Overactive bladder

Overactive bladder is characterized by a group of four symptoms: urgency, urinary frequency, nocturia, and urge incontinence. Urge incontinence is not present in the "dry" classification.{{cite journal |last1=Lightner |first1=Deborah J. |last2=Gomelsky |first2=Alexander |last3=Souter |first3=Lesley |last4=Vasavada |first4=Sandip P. |title=Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019 |journal=The Journal of Urology |date=September 2019 |volume=202 |issue=3 |pages=558–563 |doi=10.1097/JU.0000000000000309 |pmid=31039103 |issn=1527-3792|doi-access=free }}

Urgency is considered the hallmark symptom of OAB, but there are no clear criteria for what constitutes urgency and studies often use other criteria. Urgency is currently defined by the International Continence Society (ICS), as of 2002, as "Sudden, compelling desire to pass urine that is difficult to defer." The previous definition was "Strong desire to void accompanied by fear of leakage or pain."{{cite journal | vauthors = Wein A | title = Symptom-based diagnosis of overactive bladder: an overview | journal = Canadian Urological Association Journal | volume = 5 | issue = Suppl 2 | pages = S135–6 | date = October 2011 | pmid = 21989525 | pmc = 3193392 | doi = 10.5489/cuaj.11183 }} The definition does not address the immediacy of the urge to void and has been criticized as subjective.

Urinary frequency is considered abnormal if the person urinates more than eight times in a day. This frequency is usually monitored by having the person keep a voiding diary where they record urination episodes. The number of episodes varies depending on sleep, fluid intake, medications, and up to seven is considered normal if consistent with the other factors.{{citation needed|date=April 2021}}

Nocturia is a symptom where the person complains of interrupted sleep because of an urge to void and, like the urinary frequency component, is affected by similar lifestyle and medical factors. Individual waking events are not considered abnormal, one study in Finland established two or more voids per night as affecting quality of life.{{cite journal | vauthors = Tikkinen KA, Johnson TM, Tammela TL, Sintonen H, Haukka J, Huhtala H, Auvinen A | title = Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland | journal = European Urology | volume = 57 | issue = 3 | pages = 488–96 | date = March 2010 | pmid = 19361907 | doi = 10.1016/j.eururo.2009.03.080 }}

Urge incontinence is a form of urinary incontinence characterized by the involuntary loss of urine occurring for no apparent reason while feeling urinary urgency as discussed above. Like frequency, the person can track incontinence in a diary to assist with diagnosis and management of symptoms. Urge incontinence can also be measured with pad tests, and these are often used for research purposes. Some people with urge incontinence also have stress incontinence and this can complicate clinical studies.

It is important that the clinician and the person with overactive bladder both reach a consensus on the term, 'urgency.' Some common phrases used to describe OAB include, 'When I've got to go, I've got to go,' or 'When I have to go, I have to rush, because I think I will wet myself.' Hence the term, 'fear of leakage,' is an important concept to people.Campbell-Walsh Urology, Tenth Edition, Chapter 66, Page 1948

The cause of OAB is usually unclear, and indeed there may be multiple causes.{{cite journal | vauthors = Sacco E | title = [Physiopathology of overactive bladder syndrome] | journal = Urologia | volume = 79 | issue = 1 | pages = 24–35 | year = 2012 | pmid = 22287269 | doi = 10.5301/RU.2012.8972 | s2cid = 39170650 }} It is often associated with overactivity of the detrusor urinae muscle, a pattern of bladder muscle contraction observed during urodynamics.{{cite journal | vauthors = Sussman DO | title = Overactive bladder: treatment options in primary care medicine | journal = The Journal of the American Osteopathic Association | volume = 107 | issue = 9 | pages = 379–85 | date = September 2007 | pmid = 17908830 }} It is also possible that the increased contractile nature originates from within the urothelium and lamina propria, and abnormal contractions in this tissue could stimulate dysfunction in the detrusor or whole bladder.{{cite journal | vauthors = Moro C, Uchiyama J, Chess-Williams R | title = Urothelial/lamina propria spontaneous activity and the role of M3 muscarinic receptors in mediating rate responses to stretch and carbachol | journal = Urology | volume = 78 | issue = 6 | pages = 1442.e9–15 | date = December 2011 | pmid = 22001099 | doi = 10.1016/j.urology.2011.08.039 | url = http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1373&context=hsm_pubs }}

