A Comprehensive Guide on Overactive Bladder

Author

Mani Arumugam

February 22, 2022

Forty-year-old Vinay (name changed) has problems with frequent, and sometimes involuntary, urination. The condition causes him to wet his bedtime and again. Owing to society’s judgements and the shame he feels at going through something of this sort at his age, he is embarrassed to consult a doctor to find out the cause behind this issue. Instead, he has isolated himself and has limited his activities outside the confines of his home.

What Vinay suffers from is a condition called OAB, i.e. Overactive Bladder. It is rare in children but fairly common in adults aged 40+ and the elderly.

Overactive Bladder - A Brief Overview

Overactive Bladder, commonly referred to as OAB, causes a repeated and sudden urge to urinate that may be difficult to control and even involuntary at times. You may feel the need to urinate multiple times during the day and night, and may also experience unintended loss of urine (urgency incontinence)

If you have an overactive bladder, you may feel self-conscious, detach yourself from your surroundings and restrict your work life and/or social life. Fortunately, a short evaluation can establish if there is a particular cause for your overactive bladder symptoms

You can manage the symptoms of your OAB with basic behavioural strategies, such as timed holding, dietary changes, bladder holding techniques using your pelvic floor muscles. These are beginner efforts towards keeping your OAB in check. In case these do not help enough with your overactive bladder symptoms, there are other treatments available in addition.

Key Causes of Overactive Bladder

The kidneys produce urine and this urine unloads into your bladder. When you urinate, urine passes from your bladder through the urethra. The sphincter muscle in the urethra opens to release the urine out of the body.

Your bladder fills and when that happens, nerve signals are sent to your brain, triggering the need to pass urine. When you do so, these nerve signals synchronise the relaxation of the muscles of the pelvic floor and the urethra. The muscles of the bladder contract to push the urine out. This is how a normal bladder functions in the human body.

Overactive bladder is caused when the muscles of the bladder tighten involuntarily even when the urine volume in the bladder is low. This involuntary tightening leads to an urgent need to pass urine.

Several conditions may play a part in the causes of frequent urination and thus, an overactive bladder, including

Weak pelvic muscles: Childbirth and pregnancy may cause your pelvic muscles to stretch and become weak, This may cause the bladder to slump out of its usual position. These factors can come together to cause leakage.
Neurological disorders, such as stroke and multiple sclerosis
Diabetes
Nerve damage: There are times when signals are sent to the bladder and brain to empty at the wrong time. Diseases and trauma can cause this to happen, These may include Parkinson’s disease, radiation, herniated disc and pelvic and back surgery.
Medications, alcohol and caffeine can diminish the nerves, which can affect the signals to the brain. This can lead to bladder overflow. Caffeine and diuretics can cause your bladder to fill up faster and possibly leak.
An infection, such as a UTI (Urinary Tract Infection) may lead to the irritation of the bladder nerves, causing the bladder to contract and squeeze without warning.
Excess weight, i.e. being overweight puts additional pressure on the person’s bladder. This can result in urge incontinence.
Estrogen deficiency after menopause in women: Such a hormonal change can cause loss of urine due to urgency.
Abnormalities in the bladder, like tumours or bladder stones.
Other factors that obstruct bladder outflow, like constipation, enlarged prostate or operations in the past to treat other forms of incontinence.

Other factors that could possibly be associated with your excessive urination causes include:

Diminishing cognitive function due to ageing may make it more difficult for your bladder to comprehend the signals it receives from the brain.
Difficulty in walking, which may lead to urgency in the bladder due to failing to reach the bathroom in time.
Incomplete emptying of the bladder, leading to symptoms of overactive bladder, as the urine storage space decreases.

Telltale Symptoms of Overactive Bladder

You may observe the following overactive bladder symptoms if you are suffering from an overactive bladder:

Repeated urination: People experiencing this symptom may feel the need to urinate very often. Usually, it's an increase in the number of times a person urinates as compared to the number before.
Urinary urgency: This is when the person fails in the ability to postpone the urge to urinate.
Urge incontinence: In this case, there may be a leakage of urine when you feel the need to urinate.
Nocturia: This symptom is determined when a person feels the need to get up and urinate at least twice each night.

If you are experiencing any or all of these symptoms, you may need to consult a doctor. Although it is common among the elderly, it is not a natural aspect of ageing. It might be difficult or humiliating for you to discuss the symptoms with someone else but it is vital to do so if this issue interferes with your social or professional life. There are many treatments that can help you.

Potential Treatment/Management Measures

Having an overactive bladder is fairly common. It is a treatable problem, but it needs the help of a doctor. Overactive bladder treatment may include changing specific behaviours, nerve stimulations and medications.

