look for something that may be causing your symptoms. Doctors will often feel your abdomen, the organs in your pelvis, and your rectum.

Bladder Diary

You may be asked to keep a Bladder Diaryfor a few weeks. With this, 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. The bladder diary helps you track:

  • When and how much fluid you drink
  • When and how much you urinate
  • How often you have that “gotta go” urgency feeling
  • When and how much urine you may leak

Having a Bladder Diary during your first visit can be helpful because it describes your daily habits, your urinary symptoms, and shows your provider how they affect your life. Your doctor will use this information to help treat you.

Other Tests

  • Urine test: 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.
  • More tests,like a cystoscopy or urodynamic testing, are usually not needed but may be used if your provider thinks something else is going on.

Treatment

What Treatments are Available for OAB?

There are a number of things you can do to 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:

More Information

More Information

Providers and Specialists Who Treat OAB

Many types of health care providers can offer basic help for OAB. Here are the types of providers you may meet:

  • Urologist* are surgeons who evaluate and treat problems of the urinary tract. Most urologists are very experienced with incontinence. However, not all of them specialize in treating OAB. A patient should ask if their provider specializes in treating OAB.

  • Gynecologists are doctors who focus on women’s health. Most are knowledgeable about incontinence, but not all are trained to treat OAB.

  • Female Pelvic Medicine and Reconstructive Surgery (FPMRS) specialists are urologists or gynecologists who are trained as experts in female pelvic health. The public often refers to FPMRS specialists as female urologists or urogynecologists.

  • Primary Care Practitioners are doctors who can diagnose and treat common health concerns. If a primary care provider is experienced with OAB, they will tell you your options. Or, they may refer you to a specialist, especially if lifestyle changes haven’t helped.

  • Internist are general doctors who may or may not be primary care providers. They will often refer to a specialist.

  • Nurse Practitioners (NP) are highly trained nurses, able to treat many medical problems. Some NPs specialize in issues like OAB, or they will refer you to a specialist.

  • Physician Assistants (PA) are professionals licensed to practice medicine with a doctor’s oversight. NPs and PAs are often part of the health care team. Many can diagnose and treat non-surgically and can help with exercises and lifestyle changes. Some specialize in issues such as OAB.

  • Geriatricians are doctors who treat older patients, and many are able to evaluate and treat OAB. But, not all treat OAB.

  • Physical Therapists are licensed health professionals who provide physical therapy. If they have special training in pelvic floor disorders, they can help with exercises and lifestyle changes for OAB.

*Typically, specialists who treat OAB and incontinence include urologists and female pelvic medicine specialists. It helps to ask if your health care provider has direct training or experience with OAB.

Use our Find-a-Urologist tool to help find a urologist near you. Simply chose “incontinence” as a specialty for urologists with training and experience in urine leaks and OAB.

Tips for a Successful Doctor's Visit

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, help the health care provider learn what’s going on by gathering some information. Also, be ready to take notes about what you learn. It is helpful to bring:

    • A list of the prescription drugs, over-the-counter medicines, vitamins and herbs you take.
    • A list of your past and current illnesses or injuries.
    • Results from the Overactive Bladder Assessment Tool, to help you discuss your symptoms.
    • A way to take notes about treatments.
  • Bring a friend. Ask a close friend or relative to go with you to the doctor. 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, then bring up the topic yourself. It may not be wise to wait until the end of your visit, so you can be 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 has heard it all! It’s okay to tell them about your symptoms and how they impact your daily life.

  • 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 them. We offer some good questions to ask in each section of this guide to help you.

Talking with Your Health Care Provider

Questions to Ask the Doctor about OAB

  • Are my symptoms from OAB or from something else?
  • What tests will I need to find out if I have OAB?
  • What could have caused my OAB?
  • Can I do anything to prevent OAB symptoms?

Questions to Ask the Doctor about Treatment

  • What would happen if I don’t treat my OAB?
  • What lifestyle changes should I make?
  • Are there any exercises I can do to help?
  • Do I need to see a physical therapist?
  • What treatment could help my OAB?
  • How soon after treatment will I feel better?
  • What are the good and bad things that I should know about these treatments?
  • What problems should I call you about after I start treatment?
  • What happens if the first treatment doesn’t help?
  • Will I need treatment for the rest of my life?
  • Can my OAB be managed?
  • What are my next steps?

Questions to Ask Yourself about Symptoms

  • 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 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?