If bladder spasms occur or there is no urine in the drainage bag when a catheter is in place, the catheter may be blocked by blood, thick sediment, or a kink in the catheter or drainage tubing. Sometimes spasms are caused by the catheter irritating the bladder, prostate or penis. Such spasms can be controlled with medication such as butylscopolamine, although most people eventually adjust to the irritation and the spasms go away.{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/003981.htm |title=Urinary catheters |publisher=MedlinePlus, the National Institutes of Health's Web site |date=2010-03-09 |access-date=2010-12-01 |url-status=live |archive-url=https://web.archive.org/web/20101204093143/http://www.nlm.nih.gov/medlineplus/ency/article/003981.htm |archive-date=2010-12-04 }}

Diagnosis of OAB is made primarily on the person's signs and symptoms and by ruling out other possible causes such as an infection. Urodynamics, a bladder scope, and ultrasound are generally not needed.{{Citation |author1 = American Urogynecologic Society |author1-link = American Urogynecologic Society |date = May 5, 2015 |title = Five Things Physicians and Patients Should Question |publisher = American Urogynecologic Society |work = Choosing Wisely: an initiative of the ABIM Foundation |url = http://www.choosingwisely.org/societies/american-urogynecologic-society/ |access-date = June 1, 2015 |url-status = live |archive-url = https://web.archive.org/web/20150602021428/http://www.choosingwisely.org/societies/american-urogynecologic-society/ |archive-date = June 2, 2015 }} Additionally, urine culture may be done to rule out infection. The frequency/volume chart may be maintained and cystourethroscopy may be done to exclude tumor and kidney stones. If there is an underlying metabolic or pathologic condition that explains the symptoms, the symptoms may be considered part of that disease and not OAB.{{citation needed|date=April 2021}}

Psychometrically robust self-completion questionnaires are generally recognized as a valid way of measuring a person's signs and symptoms, but there does not exist a single ideal questionnaire.{{cite journal | vauthors = Shy M, Fletcher SG | title = Objective Evaluation of Overactive Bladder: Which Surveys Should I Use? | journal = Current Bladder Dysfunction Reports | volume = 8 | issue = 1 | pages = 45–50 | date = March 2013 | pmid = 23439804 | pmc = 3579666 | doi = 10.1007/s11884-012-0167-2 }} These surveys can be divided into two groups: general surveys of lower urinary tract symptoms and surveys specific to overactive bladder. General questionnaires include: American Urological Association Symptom Index (AUASI), Urogenital Distress Inventory (UDI),{{cite journal | vauthors = Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA | title = Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group | journal = Quality of Life Research | volume = 3 | issue = 5 | pages = 291–306 | date = October 1994 | pmid = 7841963 | doi = 10.1007/bf00451721 | s2cid = 22892631 }} Incontinence Impact Questionnaire (IIQ), and Bristol Female Lower Urinary Tract Symptoms (BFLUTS). Overactive bladder questionnaires include: Overactive Bladder Questionnaire (OAB-q),{{Cite journal| vauthors = Coyne K, Schmier J, Hunt T, Corey R, Liberman J, Revicki D |date= March 2000 | title = PRN6: developing a specific HRQL instrument for overactive bladder |journal=Value in Health |volume=3|issue=2|pages=141|doi=10.1016/s1098-3015(11)70554-x |doi-access=free }} Urgency Questionnaire (UQ), Primary OAB Symptom Questionnaire (POSQ), and the International Consultation on Incontinence Questionnaire (ICIQ).

OAB causes similar symptoms to some other conditions such as urinary tract infection (UTI), bladder cancer, and benign prostatic hyperplasia (BPH). Urinary tract infections often involve pain and hematuria (blood in the urine) which are typically absent in OAB. Bladder cancer usually includes hematuria and can include pain, both not associated with OAB, and the common symptoms of OAB (urgency, frequency, and nocturia) may be absent. BPH frequently includes symptoms at the time of voiding as well as sometimes including pain or hematuria, and all of these are not usually present in OAB. Diabetes insipidus causes high frequency and volume, though not necessarily urgency.

