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Urinating more than eight times a day, experiencing an urgent need to urinate or can't get to the bathroom in time so you leak urine?
If so, you may be suffering from overactive bladder.
By Lucie Turgeon
If you’ve ever had to urinate so badly that you thought you might wet your pants, you’ll have some idea of what people with overactive bladder (OAB) live with on a daily basis. Frequently undiagnosed, OAB affects one in five Canadians over the age of 35, the majority of whom are women and older adults. The key symptoms of this disorder include: frequency (a need to urinate more than eight times over 24 hours, including at night); urgency (an overwhelming need to urinate); and wetting accidents (involuntary loss of urine following a sudden strong desire to urinate).
Almost two thirds (63%) of people with OAB experience only the first two symptoms, while the remaining 37%also have wetting accidents. “Most people urinate between four and eight times a day and are capable of holding their urine,” explains Dr. Luc Valiquette, a urologist at the Hôpital Saint-Luc of CHUM in Montreal, Quebec. He points out that sufferers may need to urinate as many as 25 times a day. “It’s the urgent nature of the desire to void that characterizes this condition.”
Connection to other conditions
OAB occurs because of sudden involuntary contractions of the detrusor muscle, which is in the wall of the bladder. Although the cause is unknown, medical conditions such as dementia, diabetes, multiple sclerosis, Parkinson’s disease, spinal injury and stroke can increase the risk. Other conditions, such as urinary tract infections, bladder stones and interstitial cystitis may cause symptoms similar to OAB. A urinalysis and urine culture is performed to confirm a diagnosis of overactive bladder.
OAB and incontinence
Urge incontinence is a component of OAB and occurs when the bladder contracts involuntarily. Stress incontinence occurs when the muscles around the urethra become too weak to prevent urine from escaping and leakage occurs upon exertion (i.e. coughing,
sneezing, laughing or exercise). Many people with OAB may also have stress incontinence; however, they are different conditions with different treatments.
Altered quality of life
Having OAB can cause a significant impact on the social, personal and sexual aspects of people’s lives. They may become anxious about the possibility of leaking urine, and limit outings with friends, avoid taking trips, not participate in sports and choose not to
become involved in intimate relationships. They tend to organize their day around having close proximity to washroom facilities, so activities such as golf or skiing become out of the question. They also feel the need to always have a change of clothing with them in case of leakage. The effect of OAB on a person’s quality of life is greater than the effect of diabetes and just as significant as depression.
What you can do
Many people struggling with OAB believe there is little they can do except learn to live with the condition. While it’s not an easy topic to discuss – even with your family doctor – it’s important to let him or her know about your symptoms so that you can get the proper treatment. These treatments can include:
Behavioural therapy: This is usually the first solution presented to people with OAB. It involves behavioural modifications known to alleviate symptoms: scheduling urination times throughout the day, mapping out washrooms during outings, frequenting places with easy accessibility to washroom facilities, changing certain dietary habits (drinking less caffeine and alcohol, for example) and generally reducing fluid intake.
Kegel exercises: These exercises involve contracting and relaxing pelvic floor muscles. They can help prevent involuntary contraction of the detrusor muscle by strengthening these muscles.
Bladder training: The purpose of bladder training is to control the urge to urinate and reduce voids by gradually increasing the time between bathroom visits. A bladder diary can help you keep track of your schedule.
Medication: Medication is the cornerstone of overactive bladder. The most commonly used medications for OAB are anticholinergics, which reduce bladder contractions thereby reducing the urge to urinate.
Botox injections: Although a promising treatment, Botox is not yet specifically approved for use in OAB. (It is currently only performed in some hospitals for patients whose OAB is the result of a neurological disorder.) Injections are performed through cystoscopy, in which a small camera is inserted into the bladder through the urethra. This paralyzes the bladder muscle, which reduces bladder contractions. The procedure must be repeated every six to nine months.
Neurostimulation: When other treatments fail to deliver the expected results or are poorly tolerated, a spinal implant (known as a subdermal neurostimulator or bladder pacemaker) is considered. It sends mild electrical stimulation to the sacral nerves in order to influence the behaviour of the bladder. Extremely expensive, this treatment is limited to only the most serious cases.
Surgery: Usually considered a last resort, surgery involves enlarging the bladder or replacing a small portion of the bladder muscle with a segment of the intestine to increase bladder capacity and/or reduce bladder contractions.
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