Ways to manage your overactive bladder

Overactive bladder or OAB is a common condition, but people often feel embarrassed about this condition and don’t discuss its symptoms with their doctors. This prevents them from availing treatment to cure the problem; it is recommended that one should book a urologist consultation if any symptoms of OAB are observed. Doctors might recommend simple behavioural strategies—techniques for bladder control and timed-urination, pelvic floor exercises, dietary changes, and more—to help manage overactive bladder.

Read on to learn more about managing an overactive bladder and additional treatment options.

What is an overactive bladder?

Overactive bladder syndrome is a chronic medical condition characterised by a combination of symptoms. It can have a significant impact on the quality of life of the affected person (estimated percentage of patients with OAB is about 16.5% of the Indian population). People with OAB may feel embarrassed due to social stigma and usually don’t seek medical help. In addition, it appears that many general physicians and even gynaecologists are not particularly familiar with OAB.

There are different types of OAB disorders as well—including nocturia and incontinence—which can be treated, even if the cause is not clear. These issues generally arise in the advanced age and cause one to experience uncontrollable urges to urinate (or pee), urinate frequently, unintentional urine leaks, etc. A person may not be able to control these urges, which disrupt the flow of their day multiple times.

Urologist consultation with a specialist may uncover a specific cause (if there’s one) and provide required overactive bladder treatment.

How a healthy bladder works?

The main function of a urinary bladder is to keep collecting the urine produced by the kidneys (while filtering out blood) and send signals to the brain for urinating when the bladder capacity is full. When you go to pee, your bladder releases urine into a tube called urethra, which passes through sphincter (a muscle at the end of the urethra) to let it out of the body.

Women have their urethral opening just above the vaginal opening, and men have theirs at the tip of the penis.

Only when the bladder is full, nerve signals are sent to the brain to trigger a need to pee. The same nerves coordinate while you urinate to relax the pelvic floor muscles and the urethra and contract the bladder muscles to push urine out. When this function is disrupted, involuntary bladder contractions occur leading to overactive bladder.

Causes of overactive bladder

As mentioned earlier, overactive bladder is a result of bladder muscles contracting on their own even if the bladder is not full. These involuntary contractions create an urgent need to pee, increasing the number of bathroom trips in a day.

The specific cause of OAB may be unknown, but multiple factors and conditions may lead to an overactive bladder. These conditions may include:

1. Diabetes
2. Urinary tract infections
3. Neurological disorders (such as stroke and multiple sclerosis)
4. Hormonal changes during menopause in women (such as oestrogen deficiency)
5. Tumours or stones in the bladder
6. Enlarged prostate
7. Constipation
8. Previous surgery for incontinence
9. Nerve damage
10. Abdominal trauma
11. Medications that increase urine production in the kidneys
12. Drinking caffeine or alcohol in excess
13. Partial urinary retention or incomplete bladder emptying
14. Decline in cognitive functioning with old age

Symptoms of OAB

People often don’t realise that their frequent bathroom trips are due to a common health condition and may not even consider visiting a doctor (probably out of embarrassment). However, if you have an overactive bladder, you may have some of the following symptoms:

1. Sudden urgent needs to urinate that are difficult to suppress
2. Unintentional urine leaks
3. Frequent urination (usually eight or more times in a day)
4. Nocturia (waking up more than two times to urinate at night)

People can probably manage OAB initially, but as the condition progresses, it becomes difficult to navigate work and social events with this condition. Unexpected frequent urination, especially during the night, will lead to irritability due to disturbed sleep.

Although an overactive bladder is common among adults, do not mistake it as a typical part of ageing. If the symptoms are causing any distress or preventing you from going about your day, book a urologist consultation and talk to your doctor for available treatments.

How is OAB diagnosed?

The key symptom in OAB diagnosis—urgency—is closely related with the frequent need to pee during the day, nocturia, and incontinence (most people report nocturia as the most bothersome symptom). A doctor will likely ask about the medical history and based on their analysis move forward with a physical exam for Rutherford diagnosis.

A healthcare provider may also want to check for an infection or blood in urine, how well is the bladder functioning, and sensory issues or reflex problems. They will recommend some tests accordingly and prescribe appropriate treatment after analysing the test results. If you have a health insurance with premium health package including lab tests, talk to your insurance provider to check if they cover the treatment of OAB and diagnostic tests that are mentioned below.

The ability of bladder to empty steadily and completely is checked with the help of urodynamics tests, including:

1. Test to measure residual urine in the bladder

If the person is not able to completely empty the bladder at the time of urination (also known as voiding in medical terminology), the residual urine in the bladder post voiding may cause symptoms similar to the symptoms of an overactive bladder.