There is some controversy about the classification and diagnosis of OAB.{{cite journal | vauthors = Homma Y | title = Lower urinary tract symptomatology: Its definition and confusion | journal = International Journal of Urology | volume = 15 | issue = 1 | pages = 35–43 | date = January 2008 | pmid = 18184169 | doi = 10.1111/j.1442-2042.2007.01907.x | s2cid = 35527427 | doi-access = free }} Some sources classify overactive bladder into two different variants: "wet" (i.e., an urgent need to urinate with involuntary leakage) or "dry" (i.e., an urgent need to urinate but no involuntary leakage). Wet variants are more common than dry variants.{{cite web|url=https://www.cornellurology.com/clinical-conditions/female-urology-urogynecology/overactive-bladder/|title=Overactive Bladder|publisher=Cornell University Weill Cornell Medical College Department of Urology|access-date=25 Aug 2013|url-status=dead|archive-url=https://web.archive.org/web/20130921053909/https://www.cornellurology.com/clinical-conditions/female-urology-urogynecology/overactive-bladder/|archive-date=21 September 2013}} The distinction is not absolute; one study suggested that many classified as "dry" were actually "wet" and that people with no history of any leakage may have had other syndromes.{{cite journal | vauthors = Anger JT, Le TX, Nissim HA, Rogo-Gupta L, Rashid R, Behniwal A, Smith AL, Litwin MS, Rodriguez LV, Wein AJ, Maliski SL | title = How dry is "OAB-dry"? Perspectives from patients and physician experts | journal = The Journal of Urology | volume = 188 | issue = 5 | pages = 1811–5 | date = November 2012 | pmid = 22999694 | pmc = 3571660 | doi = 10.1016/j.juro.2012.07.044 }}

OAB is distinct from stress urinary incontinence, but when they occur together, the condition is usually known as mixed incontinence.{{Citation |last1=Harris |first1=Shauna |title=Mixed Urinary Incontinence |date=2024 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK534234/ |access-date=2024-03-07 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30480967 |last2=Riggs |first2=John}}

The usual first suggested treatment for a person with overactive bladder is a combination of lifestyle changes, exercises to strengthen the person's pelvic floor, and manage how much the person drinks and when during the day ("fluid management"). Patients who continue to experience incontinence episodes, or who express a desire for medication along with therapy, may be treated with several classes of drugs, notably anticholinergics. Patients who prove resistant to medications and therapy may then be treated with neurological interventions, such as treatment with botulinum toxin (Botox) and other minimally-invasive surgical procedures, such as sacral neuromodulation. As a last resort if all other treatment options fail, invasive surgical procedures may be performed.{{Cite journal |last1=White |first1=Nicola |last2=Iglesia |first2=Cheryl B. |date=2016-03-01 |title=Overactive Bladder |url=https://www.sciencedirect.com/science/article/pii/S0889854515001072 |journal=Obstetrics and Gynecology Clinics of North America |series=Medical and Advanced Surgical Management of Pelvic Floor Disorders |volume=43 |issue=1 |pages=59–68 |doi=10.1016/j.ogc.2015.10.002 |pmid=26880508 |issn=0889-8545}}{{Cite journal |last1=Hutchinson |first1=Alexander |last2=Nesbitt |first2=Alexander |last3=Joshi |first3=Andre |last4=Clubb |first4=Adrian |last5=Perera |first5=Marlon |date=Sep 2020 |title=Overactive bladder syndrome: Management and treatment options |url=https://pubmed.ncbi.nlm.nih.gov/32864677 |journal=Australian Journal of General Practice |volume=49 |issue=9 |pages=593–598 |doi=10.31128/AJGP-11-19-5142 |issn=2208-7958 |pmid=32864677|hdl=10072/400893 |hdl-access=free }}

Behavioral and lifestyle changes are commonly recommended as the first-line option for treating overactive bladder. These include bladder training, which involves scheduled voiding (urination) and gradually increasing the time between bathroom visits. Pelvic floor exercises, known as Kegel exercises, can help strengthen the muscles that control urination. Fluid management, which focuses on avoiding excessive caffeine and alcohol intake, is advised to reduce the rate at which the bladder fills and minimize irritation to the bladder. Weight management and maintaining a healthy diet contribute to overall bladder health, especially when weight loss is able to reduce abdominal compression of the bladder. Adopting these behavioral and lifestyle changes can often improve the condition and enhance the effectiveness of other treatment approaches.

Most patients are not able to eliminate incontinence and other symptoms of OAB with lifestyle and behavioral modifications alone. However, numerous studies have demonstrated that these therapies are effective in improving quality of life, and some data shows that they increase the likelihood that medications can keep the OAB under control.

Medications are a common treatment option for people with overactive bladder syndrome. A number of antimuscarinic drugs (e.g., darifenacin, hyoscyamine, oxybutynin, tolterodine, solifenacin, trospium, fesoterodine) are frequently used to treat overactive bladder. Long term use, however, has been linked to dementia.{{cite journal | vauthors = Araklitis G, Cardozo L | title = Safety issues associated with using medication to treat overactive bladder | journal = Expert Opinion on Drug Safety | volume = 16 | issue = 11 | pages = 1273–1280 | date = November 2017 | pmid = 28889761 | doi = 10.1080/14740338.2017.1376646 | s2cid = 10862256 }} β3 adrenergic receptor agonists (e.g., mirabegron, vibegron) may be used, as well.{{cite journal |vauthors=Sacco E, Bientinesi R |date=December 2012 |title=Mirabegron: a review of recent data and its prospects in the management of overactive bladder |journal=Therapeutic Advances in Urology |volume=4 |issue=6 |pages=315–24 |doi=10.1177/1756287212457114 |pmc=3491758 |pmid=23205058}}

