Overactive Bladder

Millions of people find their lives disrupted by the urge to urinate at inconvenient times and the loss of bladder control before reaching a toilet. The following information will help you discuss this common, yet often embarrassing, condition with your urologist and assist you in better understanding what treatments are available.

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What is Overactive Bladder?
Overactive bladder (OAB) is a condition characterized by a sudden, uncomfortable need to urinate with or without urine leakage usually with daytime and nighttime frequency.

OAB occurs when smooth muscle of the detrusor muscle of the bladder squeezes or contracts more often than normal and at inappropriate times. Instead of staying at rest as urine fills the bladder, the detrusor contracts while the bladder is filling with urine.

What Causes OAB?
By definition, the cause of OAB is unknown. However, identifiable underlying causes can include: drug side effects, nerve damage or neurological disease (e.g., multiple sclerosis, Parkinson's disease, etc.) or stroke. There are also conditions that are associated with urgency and frequency - including bladder cancer, urinary tract infections and benign prostatic hyperplasia (BPH) - that must be excluded during an examination.

Some experts believe that some individuals are predisposed to OAB. Circumstantial evidence suggests that individuals with depression, anxiety and attention deficit disorder may experience symptoms of OAB more often than the general population. Some investigators suggest that depression, anxiety, feeding disturbances, pain, irritable bowel syndrome, fibromyalgia and changes in urination are associated with disturbances in brain circuits using specific chemical messengers between nerves known as neurotransmitters, in particular serotonin 5-hydroxytryptamine (5-HT). Fibromyalgia and irritable bowel syndrome are conditions seen more often in patients with OAB and interstitial cystitis (IC) than the general population. These conditions are associated with an overactive bladder and possibly to depression, which provides a potential link with 5-HT metabolism and OAB.

How is Overactive Bladder Diagnosed?
One of the first steps toward diagnosing OAB is to keep a urination diary. Documenting symptoms - including urgency - can help your urologist make the proper diagnosis.

A urinalysis (UA) must be performed to rule out infection and to look for glucose (sugar), blood, white cells or difficulty concentrating the urine (specific gravity). After urination, residual urine is also checked using an ultrasound or catheterization. In some patients, a urine cytology or endoscopy (cystoscopy) of the bladder is warranted. It is sometimes useful to perform bladder pressure testing using cystometry (CMG) to document bladder (detrusor) overactivity during filling and exclude obstruction. Imaging of the urinary tract with cystogram, computerized tomography (CT) scan or magnetic resonance imaging (MRI) is rarely needed.

How is Overactive Bladder Treated?

Drugs
Agents that relax the detrusor or prevent a bladder contraction are effective for OAB and urge incontinence. Acetylcholine is a chemical released from nerves supplying the bladder that acts at muscarinic receptors to trigger a bladder muscle contraction, thereby producing urination. The detrusor expresses muscarinic (acetylcholine binding) M3 and M2 receptor subtypes. Antimuscarinics are used to treat OAB and urge incontinence and they include: darifenacin, hysoscyamine, oxybutynin, solefenacin, tolterodine and trospium. Although these pharmacologic agents are used as first line treatment options, side effects limit long term compliance.

Behavioral Therapies
In addition to drug therapies for OAB and urinary incontinence, behavioral regimens have been shown to reduce incontinence and urinary frequency. These regimens range from simple maneuvers such as timed or prompted urination and fluid management to biofeedback. Pelvic muscle exercises (Kegel exercises) are beneficial in appeasing urge incontinence, and can be done alone or in combination with antimuscarinic drugs. Also, patients may want to change certain aspects of their diets (e.g., decreasing caffeine or alcohol intake), lose weight and stop smoking.

Neuromodulation
Additional options exist when drugs and behavioral therapies fail to improve symptoms in patients with OAB and urge incontinence. Electrical stimulation of nerves or regions of the skin, vagina or rectum innervated by the lower spinal cord can reduce OAB and urge incontinence. Percutaneous tibial nerve stimulation weekly for several weeks has been reported to show encouraging results. The two stage sacral nerve stimulation technique using the InterStim neuromodulation device has been reported to be effective in many patients refractory to medical therapy. A new emerging option for the treatment of refractory cases of OAB is called biological neuromodulation. Early reports with the use of Botulinum Toxin injected directly to the bladder wall are very encouraging. It is now the subject of further research scrutiny.