Behavioural changes: There are many techniques and changes that you can bring about in your typical behaviour to try and help keep your overactive bladder in check.
Monitoring your diet: You should decrease or eliminate foods or beverages that may cause your bladder symptoms to worsen. These can sometimes include tea, coffee, alcohol, caffeinated soft drinks, chocolate, citrus juices and fruits, spicy foods, acidic foods and drinks, foods and drinks containing artificial sweeteners and tomatoes or tomato-based foods.
Maintaining bowel regularity: If you are frequently constipated, it places extra pressure on your bladder and may cause a negative effect on your bladder function. By keeping bowel regularity, you can avoid constipation and help the bladder to function better. The following habits are suggested for a healthy bowel:
- Foods like beans, pasta, whole wheat bread, oatmeal, fresh fruits and vegetables and bran cereal help increase your fibre intake.
- Exercising regularly can help with healthy bowel movements.
Keeping a log: During a usual day, note down your liquid intake, the number of times you pass urine, the number of accidents and the times when they occur. Note down what happened when the accidents took place, like when you sneeze, cough, laugh or failed to reach the bathroom in time.
Maintaining a healthy weight: Being obese or overweight can add additional pressure on your bladder, which may play a part in bladder control problems. If you are overweight, losing weight can help keep bladder control problems in check.
Quit smoking: Among other health hazards, cigarette smoking causes irritation to the bladder muscles. Repeated coughing caused due to a smoker's cough may lead to involuntary leakage.
Drinking a lot of non-irritating fluids: If you suffer from bladder symptoms, there are chances that you try to drink fewer fluids so that you do not have to urinate as often. Drinking fewer fluids can cause you to produce more concentrated urine. Concentrated urine has a strong smell and darker colour. More concentrated urine causes irritation to the bladder and may even lead to more frequent urination, as opposed to what you were trying to achieve by lower fluid intake. Try not to cause dehydration to your body. It is okay, even recommended, to drink enough fluids to satisfy your thirst. Limit your intake only a few hours before going to bed. You should also limit or eliminate beverages that may cause your bladder symptoms to worsen, such as caffeinated soft drinks, alcohol, coffee, tea, citrus juices and drinks containing artificial sweeteners.
Manage other chronic conditions such as diabetes, that may be playing a part in overactive bladder symptoms.
Try to figure out where your pelvic floor muscles are located and then try to strengthen them by doing Kegel exercises. Tighten the muscles, hold the position for two seconds and then relax the muscles for three seconds. Try to reach a point where you can contract the muscles for 5 seconds and then 10 seconds at a time. Do three sets of 10 repetitions every day.

Starting bladder retraining: When you are suffering from an overactive bladder, your bladder muscles become conditioned to function in a certain way over time. Retraining these muscles may help you hold urine better. In bladder retraining, you learn how to resist or inhibit the feeling of urgency, postpone voiding, avoid involuntary leakage and urinate according to a timetable (instead of urinating because you have the urge to do so)

To start with bladder retraining, you should start with your current voiding interval. For example, if you urinate every two hours on an average, then that would be your current voiding interval.
Once the starting voiding interval has been established, every time you have to urinate, you try and wait for a few minutes. Over time, you gradually increase the interval between urinations. If you develop urgency in between the voiding intervals, sit down in a comfortable position, take deep and slow breaths in and out of your mouth, imagine yourself in some other place that you like or use any other relaxation technique. Once you feel the urge has passed, proceed to the bathroom.
Start urinating around the clock at first. Don’t wait until you really have to go. For example, start urinating every 2 hours and then increase the time between urinations if you have remained dry. If you have failed to remain dry, then decrease these intervals to every hour and then slowly increase the time between bathroom visits. If normally, you visit the bathroom every hour, try to increase the intervals to one hour 15 minutes between visits.
When you can maintain your new schedule for a couple of weeks without any accidents, try to increase the time between bathroom visits by an extra 15 minutes. Keep doing this until you reach an interval you are comfortable with. The goal is to have a gap of two to four hours between visits to the bathroom.

The ability to control the urge to urinate frequently is the key to bladder retraining. There are numerous tricks and methods you can use, but remember to be patient with yourself. An entire bladder retraining programme can take up to 6 to 8 weeks to achieve satisfactory results. If at any point you experience a sudden urge to urinate, the following tips may help:

Stop whatever you are doing and stay put. If possible, sit down; otherwise, stand quietly. Remain still. When you are still, it gets easier to control the urge.
Quickly squeeze and contract your pelvic floor muscles several times. Do not fully relax between those squeezes.
Relax the rest of your body. Take some deep breaths to help you relax and let go of your stress.
Concentrate on suppressing the urge to urinate.
Try to wait until the urge subsides.
Walk to the bathroom. Try not to walk too fast; maintain a normal pace. Continue to squeeze your pelvic floor muscles quickly as you walk.

Consult your doctor for the best options to manage your overactive bladder problems. Your doctor may prescribe a mix of medications and bladder retraining to aid you in managing your bladder problems.

How can nerve stimulation help with an overactive bladder treatment?

There are many treatments that involve stimulating your nerves to help in improving the overactive bladder. Your nerves help communicate the message to your brain that your bladder needs to be emptied. By stimulating the nerves, your healthcare provider can improve your bladder control. Nerve stimulation is a reversible treatment that is considered only when conservative treatments have not worked or have not been tolerated. Conservative treatments include behavioural therapies (diet modifications, biofeedback, bladder retraining, pelvic muscle exercises) and medications.

