An overactive bladder (OAB, also known as urge incontinence) causes a sudden urge to urinate, even when your bladder isn’t full. For some people it’s simply a nuisance. For others, the urge can’t be controlled, which leads not only to incontinence but also a severe impact on quality of life. “It’s a major problem which limits people’s social lives due to fear of embarrassing urine leakage. It is a significant contributory factor to depression.
Why it happens
When the kidneys filter toxins and extra liquid from the blood, the waste (urine) is stored in the bladder. Your nerves signal the kidneys to fill the bladder, and also signal the brain when the bladder is full and needs to be emptied. When the bladder empties, the muscle in the bladder wall contracts, and the sphincter muscle that controls urine flow relaxes.
Sometimes the nerves malfunction, causing the bladder to contract unpredictably. The result is a sudden need to urinate, known as dry OAB. When the feeling is uncontrollable, urine leaks out before a person can get to a bathroom. This is called wet OAB. Symptoms of these include frequency (eight or more times per day, and several times per night), a feeling of urgency, urine leakage, and waking from sleep to urinate.
OAB is different from stress incontinence, which happens when an increase in pressure in the abdomen—when you cough, for example—pushes down on the bladder and urethra and causes leakage.
Causes and diagnosis
OAB can be caused by something temporary, such as a bladder infection. It can also result from another condition, such as multiple sclerosis, Parkinson’s disease, stroke, or diabetes. Women are twice as likely as men to struggle with OAB, because of the stress of childbirth on the urinary tract, for instance, as well as the loss of estrogen after menopause. In men, OAB may occur as the result of an enlarged prostate. “As the prostate enlarges it obstructs flow, and this results in increased bladder muscle activity,” explains urologist Dr. Michael O’Leary, a professor of surgery at Harvard Medical School.
Many people don’t report OAB symptoms to their doctor. “They are embarrassed to talk about it, they think it is a normal problem of aging, they think the doctor is too busy to deal with another problem added to their list, or they are unaware that treatment is available,” says Dr. Flesh.
Diagnosis involves a history and physical exam and possibly tests that measure how much urine your bladder can store, how much urine you are able to release, the force of your urine flow, and how much urine is still in your bladder after you’ve tried to empty it.
What you can do
If you’re a woman and your doctor determines that you have OAB, the first line of defense will likely be Kegel exercises, which involve squeezing and releasing the muscles you use to hold in urine. Vaginal estrogen creams may also relieve OAB symptoms for postmenopausal women, since estrogen helps to decrease the sensation of urgency and the chance of involuntary bladder contraction.
For men, the first line of defense is medication. Typical regimens, according to Dr. O’Leary, include alpha blockers—such as terazosin (Hytrin) and doxazosin (Cardura)—to relax the muscles in the prostate and relieve the blockage, in combination with anticholinergics—such as oxybutynin (Ditropan) and tolterodine (Detrol)—to relax the bladder muscle. Anticholinergic side effects include dry mouth and constipation.
Anticholinergics are also an option for women if Kegel exercises don’t work. You can now find oxybutynin in an over-the-counter patch formulation (as Oxytrol).
But sometimes bladders don’t respond to medications. That’s where an injection of botulinum toxin (Botox) comes in. It’s the muscle relaxant known for calming facial spasms and reducing brow wrinkles. Now it’s approved to relax the bladder muscles in both men and women, although in men it’s appropriate only if the cause is a bladder muscle problem, not an enlarged prostate. This method is considered effective, but results wear off, and the injection must be repeated in six to 12 months.
Most important is to be proactive if you’re struggling with OAB symptoms. Help is available, and a simple fix may be all it takes to let you live without the fear of wetting yourself in public.