Surgery
Surgery to enlarge the bladder - called augmentation cystoplasty - can be considered when the bladder is extremely small or generates high pressure. This is major surgery with potential complications and should be attempted as a last resort. Other surgeries such as neurolysis to cut the nerves supplying the bladder are rarely performed. In some women with OAB and urinary incontinence who also exhibit vaginal prolapse (e.g., cystocele, enterocele) and stress urinary incontinence, correction of these conditions can improve the overactive bladder.

Frequently Asked Questions

Where can I go for more information?

Loss of Bladder Control.

A Basic Guide to Bladder Health.

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Reviewed July, 2009

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Glossary Terms

acetylcholine:
	A substance that plays an important part in the transmission of nerve impulses in the parasympathetic nervous system. This system controls smooth muscles including those of the bladder and urethra.
benign:
	Not malignant; not cancerous.
benign prostatic hyperplasia:
	Also known as BPH. An enlarged prostate not caused by cancer. BPH can cause problems with urination because the prostate squeezes the urethra at the opening of the bladder.
biofeedback:
	A procedure that uses electrodes to help an individual gain awareness and control of their pelvic muscles.
bladder:
	The bladder is a thick muscular balloon-shaped pouch in which urine is stored before being discharged through the urethra.
bladder control:
	The ability to control the timing of urination. Also referred to as continence.
bowel:
	Another word for intestines or colon.
BPH:
	Also known as benign prostatic hyperplasia. An enlarged prostate not caused by cancer. BPH can cause problems with urination because the prostate squeezes the urethra at the opening of the bladder.
cancer:
	An abnormal growth that can invade nearby structures and spread to other parts of the body and may be a threat to life.
catheter:
	A thin tube that is inserted through the urethra into the bladder to allow urine to drain or for performance of a procedure or test, such as insertion of a substance during a bladder X-ray.
catheterization:
	Insertion of a narrow tube through the urethra or through the front of the abdominal wall into the bladder to allow urine drainage.
computerized tomography:
	Also known as computerized tomography, computerized axial tomography or CT scan. A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images of the body. Shows detailed images of any part of the body, including bones, muscles, fat and organs. CT scans are more detailed than general X-rays.
continence:
	The ability to control the timing of urination or a bowel movement.
contract:
	To shrink or become smaller.
cyst:
	An abnormal sac containing gas, fluid or a semisolid material. Cysts may form in kidneys or other parts of the body.
cystitis:
	Also known as bladder infection. Urinary tract infection involving the bladder, which causes inflammation of the bladder and results in pain and a burning feeling in the pelvis or urethra.
cystocele:
	Fallen bladder. When the bladder falls or sags from its normal position down to the pelvic floor. It can cause either urinary leakage or urinary retention.
cystogram:
	An X-ray examination of the bladder utilizing contrast material injected into the bladder.
cystometry:
	Alco called cystometrogram. A test used to assess the function of the bladder by measuring the pressure/volume as the bladder is slowly being filled. Cystometry is used to assess bladder, urge sensation, capacity and compliance. There are different variations of the test depending on the problem being investigated but regardless of the technique, the test always involves insertion of a catheter into the bladder.
cystoscopy:
	Also known as cystourethroscopy. An examination with a narrow, flexible tube-like instrument passed through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones.
cytology:
	The examination of cells obtained from the body tissue or fluids, especially to establish if they are cancerous.
detrusor muscle:
	Contracting muscle in the bladder that helps to expel urine.
endoscopy:
	Procedure that utilizes an endoscope.
enterocele:
	Dropping (herniation) or bulging of the bowel into the vagina or out of the anus.
fibromyalgia:
	Also called fibromyalgia syndrome, fibromyositis or fibrositis. A syndrome characterized by chronic pain in the muscles and soft tissues surrounding joints, fatigue, and tenderness at specific sites in the body.
frequency:
	The need to urinate more often than is normal.
gene:
