Overactive Bladder Syndrome: Symptoms, Causes & Treatment

What is an overactive bladder?

Urine is produced by your kidneys and journeys to your bladder. Your brain then sends signals to your body to pee. When your pelvic floor muscles relax, urine can exit your body. Your bladder muscles contract uncontrollably when you have an overactive bladder. As a result, even when your bladder is empty, you may feel the need to urinate frequently.

If you have frequent and sudden, uncontrollable urges to urinate, then you may have an overactive bladder, also known as OAB. This is a condition that can afflict any gender.

You may want to use the bathroom more often than usual during the day, the urge to urinate may also wake you up mid-sleep. No matter where you are and what you may be doing the urge cannot be curbed. For most people, urinating 6 to 7 times within 24 hours is the normal frequency. A little less than this number, around 4 to 5 times is also considered acceptable.

Overactive bladder syndrome can become an ordeal as well as poses as a disruption in your daily and social life, and for some, it may even be a cause of embarrassment. As a result, your mental health can also be impacted. Unexpected urine leakage (known as urinary incontinence) is also a possibility that can lead to skin infections. Having an overactive bladder can impact your sexual health, impede you from travelling, and fully enjoying physical exercise.

This condition can affect just about any one from children to young adults, and older adults. However, it is most common in people who are above the age of 40 years.

Symptoms of an overactive bladder

Having incontinence on occasion does not imply that you suffer from an overactive bladder. Urine leakage can occur for a variety of reasons, including excessive laughing when you are sharing a joke with someone. If you’ve been resisting the need to urinate for a long time, like when you are on a road trip with no bathroom access, you may experience urine loss.

However, here are the major symptoms of this condition that you should know of:

• Urge to urinate: The urge to go to the toilet is sudden, and you are unable to exercise any control over it.
• Frequency: If your trips to the toilet have exceeded 6 to 7 times in a day and night.
• Urge incontinence: If there is frequent involuntary loss or leakage of urine.
• Nocturia: You wake up more than once in the night to empty your bladder.
  Sometimes you may have other related symptoms like difficulty in trying to urinate, forcing or straining to pee, or having a weak or thin stream of urine.

Causes of Overactive Bladder

The specifics behind the causes of an overactive bladder are unknown because it could manifest due to a variety of reasons. With age, there is a higher chance of developing this condition. You shouldn’t disregard symptoms because an overactive bladder isn’t a typical aspect of ageing. Some people also have bowel control issues along with an overactive bladder. Visiting your doctor can ensure that you receive the proper diagnosis.

Some possible causes can be:

• Abdominal trauma from pregnancy and childbirth: Your pelvic muscles may be stretched and weakened during pregnancy and childbirth. Your lower abdominal organs are supported by the muscles and tissues in your pelvis. If the muscles in your pelvic area deteriorate, your bladder can sag from its normal position.
• Neurological issues: If you have gone through radiation therapy for uterine, colon, rectal, or prostate cancer, ever had herniated discs, then there is a possibility of pelvic nerve damage. Other neurological conditions that can cause an overactive bladder include Parkinson’s disease, multiple sclerosis, and stroke.
• Excess alcohol and caffeine intake: Caffeine, alcohol, and medical diuretics might make your bladder fill up quickly and possibly leak. Caffeine and alcohol are known to cause water loss through frequent urination. Then, there are some medications that cause your body to produce a lot of urine because they must be consumed with a lot of water.
• Infections and abnormalities: A urinary tract infection (UTI) may be a commonly understood cause behind an overactive bladder. In this case, you may also have itchiness and pain when you pee. If you have bladder stones, or a tumour in your bladder then you might experience incontinence.
• Diabetes: Bladder dysfunction is a possibility with poorly controlled diabetes. Diabetic bladders often retain urine, so you are unable to pass it out of your body entirely. Thus, you have the urge to frequently urinate. Frequent urination is also caused by hyperglycaemia in Type 1 and Type 2 diabetes. Nerve damage can also happen with diabetes, leading to an overactive bladder.
• Hormonal changes: A female weak bladder or incontinence can happen when there is a deficit of oestrogen in the body during menopause.
• Weight gain and obesity: Being overweight or obese can put pressure on the bladder, leading to leakage.