Nerve stimulations are of several types. These can include sacral nerve stimulation, botox injections into the bladder muscle, percutaneous tibial nerve stimulation, etc.

Complications With Your Overactive Bladder

There are different types of incontinence, but any kind of incontinence can disrupt your normal life. When your overactive bladder disrupts your daily life, you may also have:

Anxiety
Interrupted sleep cycles and sleep disturbances
Depression or emotional distress
Issues with sexuality

In several cases, treatment of the above issues may help you with your incontinence and urinary symptoms.

Women suffering from an overactive bladder may also have a disorder called mixed continence when both stress and urgency incontinence occur. Stress incontinence is the involuntary loss of urine caused by physical movement or activity that puts pressure on your bladder, such as sneezing, laughing, exercising or coughing. Treating stress incontinence is not very likely to help with your overactive bladder symptoms. Similarly, treating overactive bladder symptoms is not likely to help with your stress incontinence symptoms.

Some people may suffer from a common combination of bladder emptying issues and bladder storage problems. In this case, the bladder may cause a lot of urgencies, even incontinence, but it still doesn’t empty well. For such a combination of bladder-related problems, you should consult a specialist.

Medications to Ask Your Doctor About

Your doctor will first try to help you manage your symptoms using behavioural techniques to control the urge of frequent urination instead of having you use medication for overactive bladder treatment. Nevertheless, medications can work quite well to return the bladder to its normal function. Consult your doctor about the pros and cons of using the following commonly prescribed medicines:

Anticholinergic medications: Oxybutynin, Oxybutynin XL, Oxybutynin TDDS, Tolterodine, Solifenacin, Fesoterodine, Darifenacin, Trospium, Oxybutynin Gel. These medications help in controlling muscle spasms in the bladder.
Beta-3 Adrenergic medication: Mirabegron (Myrbetriq)

Consult your doctor about these medications and take them according to their prescription. Do not consume them without a doctor’s prescription.

Tests that help diagnose your OAB

Several tests can help figure out the cause of your overactive bladder. They are:

Cystometry: Checks how much urine your bladder can store and your body’s ability to sense the fullness of the bladder. It also helps detect nerve overactivity.
Postvoid residual volume: Checks the amount of urine remaining in your bladder after you have emptied it.
Urinalysis: Tests the makeup of your urine,
Uroflowmetry: Measures the speed and volume of your urine.

Friends' Adult Diapers - How Significant Are They in Managing Overactive Bladder Symptoms

Friends’ Adult Diapers can be your best friend and saviour while dealing with something difficult like an overactive bladder. Friends’ Adult Diapers help you break your shackles to your toilet. Friends’ Adult Diapers:

Are affordable, so you don’t burn a hole in your pocket.
Offer up to 16+ hours of protection, so you don’t have to worry about diaper changes on long work trips or hangouts with friends and family.
Have a wetness indicator, so no more embarrassing accidents.
Have an odour lock to help you avoid emitting any odour

Friends’ Adult Diapers are the makers of India’s no. 1 leak-proof elderly diapers. Friends have over twenty years of experience in using innovation and technology to solve all bladder and continence-related issues. Here’s why Friends Adult Diapers are the best fit for you:

Zero leaks: Friends diapers for the elderly are made with high quality imported Super Absorbent Polymer. This Super Absorbent Polymer instantly converts liquid to gel, locking it within the diaper giving the wearer a quick, leakproof and dry feel.
Comfort fit: Friends unisex adult diapers are extremely soft, super-sleek and highly absorbent. This combination ensures that users can wear them for long hours, be it for entire days out, long work trips or a good night’s sleep,
Skin-safe: We understand how sensitive your skin is. Most inhibitions against diapers are because people believe their skin might not be able to handle them. That is exactly why Friends Diapers for the elderly are anti-bacterial and aloe-vera treated. The special anti-bacterial layer protects you from infections while the goodness of aloe vera keeps away rashes, itching and redness.
Sleep-friendly: Friends Overnight Adult Diapers are designed to absorb liquid for up to 16 hours. This makes sure that users can get up to 12 hours of uninterrupted, restful sleep free of leaks, stains and constantly getting up for bathroom breaks.

Friends’ Adult Diapers are designed for the Indian body type and climate and made with the best materials and technology imported from all over the world. The makers of Friends’ Adult Diapers, Nobel hygiene, are an undisputed leader in elderly diapers and are the only Indian manufacturers of both baby and adult diapers. Friends Diapers have been a market leader in the category since their launch in 2000 and are committed to providing our consumers with the best quality products and a wide range of features. Our products are simple to use and provide customers with not just improved incontinence management but also superior comfort.

Adult diapers are helpful for the short term and even the long term based on how much your medication and exercises have helped you keep your overactive bladder in check. Adult diapers help you to continue with your life along with treatment instead of isolating yourself while waiting for your treatment to achieve significant results.

Overactive Bladder (OAB) - A Comprehensive Guide

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