Overactive bladder is a common condition marked by symptoms relating to the frequency and urgency of urination.
In the United States today, overactive bladder (OAB) may impact as many as 40 percent of women and 30 percent of men.
The chances of developing OAB increase with age but the condition is not a byproduct of aging. Most OAB cases begin with minor symptoms that progress over the long-term.
OAB describes a group of urinary symptoms rather than a specific disease. It is a common condition worldwide.
It is also called unstable or irritable bladder, and those with OAB often have a sudden, uncontrollable urge to urinate even if the bladder is not full.
Typically, the bladder gets a signal from the brain to empty when half full, or holding around 2 cups of urine. The sphincter muscle then relaxes and the detrusor muscle contracts to push out urine.
When some sort of a disruption occurs anywhere in this process, OAB symptoms and incontinence can occur.
A cross-sectional study of American men and women found 8 percent of men reported experiencing OAB symptoms often and 17 percent sometimes. In the same study, 20 percent of women reported experiencing OAB symptoms often and 30 percent sometimes.
Different ethnic groups may experience differing prevalence rates for OAB. Some studies have shown an increased rate of OAB in African American men and women as well as Hispanic males.
The physical symptoms of OAB vary but typically involve a loss of urinary control and the feeling of needing to urinate more often.
Around half of those with OAB also experience urgency urinary incontinence (UUI), or urine leakage.
Men and women experience differences between symptoms based on anatomical differences.
The EPIC study found that women with OAB might experience symptoms related to the storage of urine more frequently than men. The study also found that men with OAB tend to experience more issues with the release of urine than women.
The most common symptoms of OAB include:
- urinary urgency, or being unable to control urination
- urinating more than 8 times a day
- uncontrollable urge to urinate spontaneously, especially when hearing running water
- the need to wake during the night to urinate
- leakage of urine due to a failure to make it to the washroom
- strain or discomfort during urination
An increase in urination frequency and loss of bladder control are only symptoms of aging to an extent. Anyone at any age can develop OAB. A doctor should also be seen if symptoms become worrisome, or a burden to everyday life.
The symptoms of OAB can be disabling. One study found that the rate at which work productivity was impaired in people with OAB compared to those without, was roughly four times higher for men and three times higher for women. These rates are comparable with the rates of other long-term conditions like asthma.
Many with OAB don't seek help from their doctor because they don't know how to talk about their symptoms, or aren't aware of treatment options.
Many people with OAB also avoid treatment out of embarrassment. The National Association for Continence estimate that only 45 percent of those with OAB seek treatment.
The American Urology Association offer a printable quiz that can make starting the conversation about OAB symptoms easier.
There are also tools available to track symptoms. There are free apps that can be used to monitor fluid intake, urination, and leakage. A bladder diary can also help track the movement of liquids through the body.
Many with OAB will also experience emotional and mental symptoms as the result of the condition's physical symptoms.
Further complications of OAB include:
- social or workplace anxiety
- loss of sleep or sleep quality due to needing to urinate at night
- depression often related to lack of sleep
- decreased sense of intimacy
- strained relationships with partners
- lower self-confidence
- reduced physical activity
Stress urinary incontinence is not the same as OAB. Stress urinary incontinence (SUI) occurs when urine leakage accompanies activities like laughing, light coughing, or sneezing.
Lifting and straining can also trigger urine leakage in those with SUI. Even standing up, bending over, or walking can be enough to cause urine leakage with moderate to severe cases of SUI.
Unlike OAB, people with SUI typically do not experience problems with the urgency or frequency of urination. People also only pass a small amount of urine during incidents.
Roughly one in three women in the U.S. have SUI. White and Hispanic women are more likely to develop SUI than African American women. Several other factors can also contribute to the development of SUI, such as:
- nerve damage
- chronic coughing
Most cases of SUI are linked to a weakening of the neck of the bladder. Vaginal childbirth, obesity, aging, and menopause are also major causes of SUI.
Performing pelvic floor muscle activities, losing weight, or stopping habits like smoking that lead to coughing, can often lessen or improve SUI symptoms. Minimally invasive surgery options exist to treat the condition as well.
As in OAB, people with SUI often experience emotional and mental symptoms alongside the physical symptoms of the condition. Depression, social anxiety, and decreased sense of intimacy are common.
The symptoms of OAB are also sometimes confused with those of benign prostatic hyperplasia (BPH), an enlargement of the prostate that is common among men over 50. Most people with BPH wake several times through the night to urinate and have a slower, weaker stream of urine.
If burning, intense pain, or blood accompanies urination, a person should see a doctor immediately. A doctor should also be consulted if urine flow stops completely. The American Urological Associated have a BPH symptom score index that can be filled out before a person visits their doctor.
There are a number of misconceptions about OAB. While some of these have a base in science, simplifying patterns, or placing too much importance on apparent links, can be more harmful than helpful.
Many people who do not seek treatment for OAB have been misinformed about the facts of the condition.
Common myths include:
- OAB is simply part of aging
- OAB in men is usually caused by an enlarged prostate or prostate conditions
- OAB is the result of a small bladder
- OAB symptoms are caused by overexertion or activity
- OAB can be controlled by limiting fluid intake
- OAB is a woman's condition
- OAB is simply something to live with
- everyone gets OAB eventually
- OAB has few or no treatment options
- most people with OAB don't see reduced symptoms with treatment
- surgery is the only treatment option for OAB