Complications of overactive bladder

There’s no doubt that a condition like this can hinder your quality of life. You may be embarrassed to share your experience with your social circle and family, leaving you isolated and lonely. Emotional distress is commonly experienced by those who have an overactive bladder. Anxiety, sleep disturbances, and issues with your sexual health are also complications that may arise because of this condition.

When both urge and stress incontinence occur, a condition known as mixed incontinence affects women with overactive bladders. The unintended loss of urine caused by physical activity or movement that exerts strain on your bladder, such as coughing, sneezing, laughing, or exercising, is known as stress incontinence. Treatment for stress incontinence is unlikely to relieve the symptoms of an overactive bladder. Treatment of an overactive bladder is unlikely to reduce the symptoms of stress incontinence.

Some individuals may struggle with bladder emptying and bladder storage problems at the same time. Although the bladder doesn’t empty well, it might produce significant urgency and even incontinence. You might be able to get assistance from a professional if you’re experiencing both bladder issues.

How common is overactive bladder syndrome in India?

Overactive bladder seems to be a common issue in India, with about 10% to 15% of people affected by it. Male weak bladders are more common in comparison to female weak bladders.

Prostate growth is among the most frequent causes of overactive bladder symptoms in males. As men age, their prostates may just enlarge, but they may also indicate a significant growth or prostate cancer. The passage of urine out of the urethra may get obstructed by the prostate if it expands a lot. Treating the enlarged prostate will likely ease overactive bladder symptoms.

Diagnosis of overactive bladder

The diagnosis of any medical condition usually begins with the doctor taking down your medical history, checking how long the symptoms have persisted for, and conducting a physical examination. The doctor will also ask if you have a family history of an overactive bladder as well as about the medication you take, the kind of fluids you drink daily, the food you eat, and more. You may be referred to a urologist, a specialist who treats issues of the urinary tract.