A healthcare professional will take an ultrasound of your bladder to measure residual urine post voiding. In some cases, a catheter (thin tube) may be passed through the urethra into your bladder to drain the residual urine, which is measured later.

2. Test to measure urine flow rate

For this test, a lab assistant will ask you to urinate into a uroflowmeter, which catches and measures the urine. This data is then translated into a graph of changes in the flow rate.

3. Test to measure bladder pressure

For this test, a doctor fills your bladder slowly with warm fluid using a catheter. They also place a sensor (to measure pressure in the bladder and nearby regions) attached to a catheter, which is placed in the vagina for women and the rectum for men. This sensor records the pressure exerted by the bladder to completely empty itself.

Also known as cystometry in medical jargon, this test is used to identify if you have involuntary muscle contractions or the bladder is stiff and not able to store urine under pressure.

Please note: These tests are recommended by doctors to patients with severe symptoms and are not mandatory for diagnosing OAB or proceeding the treatment.

OAB in men

Several cases of overactive bladder amongst men are caused by an enlarged prostate. Swollen glands add to the pressure on the bladder and restrict urine flow leading to urine incontinence.

The chance of having an enlarged prostate increases with age; hence, overactive bladder is more common in older men than young individuals.

OAB in women

Although overactive bladder can occur at any age, the condition is more prevalent in women after they hit their menopause (likely due to oestrogen deficiency). The causes of OAB are not clear yet.

OAB in children

Children, while growing up, often report unintentional leakage of urine in their sleep or during the day; OAB is common in childhood. Generally, they learn to control their bladder and overcome the condition on their own, but consulting a doctor for appropriate treatment options is better to help with severe symptoms and to prevent complications.

Following are the common causes of OAB in children:

1. Urinary tract infection (UTI)
2. Allergy
3. Anxiety and stress
4. Constipation
5. Structural abnormalities
6. Caffeine

Complications related to an overactive bladder

If you have an OAB, there are few conditions that might be making the condition worse. Look for symptoms and discuss the possibility with your doctor. Treating the following complications may help in alleviating the symptoms of OAB in some cases.

1. Depression
2. Emotional distress or anxiety
3. Sleep disturbances
4. Issues during intercourse

Women with OAB may also have mixed incontinence—when both stress and urgency incontinence occur. The treatment of stress incontinence (unintentional urine leaks prompted by sneezing, coughing, laughing, or exercising) is not likely to reduce the symptoms of OAB and vice versa.

Some people may have a combination of issues with bladder emptying and storage—the bladder causes incontinence and urgency to pee but does not get emptied completely. In such cases, you need to contact a specialist to explore treatment options.

Risk factors

The risk of developing OAB increases as you age. People who are overweight and/or facing decline in cognitive abilities (including Alzheimer’s disease and stroke) are also at a high risk of developing the condition. Additionally, health problems such as enlarged prostate and diabetes can contribute to OAB. Some people also face trouble with bowel control with an overactive bladder; do not take this lightly and talk to your doctor.

Overactive bladder treatment

Some medications are prescribed by doctors for the treatment for weak bladder, along with bladder retraining, to normalise bladder function. Here is a list of some common prescription drugs for overactive bladder:

1. Anticholinergic medications help in controlling muscle spasms in the bladder. For example, fesoterodine, tolterodine, and darifenacin.
2. Beta-3 adrenergic medications cause the bladder to store more pee by relaxing the detrusor muscles in the bladder. For example, vibegron and mirabegron.
3. For women after menopause, muscles and tissues in the urethra and vaginal area can be weak, doctors may prescribe vaginal oestrogen therapy.

Make sure you go for a urologist consultation and discuss the condition before taking any medication. Some common side effects of such drugs include parched mouth, dry eyes, and constipation, which may prompt people to drink more water and aggravate OAB symptoms. The doctor might recommend swishing water in your mouth instead of drinking it, eye drops for curbing the dryness, and fibre-rich diet to prevent constipation.

Surgery

This form of overactive bladder treatment is reserved as the last resort for people who have severe symptoms and don’t respond well to the other forms of treatment. The basic idea behind surgery is to increase the bladder’s urine storage capacity and relieve its pressure, but these procedures won’t relieve pain in the bladder.

A surgeon uses a part of a person’s bowel or stomach to increase the size of their bladder; this procedure is referred to as augmentation enterocystoplasty. This is an expensive procedure that requires a long recovery time. With this surgery, there is also a chance of complication if the new bladder does not empty completely. This may require temporary or permanent intermittent catheterisation.