Patients taking oxybutynin and other anticholinergic drugs experience a 70% reduction of incontinence episode frequency, on average. Approximately 1 in 4 patients experience complete dryness while taking oxybutynin. Therefore, medication management alone is sufficient for a substantial minority, but not the majority, of patients with overactive bladder.{{Cite journal |last1=Diokno |first1=Ananias |last2=Ingber |first2=Michael |date=Nov 2006 |title=Oxybutynin in Detrusor Overactivity |url=https://linkinghub.elsevier.com/retrieve/pii/S0094014306000620 |journal=Urologic Clinics of North America |language=en |volume=33 |issue=4 |pages=439–445 |doi=10.1016/j.ucl.2006.06.003|pmid=17011379 }}

Botulinum toxin A (Botox) is approved by the Food and Drug Administration in adults with neurological conditions, including multiple sclerosis and spinal cord injury.{{cite news | work = Reuters | date = 24 August 2008 | url = https://www.reuters.com/article/us-fda-allergan-idUSTRE77N5BH20110824 | title = FDA approves Botox for loss of bladder control | url-status = live | archive-url = https://web.archive.org/web/20150924154821/http://www.reuters.com/article/2011/08/24/us-fda-allergan-idUSTRE77N5BH20110824 | archive-date = 24 September 2015 }} Botulinum Toxin A injections into the bladder wall can suppress involuntary bladder contractions by blocking nerve signals and may be effective for up to 9 months.{{cite book |last= Chancellor|first= Michael B |author2=Christopher Smith |title= Botulinum Toxin in Urology |publisher= Springer |date=August 2011 |isbn= 978-3-642-03579-1}}{{cite journal |vauthors=Sacco E, Paolillo M, Totaro A, Pinto F, Volpe A, Gardi M, Bassi PF | year = 2008 | title = Botulinum toxin in the treatment of overactive bladder | journal = Urologia | volume = 75 | issue = 1| pages = 4–13 | pmid = 21086369 | doi = 10.1177/039156030807500102 | s2cid = 208149855 }} The growing knowledge of pathophysiology of overactive bladder fueled a huge amount of basic and clinical research in this field of pharmacotherapy.{{cite journal |vauthors=Sacco E, Bientinesi R | year = 2012 | title = Future perspectives in pharmacological treatments options for overactive bladder syndrome | journal = Eur Urol Review | volume = 7 | issue = 2| pages = 120–126 }}{{cite journal | vauthors = Sacco E, Pinto F, Bassi P | title = Emerging pharmacological targets in overactive bladder therapy: experimental and clinical evidences | journal = International Urogynecology Journal and Pelvic Floor Dysfunction | volume = 19 | issue = 4 | pages = 583–98 | date = April 2008 | pmid = 18196198 | doi = 10.1007/s00192-007-0529-z | s2cid = 23846583 }}{{cite journal |vauthors=Sacco E, etal | year = 2009 | title = Investigational drug therapies for overactive bladder syndrome: the potential alternatives to anticholinergics | journal = Urologia | volume = 76 | issue = 3| pages = 161–177 | doi = 10.1177/039156030907600301 | pmid = 21086288 | s2cid = 208148685 }}

Overactive bladder may be treated with electrical stimulation, which aims to reduce the contractions of the muscle that tenses around the bladder and causes urine to pass out of it. Both invasive and non-invasive electrical stimulation procedures may be used to treat overactive bladder.

If non-invasive and pharmacological approaches are not helpful, some people may be eligible for a surgical procedure to treat overactive bladder. Surgical options may include urinary diversion, sacral neuromodulation, or augmentation cystoplasty.{{Cite web |date=2 April 2019 |title=Overview {{!}} Urinary incontinence and pelvic organ prolapse in women: management {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/ng123 |access-date=2023-04-24 |website=www.nice.org.uk}}

