Overactive bladder (OAB) is a condition where patients experience a sudden urge to urinate which is difficult or impossible to control. This may be accompanied by incontinence or leakage of urine. Other common symptoms include frequency and nocturia (getting up at night to void). These symptoms are caused by the bladder itself and are not due to other problems, such as urinary tract infections. Men and women can be affected by OAB.
Patients with OAB often feel annoyed or embarrassed by their bladder. They may know the location of every washroom in the mall or around town. Many patients wear protective garments to minimize the risk of leakage of urine.
Symptoms of OAB include:
- A sudden and compelling urge to urinate which is difficult to control
- Unintentional loss of urine associated with this feeling
- Frequent voiding throughout the day
- Getting up >2 times at night to void
OAB occurs when the bladder muscles contract involuntarily. The volume of urine in your bladder may be low, and you may feel as though your bladder doesn’t empty well.
OAB in many patients is idiopathic, meaning there is no specific cause or condition resulting in the symptoms.
Some conditions may contribute to OAB, these include:
- Neurological disorders, such as MS, spinal cord injury, or stroke
- Diabetes
- Urinary tract infections
- Hormonal changes after menopause in women
- Enlarged prostate
Investigations:
- Your doctor will start with reviewing your medical history and medications.
- You will have a physical exam, which may also include a cystoscopy.
- You may be asked to take a urine sample to the lab or have an ultrasound on your kidneys and bladder.
Treatment Options:
- First line treatment includes behavioural therapies, lifestyle changes, and patient education:
- Increasing fluid intake to ensure you are well hydrated
- Avoiding constipation
- Being aware of bladder irritants:
- Coffee
- Tea
- Alcohol
- Spicy food
- Citrus food
- Weight loss
- Pelvic floor physiotherapy
- Smoking cessation
- Second line treatment includes oral medications for your bladder
- These help to relax the bladder muscle to allow the bladder to hold more urine, and alleviate the symptoms of urgency, frequency, and urine leakage
- Please see medication options below
- If medications do not work, your doctor may recommend Botox in your bladder
- This medication is injected into the muscle of the bladder to help manage the symptoms of urgency
- Intravesical botox injections
Common Medications for OAB:
- There are two (2) main classes of medications available for overactive bladder: antimuscarinics and beta 3 agonists
- Antimuscarinics:
- There are many different options for this medication class
- Solifenacin, darifenacin, trospium, tolterodine, and oxybutynin are typically used
- Common side effects of these medications include dry mouth, dry eyes, and constipation
- Studies have found that solifenacin and tolterodine are well tolerated
- Oxybutynin is not recommended for patients who are elderly due to the risk of cognitive impairment
- Beta 3 agonist:
- Mirabegron is the only medication currently available in Canada
- This medication is very well tolerated
- Common side effects include: a slight increase in blood pressure, headache, and urinary tract infection
The goal of treatment of overactive bladder is improvement in quality of life. The significant negative impact that OAB can have on daily activities, mental health, and sexual function has been highlighted by many scientific studies. Symptoms of OAB can be linked with depression and decreased sense of well-being. It is important to talk to your doctor about these symptoms.
Patients who are awaiting an appointment with a urologist may want to speak to their family doctor about the lifestyle modifications and medication options listed above.