Alternative treatment methods

Besides the mainstream medication, there are other ways to treat overactive bladder. Two primary approaches are discussed below:

• Mind and body approach

Many people find mind–body treatments extremely helpful in managing and reducing the symptoms of OAB with the following approaches:

• Biofeedback

This is also a cognitive-behaviour modification technique that can help people control their bodily functions at will, which can go a long way in retraining your bladder and pelvic muscle group to reduce unintentional urine leaks. Be using electrodes to gather and display information, the healthcare provider will teach you how to be more in control of your body.

• Acupuncture

Chinese medicine may provide relief to people who try acupuncture for the treatment for weak bladder. With the help of fine-tipped needles, professionals target specific areas of the body to improve the flow of ‘Qi’ (or energy) throughout.

• Guided imagery

It is a form of cognitive therapy that can change the way you think. In this method, a qualified practitioner will guide you to a relaxed state of mind to promote relaxation, reduce stress and anxiety. Soothing music accompanied by the sounds of nature may help in bladder relaxation and reduce the urge to urinate.

• Hypnotherapy

When paired with other therapies (such as meditation involving visualisation and relaxation) hypnotherapy may be able to significantly improve a person’s perception of their condition and improve their symptoms.

• Nerve stimulation

Nerve stimulation works by targeting the passageway (nerves) between the bladder and the brain. This is a reversible treatment and can be revoked if things don’t improve or get worse.

• Sacral nerve stimulation

In this procedure, which is also known as sacral neuromodulation, a healthcare provider will implant a neurotransmitter (that creates electrical impulses) under the skin near the upper buttock. The sacral nerve (in the lower back) receives mild signals through a nearby wire that help in controlling the bladder.

This is an advanced treatment recommended to people who don’t seem to be benefiting from any other form of medication, behavioural therapy, or lifestyle changes. Sacral neuromodulation can reduce the frequency of your urination and/or accidental leaks.

• Percutaneous tibial nerve stimulation

In this minimally invasive form of overactive bladder treatment, a healthcare provider uses a needle to stimulate the tibial nerve through your ankle. Then, impulses travel to the nerve roots in the spine and block abnormal signals from the bladder. This treatment also helps in preventing bladder spasms.

Exercises for women

Apart from the exercises to strengthen pelvic floor muscles, women are recommended to work with vaginal cones at least once a day for a few minutes. As the name suggests, these are small cones that can be inserted in the vagina. After inserting them women are supposed to hold them in while squeezing the muscles of lower abdomen and glutes.

Practising with vaginal cones can give you a basic idea of which muscle group to use for controlling the bladder. The weight of the cone can be increased with time and practice as you get the hang of it.

The doctor might recommend the use of vaginal cones and where to get them; they are usually available in surgical stores. Ensure that you ask the doctor about the upkeep of these cones and keep them clean to avoid an infection.

Management strategies for OAB and resilient OAB

Many people who are in the middle of a treatment may find it difficult to continue their day-to-day activities due to OAB. The following tips are some of the most effective ways to manage OAB:

• Use incontinence products

Incontinence products, including adult diapers and disposable pads, can help you in managing the condition if either treatment is ineffective or requires more time to show results. They give a person some freedom to move around without worrying about leaks.

Make sure to change these products regularly to reduce odour. In addition, applying barrier ointments or lotions on the skin before using these products helps in preventing inflammation from constant exposure to urine. People are also recommended to wear loose-fitted comfortable clothes to avoid feeling conscious—incontinence products can be bulky. Carry a change of clothes (especially while travelling) just in case that any leaks occur.

• Keep a bladder diary

When dealing with OAB, tracking one’s urine schedule is not as absurd as it seems; it can provide valuable insight to you and your healthcare provider to determine what measures to take and how to treat the condition.

After a urologist consultation, the doctor may ask you to keep a bladder diary for a few weeks, noting every trip to the bathroom and every urine leak, all of which reveals the nuances of your day-to-day symptoms.

Make a table for the following information beforehand for a month:

1. Fluid intake: type, frequency, and quantity in a day
2. Bathroom breaks: frequency and quantity in a day
3. Number of times you had the urgent need to urinate in a day
4. Urine leaks: frequency and quantity in a day
5. Any triggers such as laughing, sneezing, or coughing

• Monitor your diet

There are some common food items or drinks that may trigger the symptoms of OAB, including:

1. Tea and coffee
2. Alcohol
3. Chocolate
4. Acidic and/or spicy foods
5. Caffeinated and aerated beverages
6. Fruit juices
7. Foods and drinks with artificial sweeteners

Some people may be triggered by other food items (for example, gluten-rich food items), notice when your symptoms suddenly change, while others are not affected at all. It helps to ponder over what you were doing during the past few days and what you ate; your diet has a direct impact on your body’s health.