One surgical intervention, called a cystoplasty, involves the enlargement of the bladder using tissue taken from the patient's ileum, which is part of the small intestine. This procedure is rarely performed, and is only done for patients who have proven resistant to all other forms of treatment. This procedure can greatly enlarge urine volume in the bladder.{{Cite journal |last1=Scarneciu |first1=Ioan |last2=Lupu |first2=Sorin |last3=Bratu |first3=Ovidiu Gabriel |last4=Teodorescu |first4=Andreea |last5=Maxim |first5=Laurian Stefan |last6=Brinza |first6=Adrian |last7=Laculiceanu |first7=Alexandru Georgian |last8=Rotaru |first8=Ruxandra Maria |last9=Lupu |first9=Aura-Mihaela |last10=Scarneciu |first10=Camelia Cornelia |date=2021-10-14 |title=Overactive bladder: A review and update |journal=Experimental and Therapeutic Medicine |volume=22 |issue=6 |pages=1444 |doi=10.3892/etm.2021.10879 |issn=1792-1015 |pmc=8549091 |pmid=34721686}}

Because overactive bladder is most commonly associated with aging, the majority of patients experience symptoms (with or without incontinence) for the rest of their lives. A minority of age-related OAB cases may be cured or indefinitely suppressed by medications and behavioral modification. If the OAB is due to a different condition, such as a urinary tract infection, then symptoms should resolve after the underlying problem has been treated.{{Cite book |last1=Ouslander |first1=Joseph |title=Harrison's Principles of Internal Medicine |last2=Reyes |first2=Bernardo |publisher=McGraw Hill |year=2022 |isbn=978-1264268504 |edition=21st |location=New York |chapter=Chapter 477: Caring for the Geriatric Patient}}

Earlier reports estimated that about one in six adults in the United States and Europe had OAB.{{cite journal | vauthors = Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, Hunt TL, Wein AJ | title = Prevalence and burden of overactive bladder in the United States | journal = World Journal of Urology | volume = 20 | issue = 6 | pages = 327–36 | date = May 2003 | pmid = 12811491 | doi = 10.1007/s00345-002-0301-4 | hdl = 2027.42/42170 | s2cid = 15994916 | hdl-access = free }}{{cite journal | vauthors = Milsom I, Abrams P, Cardozo L, Roberts RG, Thüroff J, Wein AJ | title = How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study | journal = BJU International | volume = 87 | issue = 9 | pages = 760–6 | date = June 2001 | pmid = 11412210 | doi = 10.1046/j.1464-410x.2001.02228.x | s2cid = 23650548 }} The number of people affected with OAB increases with age, thus it is expected that OAB will become more common in the future as the average age of people living in the developed world is increasing. However, a recent Finnish population-based survey{{cite journal | vauthors = Tikkinen KA, Tammela TL, Rissanen AM, Valpas A, Huhtala H, Auvinen A | title = Is the prevalence of overactive bladder overestimated? A population-based study in Finland | journal = PLOS ONE | volume = 2 | issue = 2 | pages = e195 | date = February 2007 | pmid = 17332843 | pmc = 1805814 | doi = 10.1371/journal.pone.0000195 | bibcode = 2007PLoSO...2..195T | editor1-last = Madersbacher | editor1-first = Stephan | doi-access = free }} {{open access}} suggested that the number of people affected had been largely overestimated due to methodological shortcomings regarding age distribution and low participation (in earlier reports). It is suspected, then, that OAB affects approximately half the number of individuals as earlier reported.

The American Urological Association reports studies showing rates as low as 7% to as high as 27% in men and rates as low as 9% to 43% in women. Urge incontinence was reported as higher in women. Older people are more likely to be affected, and the number of symptoms increases with age.

• National Association For Continence
• Underactive bladder

{{Reflist}}

• {{cite journal | vauthors = Sacco E, Bientinesi R, Marangi F, D'Addessi A, Racioppi M, Gulino G, Pinto F, Totaro A, Bassi P | title = [Overactive bladder syndrome: the social and economic perspective] | language = it | journal = Urologia | volume = 78 | issue = 4 | pages = 241–56 | date = 2011 | pmid = 22237808 | doi = 10.5301/RU.2011.8886 | s2cid = 36693916 }}
• {{cite web | url = https://medlineplus.gov/overactivebladder.html | publisher = U.S. National Library of Medicine | work = MedlinePlus | title = Overactive Bladder }}

{{Urinary tract disease}}

{{Urinary system symptoms and signs}}

{{Medical resources

| meSH2 = D053202

| ICD10 = {{ICD10|N|32|8}}, {{ICD10|N|39|4}}

| ICD9 = {{ICD9|596.51}}, {{ICD9|788.31}}

| OMIM =

| DiseasesDB = 3612

| MedlinePlus = 001270

| eMedicineSubj = article

| eMedicineTopic = 459340

| MeSH = D053201

| SNOMED CT = 236633002

| ICD10CM = {{ICD10CM|N32.81}}

}}

{{Authority control}}

{{DEFAULTSORT:Overactive Bladder}}

Category:Urinary bladder disorders

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