	The basic unit capable of transmitting characteristics from one generation to the next.
glucose:
	A simple sugar produced in animals by the conversion of carbohydrates, proteins and fats.
hyperplasia:
	Excessive growth of normal cells of an organ.
incontinence:
	Loss of bladder or bowel control; the accidental loss of urine or feces.
infection:
	A condition resulting from the presence of bacteria or other microorganisms.
innervated:
	Supply an organ or body part with nerves. Stimulate a nerve, body muscle or organ to action.
interstitial cystitis:
	Also referred to as IC and painful bladder syndrome. A disorder that causes the bladder wall to become swollen and irritated, leading to scarring and stiffening of the bladder, decreased bladder capacity, and, in rare cases, ulcers in the bladder lining.
ions:
	Electrically charged atoms.
irritable bowel syndrome:
	Also called IBS, irritable colon or spastic colon. A disorder characterized by abnormally increased motility of the small and large intestines, producing abdominal pain, constipation or diarrhea.
magnetic resonance imaging:
	Also referred to a MRI. A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
metabolism:
	The ongoing interrelated series of chemical interactions taking place in living organisms that provide the energy and nutrients needed to sustain life
MRI:
	Also referred to a magnetic resonance imaging. A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
multiple sclerosis:
	A serious progressive disease of the central nervous system.
neurologic:
	Pertaining to the nervous system.
neurological:
	Pertaining to the nervous system.
neurotransmitter:
	A chemical that carries messages between different nerve cells or between nerve cells and muscles.
overactive bladder:
	A condition in which the patient experiences two or all three of the following conditions: urinary urgency, urge incontinence or urinary frequency--defined for this condition as urination more than seven times a day or more than twice at night.
prolapse:
	The protrusion or dropping of the uretus (uterine prolapse), rectum (rectocele) or bladder (cystocele) into the vagina.
prostatic:
	Pertaining to the prostate.
receptor:
	A nerve ending that is sensitive to stimuli and can convert them into nerve impulses.
rectum:
	The lower part of the large intestine, ending in the anal opening.
residual urine:
	Amount of urine remaining in the bladder after urination.
stress urinary incontinence:
	Also referred to as stress incontinence. The most common type of incontinence that involves the leakage of urine caused by actions--such as coughing, laughing, sneezing, runnig or lifting--that put pressure on the bladder from inside the body. Can result from either a fallen bladder or weak sphincter muscles.
ultrasound:
	Also referred to as a sonogram. A technique that bounces painless sound waves off organs to create an image of their structure to detect abnormalities.
urge:
	Strong desire to urinate.
urge incontinence:
	Also referred to as urge urinary incontinence. Wetting. Involuntary urinary leakage when the bladder contracts unexpectedly by itself. The inability to hold urine long enough to reach a restroom.
urgency:
	Strong desire to urinate.
urinal:
	A portable device that is used as a receptacle for urine.
urinalysis:
	A test of a urine sample that can reveal many problems of the urinary system and other body systems. The sample may be observed for physical characteristics, chemistry, the presence of drugs or germs or other signs of disease.
urinary:
	Relating to urine.
urinary frequency:
	Urination eight or more times a day.
urinary incontinence:
	Inability to control urination.
urinary incontinence:
	Inability to control urination.
urinary tract:
	The system that takes wastes from the blood and carries them out of the body in the form of urine. Passageway from the kidneys to the ureters, bladder and urethra.
urinary tract infection:
	Also referred to as UTI. An illness caused by harmful bacteria, viruses or yeast growing in the urinary tract.
urinate:
	To release urine from the bladder to the outside. Also referred to as void.
urination:
	The passing of urine.
urine:
	Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.
urologist:
	A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. (Download the free Acrobat reader.)
vagina:
	The tube in a woman's body that runs beside the urethra and connects the uterus (womb)to the outside of the body. Sometimes called the birth canal. Sexual intercourse, the outflow of blood during menstruation and the birth of a baby all take place through the vagina.

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