• Physical examination: This enables your doctor to check for an enlarged prostate or feel for soreness around your abdomen and kidneys.
  Urinalysis: Your urine is sampled and checked for any anomalies or infections. A urinalysis can be used to diagnose urinary tract infections and other issues with the urinary system.
  Ultrasound: The ultrasound will take a scan of your bladder for any abnormalities like measuring the amount of urine left after you have gone to the bathroom. A CT scan give a 3D image of your bladder.
  Urodynamic testing: This testing is done to assess how your bladder and urethra function while holding and emptying urine out of the body. It also assesses how fast you pee, how much you pee, and how much pressure is put on your bladder when it fills up with urine.
  Cystoscopy: A medical professional will check inside your bladder through your urethra by using a specialised tool called a cystoscope. To prevent pain, the doctor usually applies a numbing gel. In extremely rare circumstances, they might administer general anaesthesia, rendering you unconscious.
  Overactive bladder treatment
  Your overactive bladder may respond to a variety of therapies. Modifying certain behaviours, taking medicine, and nerve stimulation are all possible treatments.
• Behavioural changes: The most effective method for controlling an overactive bladder is behavioural intervention. This method frequently works well and has no negative side effects. Doing Kegel exercises can help maintain some control over your pelvic muscles and urinary sphincter. These exercises also help strengthen these muscles. Usually, a physical therapist can help guide you to do these exercises. Other pelvic floor exercises include:
  Vaginal weight training: This is like Kegel exercises, but you use insert a weight into the vagina, tie a weight to the other end, and lift the weighted object.
• Pelvic floor exercise with biofeedback: Exercises for the pelvic floor include biofeedback. These are exercises that a physiotherapist or specialised nurse can teach you to help retrain your pelvic muscles. A tool for pelvic floor therapy is biofeedback. Using this method, you insert a little gadget into your bottom as you perform the exercises. The visual and aural stimuli provided by this device give you feedback on how effectively you are performing the exercises.
• Pelvic-floor electrical stimulation: This is a painless yet effective process where a low-grade current stimulates the muscles so they contract like they would during Kegel exercises. Your pelvic floor muscles can become stronger because of this movement, which can reduce urine frequency, urgency, and incontinence as well as strengthen your pelvic floor and vaginal muscles. To stimulate a group of nerves or muscles with electrical stimulation, a small, safe probe the size of a small tampon is inserted into the vagina and used for a session lasting 20 to 30 minutes.
• Scheduling your toilet breaks by spacing them at comfortable intervals can train your bladder. Using adult diapers to avoid any accidents because of incontinence can also be helpful. Bladder training is another behavioural moulding technique that can be used to delay going to the bathroom often. You are required to disregard your usual urge to urinate and only go in regular intervals of 30 minutes initially. The intervals are eventually increased with time. This process may increase the bladder’s capacity slowly and steadily. Usually, any form of behavioural therapy combined with oral drug therapy can be the most effective.
• Medication: Vaginal oestrogen treatment is usually recommended to women who have overactive bladders because of menopause. Then, there are other medicines like anticholinergic drugs, beta-3 agonist, and alpha-blockers that can help relax the bladder and make you not want to urinate frequently. However, with these medicines come side effects that your doctor will brief you about. You will also be briefed on how to deal with these side effects without aggravating your overactive bladder.
• Natural treatments: Natural or holistic treatments should not be the sole way to tackle an overactive bladder. You can take them up after consulting with your doctor along with your regular, allopathic treatment. This is to ensure that they do not interfere with your treatment in any way. Acupuncture has been known to give some relief to those with overactive bladders. Essential oils like ylang-ylang, lavender, and pumpkin seed oil can also relieve your symptoms by calming your nerves and easing any stress. Meditation is a grounding technique that can alleviate stress that may be recommended.
• Bladder injections: Botox injections in small doses can be injected into the bladder muscles to help relax them. However, the effect of these injections usually lasts for about six months. This cannot be a long-term solution to incontinence due to an overactive bladder because Botox’s side effects include urinary tract infections and urinary retention.
• Surgery: Surgery is typically not advised until after all other treatment options have been exhausted and no relief has been obtained. The intention is to lessen bladder pressure and increase the bladder’s capacity to hold pee. These techniques won’t, however, ease any bladder pain. There is surgery done to increase the bladder’s capacity to hold urine, and in some cases the bladder is entirely removed. In the original bladder’s place, usually there is a surgically reconstructed bladder or an opening in the body is made to attach a bag that collects urine.
• Diet: One can wonder how diet can influence or aggravate bladder issues, but it plays a big role. Food and beverages can put pressure on your bladder, increasing the likelihood of irritation and overactive bladder symptoms. What influences you, though, might not affect someone else. You can determine which foods worsen your symptoms by keeping a meal journal. It’s ideal to avoid aerated drinks, caffeine, alcohol, and products with artificial flavourings. It’s also recommended that you do not drink anything before your bedtime, so you don’t have to get up to urinate in the night.
• Nerve stimulation: The symptoms of overactive bladder can be improved by controlling the nerve impulses to your bladder. One operation, sacral nerve stimulation, involves placing a small wire near to the sacral nerves, which pass close to your tailbone and convey impulses to your bladder. This is a minimally invasive procedure; so, the pain is next to none. Another process is percutaneous tibial stimulation where nerve impulses are sent to a nerve branch close to your ankle. This therapy aids in enhancing bladder control. Outpatient surgery is performed with percutaneous tibial nerve stimulation. Many patients require 12 weekly sessions, followed by monthly follow-up sessions.

Prevention and management of overactive bladder

Daily challenges can be brought on by an overactive bladder. However, you can lessen the frequency of desires to pee by changing your lifestyle and using prescription medications.
Maintaining a healthy is beneficial in the long run not just for your overactive bladder but also your overall health. Eating a balanced diet that is devoid of any artificial flavourings and additives is also a good idea. Drink an adequate amount of fluids in the form of water, coconut water, fruit juice. Drinking too much can trigger symptoms and drinking not enough is equally bad.

Talking to your doctor is the most crucial action you can take if you experience overactive bladder symptoms or difficulties managing your urination. Because of shame and fear of social stigma, this ailment is frequently underreported.