ExcelUrology

Overactive bladder

BACKGROUND AND RESOURCES

What is OAB?

Overactive Bladder (OAB) is the name given to a group of troubling urinary symptoms. It occurs in both men and women—and although it can occur at any age, risk increases as people grow older The International Continence Society (ICS) defines OAB as the presence of "urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of UTI [urinary tract infection] or other obvious pathology."

 

The hallmark symptom of OAB is a sudden, uncontrollable urge to urinate that makes your patient fear they will leak urine if they don’t get to a bathroom immediately. In some patients, the feeling of urgency is followed by urine leakage (urge incontinence). People with OAB may also experience other symptoms, including frequent urination (characterized as eight or more times a day), and nocturia (waking at night to urinate).

Risk factors for OAB include:

  • age

  • neurological diseases such as stroke and multiple sclerosis

  • menopause (in women)

  • history of prostate problems (in men)

 

OAB is different from another common problem called Stress Urinary Incontinence (SUI). SUI is the involuntary leaking of urine when a person is engaged in some type of physical activity, such as sneezing, coughing or exercise. However, some patients have mixed incontinence — both OAB and SUl.

 

What Treatments are Available?

Behavioral treatment is often the first therapy used to treat OAB. These include monitoring trips to the bathroom with a bladder diary, scheduled voiding, delayed voiding, double voiding, pelvic floor muscle training (including active use of pelvic floor muscles for urge suppression), urge control techniques, fluid management, caffeine reduction, dietary changes (avoiding bladder irritants), and weight loss.

Prescription medications are sometimes used in conjunction with behavioral changes, or if behavioral changes aren’t effective. These drugs include the most commonly prescribed anti—muscarinic, and a new type of medication that is a beta—3 adrenergic agonist. Both types of medications relax the bladder muscle and help prevent it from contracting involuntarily.

When lifestyle changes and medications are unsuccessful in controlling OAB symptoms, you may want to refer your patients to a specialist with expertise in urinary problems, such as an urologist. Third line treatments for OAB include neuromodulation therapies, such as SNS (sacral neuromodulation) and PTNS (percutaneous tibial nerve stimulation), which deliver low dose electrical impulses directly to nerves in order to change their activity and injection of onabotulinumtoxinA ("Botox") into the detrusor muscle.