What is an Overactive Bladder?

May 23, 2007
Diane K. Newman, RNC, MSN, FAA

‘Overactive bladder’ (OAB) may include increased frequency of urination, urinary urgency, and urge-related incontinence symptoms that occur either alone or in combination.

‘Overactive bladder’ (OAB) may include increased frequency of urination, urinary urgency, and urge-related incontinence symptoms that occur either alone or in combination. Urge-related incontinence is defined as urine leakage that happens shortly after or in concert with the urge sensation to void. Urge UI is caused by involuntary bladder contractions that occur as your bladder fills. With urge UI, a person may be aware of the urge sensation but will be unable to stop leakage until getting to the toilet. Urine loss is usually in large amounts that soak underwear and even outer clothing. 

An additional symptom seen very often in the elderly is nocturia, awakening at night to void, which will often disrupt sleep. This bothersome medical condition affects men and women of all ages, although it’s incidence increases significantly with age. Many people find it difficult to discuss this problem with their doctor or nurse. 

Some medical conditions, especially strokes, impair inhibition of bladder contractions (detrusor hyperreflexia.) Other local factors such as urinary tract infection or bladder tumors can cause bladder irritation leading to OAB. 

The prevalence of overactive bladder is poorly understood. In the past, many experts believed that such voiding dysfunction symptoms as urgency and frequency were harmless and did not cause significant problems for individuals. New research shows that the triad of symptoms - urinary frequency, urgency and urge incontinence, alone or in combination - can have a significant impact on someone’s quality of life. 

Many people with OAB adjust their habits and lifestyle to accommodate the management of symptoms and may adopt such coping mechanisms as restricting fluids and urinating to a timed schedule or at the first sensation of urgency. Car trips and vacations are limited. Shopping, visiting public places, entertaining or socializing are curtailed and in some cases stopped. Finding accessible public toilets, a behavior referred to as ‘toilet mapping’, becomes a source of major anxiety. Initially, increasing the frequency of bladder emptying may reduce the number of incontinent episodes. 

Typical symptoms of OAB include: A strong and sudden desire to void that cannot be controlled – urgency. The need to empty the bladder frequently, usually more often than eight times a day - frequency. Urinary leakage if the urge sensation cannot be suppressed. Leakage occurs usually on the way to the bathroom or during change of position like getting up out of a chair – urge incontinence. Getting up several times at night because of the need to urinate – nocturia. 

Considered abnormal at any age, overactive bladder is a highly prevalent condition that affects both genders but is more common in women. Many people never report symptoms of OAB due to their perceptions that treatment is not available or effective or that the symptoms are normal consequences of aging or childbirth. Effective treatment includes the combination of new drug management with behavioral interventions.

References:

References:

1. Milsom, I, Stewart, W, Thuroff, JW (2000) The Prevalence of Overactive Bladder. The American Journal of Managed Care, 6(11), Sup:S565-S573.

2. Wein AJ, Rovner ES. (2000) The overactive bladder: an overview for primary care health providers. Int J Fertil Womens Med 1999; 44: 56-66.

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