Drinking an adequate amount of water can also make a huge difference. One shouldn’t drink too much or too little water; talk to your doctor to know the appropriate fluid intake for yourself. In addition, if you observe that drinking water before bed makes you wake up in the night to urinate, try resisting the urge to drink for a few hours before bed and see how that works. People recommend drinking 1 to 2 hours before bedtime to avoid waking up during the night. If you still face issues after taking these measures, experiment with stopping water intake earlier.

• Maintain bowel regularity

Take measures to avoid constipation as it can put additional pressure on the bladder and aggravate OAB symptoms. Increasing fibre intake, drinking 2–4 glasses of water every day, and regular exercise can help with a healthy bowel moment. In addition, having fibre supplements may help.

• Manage your weight

Having additional fat will put pressure on the bladder and increase the urge to pee frequently. Thus, start exercising, and watch your diet to reduce weight if you are overweight.

• Quit tobacco and its products

Cigarettes and other tobacco products have adverse effects on OAB, and stepping away from such habits can help in alleviating the symptoms of OAB.

Retraining the bladder

People with OAB have their bladder muscles functioning in a different way than normal people. By reconfiguring this system, people can better control their urges to pee and prevent leaks. Bladder retaining trains you to resist feelings of urgency and pee as per a pre-defined timetable and tolerate delays in going to the bathroom.

The following steps can help to reset an overactive bladder:

1. Observe the current voiding interval (how often you pee) and note it in your bladder diary.
2. After establishing the current voiding interval, add time to it by waiting for one (or a few) minute after you start feeling the need to pee before going to the bathroom. Keep increasing the time between two bathroom breaks gradually.
3. Once you are habitual of waiting for a few minutes to go to the bathroom, practice increasing the voiding interval by 15 minutes every week. For example, you started with a 40-minute voiding interval on a Monday, by Sunday you should be able to hold for 55 minutes or so before going to the bathroom again.

Continue this approach until you achieve a comfortable voiding interval suitable to your daily schedule.

4. Stick to this schedule as much as possible to prevent urine leaks and better manage OAB.

Controlling urges while retraining the bladder

This is the most challenging part of retraining an overactive bladder. Here are some strategies that might help when strong urges to pee arise:

1. Pause for a while and stand quietly or sit down, if possible. Being still will make it easier to suppress the urge and stick to your bathroom schedule.
2. Squeeze your pelvic floor muscles in quick succession like in Kegels without relaxing in between the squeezes.
3. Take deep breaths, relax rest of your body. Focus your brain on something else for a short while to distract yourself from the urge to pee.
4. Wait for the urge to go away. If after a few minutes, you still feel the need to pee, go to the bathroom without rushing, walk at a normal pace and keep squeezing your pelvic muscles as you walk.
5. Practice consistently and have patience; it usually takes 6–8 weeks for you to see any significant improvement.

If you are not satisfied with your progress, book the urologist consultation again and talk to your doctor. They may supplement your bladder retraining with some medications.

Prevention

By simply making few lifestyle changes, you may reduce the risk of developing an overactive bladder. These changes may include:

1. Regular exercise (including Kegels or other exercises for strengthening pelvic floor muscles)
2. Maintaining a healthy weight according to the advised body-mass index for you
3. Limiting alcohol and caffeine intake
4. Quitting the consumption tobacco and its products (such as cigarettes)
5. Not drinking too much or too less fluids
6. Managing chronic conditions, such as diabetes or UTIs, that may lead to OAB

OnabotulinumtoxinA and Botox

OnabotulinumtoxinA, also known as Botox, is used for overactive bladder treatment to manage severe symptoms and incontinence. It is a protein that is injected directly into bladder tissues by using a cystoscope in small doses, which causes bladder muscles to relax.

Injecting Botox is a temporary treatment method with effects usually lasting for about 6+ months, after which people require another injection. Nonetheless, it is a very effective method of treatment for weak bladder and is used for patients who don’t respond to other treatments.

Some people complain about having temporary urinary retention (difficulty peeing) after undergoing this treatment. Other side effects include UTIs. The doctor will tell those who are considering Botox treatment beforehand that they may have to use a catheter (sometimes even by themselves) in case of urinary retention.

Living with OAB

An overactive bladder is more than mere inconvenience for most people; the condition disrupts the flow of the day of a person and may lead the person to isolate themselves or get depressed. Consulting a urologist or a general physician should be the first order of business when you observe two or more symptoms from the list (mentioned earlier); if you are undergoing treatment follow the management tips listed in the article.

Few lifestyle adjustments—maintaining a healthy weight, getting regular exercise, drinking an adequate amount of fluids, retraining bladder—may reduce overactive bladder symptoms.

If the symptoms seem to be getting worse over time or there’s no improvement, talk to your doctor or go to a specialist.