OVERACTIVE BLADDER

GENERAL INFORMATION

The bladder is a hollow muscular organ located in the lower part of the abdomen behind the pubic bone. The kidney produces urine that drains regularly into the bladder through two tubes called the ureters. The bladder is like a pouch that expands and has the capacity to hold half a litre of urine. When it is full, signals are sent to the brain and you will feel the desire to urinate. The bladder should be able to store the urine without leakage, until it is convenient to use the toilet.

Overactive bladder (OAB) affects up to 15% of women, men and children. OAB is not a disease, but a condition that is generally not life threatening and can be treated with simple measures. Sometimes known as a ‘weak bladder’, the symptoms are usually chronic and interfere significantly with a person’s daily activities. OAB sufferers are often too embarrassed to seek help, or think that it is a ‘normal’ part of growing up or ageing. They will make lifestyle adjustments and put up with the symptoms for many months or years.

SYMPTOMS

You may have OAB if you experience the following symptoms:

  • Urgency (difficulty holding on)
  • Incontinence (leakage when unable to access a toilet quickly)
  • Frequency (urinating every 2 hours or less)
  • Nocturia (waking up more than once at night to urinate)
  • Dull pain in the lower pelvic area

Some ways you may be dealing with these problems include:

  • Using incontinence products such as liners and pads regularly
  • Limiting your fluid intake to avoid going to the toilet frequently
  • Restricting use of public transport for fear of not being able to access a toilet
  • Avoiding social activities as you need to go the toilet constantly or smell of urine
  • Not engaging in intimate relationships due to embarrassment and fear of leaking
  • Memorising where toilets when you are out, so that you can get to one in a hurry
  • Changing your underwear or clothes regularly due to dampness or odour

CAUSES

Bladder structure and function has been the focus of medical research for many decades. Scientists now know that in OAB, there are abnormalities in the nerve receptors and neurotransmitters in the bladder, the feedback reflexes between the sacral nerves and the bladder and the transmission of signals from the brain to the sacral nerves. This has allowed researchers to develop effective treatment modalities. However the actual cause or trigger for the condition is unknown.

Urgency, frequency and urge incontinence is associated with:

  • Bladder infections (cystitis)
  • Bladder cancer
  • Bladder prolapse
  • Obstruction due to prostate enlargement or stricture
  • Previous radiation exposure or therapy in the lower abdomen
  • Bladder stones
  • Neurological conditions
    • Parkinson’s disease
    • Multiple sclerosis
    • Spinal cord injury
    • Spina bifida
    • Stroke
    • Brain or spinal tumours
  • Delayed toilet training as a child
  • Nocturnal enuresis (bed-wetting)

DIAGNOSIS

Serious conditions listed above must be excluded, before the symptoms can be diagnosed as OAB. A thorough assessment may include:

  • History
  • Bladder Diary
  • 24-hour pad weight
  • Examination
  • Urine tests
  • Uroflowmetry – assessment of flow rate when urinating
  • Ultrasound scan
  • MRI brain and spine – to look for neurological diseases
  • Cystoscopy – minimally invasive procedure to visualise the bladder lining
  • Urodynamic studies – measurement of bladder pressures and activity with filling and emptying

TREATMENT

There are many simple measures that can be used to treat OAB. Your general practitioner may involve a physiotherapist, continence nurse and/or urologist in your care for better results.

  • Pelvic floor muscle exercises – when stress incontinence is also present
  • Bladder retraining
  • Medications to suppress the bladder urge include:
    • Oxybutynin tablets (Ditropan, 2-4 times daily)
    • Oxybutynin skin patches (Oxytrol, changed twice a week)
    • Tolteridine tablets (Detrusitol, once daily)
    • Solifenacin tablets (Vesicare, once daily)

If you have persistent bothersome symptoms despite an adequate trial of simple measures, then your urologist may undertake further assessment and counsel you about surgical options. These include:

  • Sacral neuromodulation – insertion of a pacemaker to control bladder function
  • Botox injections into the bladder to paralyse parts of the bladder

In rare circumstances, a handful of patients do not respond to any of treatments listed above. These patients are often desperate and may request for permanent catheterisation, bladder augmentation surgery or diversion of urine into a stoma bag.

RESOURCES

Urology Care Foundation OAB fact sheet
urologyhealth.org is the official Web site of the Urology Care Foundation, the official foundation of the American Urological Association. This site provides patients, health care professionals and caregivers with accurate and up-to-date educational materials about urologic problems.

Useful Information

OAB Fact Sheet

Bladder Retraining

Bladder diary

Contact Us

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