Overactive Bladder (OAB): Symptoms, Diagnosis & Treatment

Introduction

Overactive bladder (OAB) A problem with bladder function that causes a frequent feeling of needing to urinate. It is not the diseases it is the condition where sudden urge to urinate that may be difficult to control.

If there is loss of bladder control then it is known as urge incontinence. The urge to urinate may be difficult to control and lead to the involuntary loss of urine (incontinence). It may be embarrassing or limit activity. You may pass urine many times during the day and night.

One or all of these symptoms can cause considerable stress and a negative impact on your quality of life.

OAB does not tend to affect lifespan, but it can impact quality of life. The condition may affect work, relationships, and sleep.

Symptoms of overactive bladder

1. Urinary urgency: In this condition there is sudden, strong urge to urinate that you can’t ignore or compelling desire to pass urine that is difficult to defer.
2. Urge incontinence:  In this case, there can be a leakage of urine when you get the urge to urinate. In this symptom there is Loss of urine immediately happen.
3. Nocturia: This symptom is characterized by the need to get up and urinate at least two times each night. You have to wake from sleep to go to the bathroom more than once a night.
4. Urinate frequently- In this symptom you need to urinate very often. You may need to go to the bathroom many times during the day. The number of times someone urinates varies from person to person.

Causes of Overactive bladder

The urinary tract   is the important system in our bodies that removes liquid waste which we called as urine.It cover all urinary system.

Overactivity of a muscle in the bladder wall is considered to be the main cause of OAB. OAB it is result of spasms in the detrusor muscle, the main muscle of the urinary bladder wall. When the brain senses the bladder is about half full, it usually sends out nerve signals. These cause the pelvic floor and sphincter muscles to relax while the detrusor contracts, squeezing out urine.

OAB can impact anyone at any age, the likelihood of developing the condition increases greatly with age

An overactive bladder can be caused by several things

1. Weak pelvic muscles: Pregnancy and childbirth can cause your pelvic muscles (the muscles and tissues that support the organs in your lower abdomen) to stretch and weaken. This can cause the bladder to sag out of its normal position. All of these factors can cause leakage.

2.  Over activity of the detrusor urinae muscle-The function of detrusor urinae muscle is to remains relaxed to allow the bladder to store urine, and contracts during urination to release urine. If it’s overactive than its causes Overactive bladder.

3. Nerve damage– 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.  Trauma and diseases can cause this to happen.

4. Infection– An infection, like a urinary tract infection (UTI), can irritate the bladder nerves and cause the bladder to squeeze without warning leads to frequent urination.

5. Excess weight– Being overweight or obesity places extra pressure on your bladder. This can lead to urge incontinence

• Medications, alcohol and caffeine – These products and diuretics can dull the nerves, which affects the signal to the brain, results in overflow of bladder.
• Estrogen deficiency after menopause – This hormonal change could contribute to a loss of urine due to urgency.
• Ageing– due to aging, it may make more difficult for your bladder to understand the signals it receives from your brain.
• Incomplete bladder emptying-This symptoms which may lead to symptoms of overactive bladder, as you have little urine storage space left.

Neurological disorders like stroke and multiple sclerosis,Diabetes,Abnormalities in the bladder, such as tumours or bladder stone, enlarged prostate, constipation

• Drinking too much fluid and water

Several conditions may contribute to signs and symptoms of overactive bladder, including:

• Neurological disorders, such as stroke and multiple sclerosis
• Diabetes
• Urinary tract infections that can cause symptoms similar to those of an overactive bladder
• Hormonal changes during menopause in women
• Abnormalities in the bladder, such as tumors or bladder stones
• Factors that obstruct bladder outflow — enlarged prostate, constipation or previous operations to treat other forms of incontinence
• giving birth via the vagina
• pelvic organ prolapse
• catheter use
• structural problems with the bladder

Risk factors of overactive Bladder

• Neurologic disorders or damage to the signals between your brain and bladder
• Hormone changes-women facing this issue mainly after post menopause
• 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
• Ageing
• Smoking
• Pregnancy
• Chronic constipation
• Long term dehydration
• Gestational Diabetes

Diagnosis of over active bladder

After you talk about your symptoms, your health care provider may do an exam right away.

1. Physical Exam

Doctors will often feel your abdomen, tenderness around your abdomen and kidney and organs in your pelvis, and your rectum.

2. Bladder scan : This test uses an ultrasound to measure the amount of urine or how much urine is left in your bladder after you urinate or you go to the bathroom.

3. Urine test: Doctor may ask you to leave a sample of your urine to test for infection or blood and help identify a urinary tract infection or other urinary tract problems.

4. Urodynamic testing: This tests help to assess the bladder’s ability to hold and store urine.

What are the treatments for an overactive bladder?

The treatment for overactive bladder can vary with each individual. Everyone has a different experience with what works best. You may try one treatment alone, or several at the same time. The recommended first line of therapy is behavioral, dietary, and lifestyle therapies. The lifestyle changes that are recommended for preventing and managing over active bladder

Prevention

Prevention and management options of over active bladder include

• Staying hydrated ,maintain hydration level.
• losing weight
• treating chronic constipation through medication or diet
• pelvic floor muscle exercises, Kegels exercises specially for women’s
• treating urinary and bladder infections
• quitting smoking to reduce coughing
• regular exercise for 30 minutes.

