It’s Bladder Health Awareness Month, so we talked to Gillian Stearns, MD, urologist, about a topic we get a lot of questions about: overactive bladder.

What is overactive bladder? 

Overactive bladder (OAB) refers to a group of urinary symptoms associated with urgency and urinary frequency. We also associate OAB with incontinence without another explanation (such as a urinary tract infection). In the past, we called OAB a frequency-urgency syndrome.

Urgency is different from a normal sensation to void, which everyone should have. Urgency is sudden and usually does not allow for much time to make it to the toilet.

What causes OAB?

We’re not entirely sure what causes it. It essentially is a diagnosis of exclusion as other causes of urgency include enlarged prostate, urinary tract infection, cancer of the urinary tract, kidney or bladder stones, diabetes, increased fluid intake, pelvic floor dysfunction, and painful bladder syndrome. We diagnose overactive bladder (OAB) when we rule out these causes.

What are the symptoms of OAB?

Symptoms include the sudden need to urinate, waking up frequently at night to void, or the loss of urine because people aren’t able to make it in time.

Who does it affect? Who is at risk for OAB?

It’s common and occurs in up to 11 percent of the population. Some studies show that OAB will continue to increase in frequency.

There are people who have overactive bladder, but are not bothered by their symptoms, so it’s hard to say exactly how prevalent this is, as those people tend not to discuss their symptoms with their physician or urologist. Some studies have suggested a genetic cause to OAB, but this was found to be more associated with environmental factors.

What lifestyle changes can we make to alleviate OAB?

Lifestyle changes to help alleviate the symptoms of OAB include monitoring fluid intake. Some people need to increase this and some people need to decrease this. Paying attention to what you’re drinking also helps as there are many fluids that are bladder irritants and can exacerbate symptoms. These include coffee, soda, seltzer water, and alcohol. Some foods such as chocolate, acidic foods such as citrus fruits and tomatoes or spicy foods may make things worse as well.

Pelvic floor physical therapy is also used to help modify the pelvic floor’s response to urgency, as well as teach appropriate toileting and techniques that may allow you to get to the bathroom in time.

What health care treatments can alleviate OAB?

Beyond lifestyle modifications, multiple options exist for patients. Medications exist to quiet down the bladder. If those medications fail or are not tolerated, procedures can be done to work to calm the bladder down, in particular OnabotulinumtoxinA (Botox) or sacral neuromodulation (InterStim). Botox is injected directly into the muscle of the bladder and can be done in the office or operating room. InterStim works like a pacemaker for the bladder.

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