Lifestyle Changes

• Dietary modification– There is certain foods and drinks known to irritate the bladder. Try to avoid diuretics like coffee, tea and alcohol, soda and other fizzy drinks, Chocolate (not white chocolate), Some spicy foods, tomatoes based food. Avoid vinegar and soy sauce, ketchup, and mustard.
• Reducing fluid and water intake may decrease the symptoms of oab.
• Management of weight-Weight loss in obese individuals may decrease incontinence episodes. Heavier people are also at greater risk of stress urinary incontinence, which may improve with weight loss.
• Double voiding- when you empty your bladder twice. This may be helpful for people who have trouble fully emptying their bladder, wait and try to urinate again.
• Bathroom schedule– Instead of going when you feel the urge, you go at set times during the day, set time for urination.
• Absorbent pads. Wearing absorbent pads or undergarments can protect your clothing and help you avoid embarrassing.
• Exercises-do Moderate 30 min exercises and try Different workout like-

Kegel exercises- This exercises which helps to tightening and holding your pelvic muscles tight and helps to strengthen the pelvic floor.

Biofeedback: biofeedback helps to control their pelvic muscles and also to ensure proper contractions of these muscles. It should be done under the guidance of health care

• Keep a bladder diary-try to understand your body and keep a note on water ,food and time of urination.
• Avoid indwelling catheters as much as possible, as these are associated with a risk of urinary tract infection, stones, and urethral and bladder irritation.

Medication and drugs- The main goals of OAB treatment are to

• reduce urinary urgency and frequency,
• increase voided volume (bladder capacity), and
• Decrease urge incontinence (reduce leakage episodes).

Drugs, like anti-muscarinics and beta-3 agonists, can help stop your bladder from squeezing when it’s not full , these drugs can relax the bladder muscle and increase the amount of urine your bladder can hold and empty.

Bladder Botox Treatment

This helps the muscles relax, which will give you more time to get to the bathroom when you feel the need to urinate. doctor will inject tiny amounts of botulinum toxin into the bladder muscle. This procedure is performed in the office with local anesthesia. The effects of Botox last up to six months. The effect of Botox is not permanent, thus repeat injections are needed to maintain the improvement, typically once every six to 16 months.

Bladder Reconstruction/Urinary Diversion Surgery-

There are two types of surgery available. Augmentation cystoplasty enlarges the bladder. Urinary diversion re-routs the flow of urine. There are many risks to these surgeries, so it is offered only when no other option can help.This will be done in serious case

Nerve Stimulation

In this treatment sends electrical pulses to nerves that share the same path for the bladder. In OAB, the nerve signals between your bladder and brain do not communicate correctly. These electrical pulses help the brain and the nerves to the bladder communicate so the bladder can function properly and improve OAB . The electrical signals can be performed using a small wire inserted into the low back or a small needle inserted through the skin of the lower leg. Sacral neuromodulation is usually performed in two stages. The first stage involves the placement of wires (leads) into areas in the sacrum and then using a small generator to test the response to stimulation. If there is a 50% or more improvement in symptoms the wires (leads) are internalized and an internal generator is placed, typically under the skin near the buttocks.

Bladder Removal-Removal of bladder ,in this process Doctor reroute urine from your kidneys to an ostomy bag or and outside your body.

What are some of the complications of overactive bladder?

• skin irritation,
• skin infection,
• bladder stones,
• falls/fractures in elderly,
• sleep disturbances,
• negative impact on quality of life, and
• Depression.
• Frequent urinary tract infections.
• Falls and fractures in elderly attempting multiple trips to the bathroom.
• Social isolation.
• Overall poorer quality of life of the patient and caregivers.
• Anxiety
• Sleep disturbances and interrupted sleep cycles
• Issues with sexuality

Prevention of overactive bladder–

• Maintain a healthy weight.
• Get regular, daily physical activity and exercise.
• Limit consumption of caffeine and alcohol.
• Quit smoking.
• Manage chronic conditions, such as diabetes, that might contribute to overactive bladder symptoms.

Tricks to a Calm Bladder

1. Defeat Dehydration and Drink Water-Drink 2.5 to 3liters of water. Take sips; don’t gulp down a lot of water at once
2. Try Chamomile and Peppermint Teas.-it helps to sooth the nerves and maintain stress
3. Choose Foods that Reduce Constipation-avoid processed and bakery food
4. Eat Foods Rich in Magnesium-Magnesium rich food  reduces bladder muscle spasms and allows the bladder to empty completely. eat nuts,green veg,complex carbs like brown bread,grains,brown rice.

Foods to Help with Incontinence

• Whole grain cereal.
• Whole grain crackers.
• Barley.
• Brown Rice.
• Oatmeal.
• Raw vegetables.
• Beans (such as black beans, kidney beans, split peas, lentils, chickpeas and pinto beans)
• Vit C rich food-orange,lemon and amla .

 Prognosis for overactive bladder

Overactive bladder (OAB) is the name for a group of urinary symptoms. It is not a disease. The most common symptom is a sudden, uncontrolled need or urge to urinate. Some people will leak urine when they feel this urgeOAB is a very common and treatable condition.Through a combined approach of behavioral modifications and medications, the patient can help significantly improve bladder urgency, and the quality of life of those affected by overactive bladder can substantially improve.

OAB is a chronic condition; it can get better, but it may not ever go away completely.

References

1. https://www.dovepress.com/evaluation-and-management-of-overactive-bladder-strategies-for-optimiz-peer-reviewed-article-RRU
2. https://www.karger.com/Article/FullText/447205
3. https://pmj.bmj.com/content/83/981/481