By definition, the cause of OAB is unknown. However, it is important and rules out a significant underlying cause, and investigations might include a urine test to rule out infection or the presence of abnormal cells, a scan of the bladder and bladder function test (urodynamics).
What is Overactive Bladder?
Overactive bladder (OAB) is a common condition affecting women and men, which can have a significant impact on a patient’s (and partner’s) quality of life. Symptoms include urgency (the need to rush to pass urine),
frequency (going to pass urine often), nocturia (needing to get up at night to pass urine) and urinary urge incontinence (urine leakage). It is caused by the bladder muscle contracting too readily, often at inconvenient times.
More significant underlying causes which need to be ruled out include bladder cancer, urinary tract infections and benign prostatic hyperplasia.
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What Causes Overactive Bladder?
By definition, the cause of OAB is unknown. However, it is important and rules out a significant underlying cause, and investigations might include a urine test to rule out infection or the presence of abnormal cells, a scan of the bladder and bladder function test (urodynamics). It is often helpful to complete a frequency volume chart prior to your appointment, and in men especially, to perform a flow test and residual bladder scan. Some patients may require a flexible cystoscopy.
In some patients there is an identifiable underlying cause. These can include nerve
damage or neurological disease such as multiple sclerosis, Parkinson’s disease, or stroke, in which case the diagnosis is called neurogenic detrusor overactivity. More significant underlying causes which need to be ruled out include bladder cancer, urinary tract infections (see above) and benign prostatic hyperplasia.
For some people with complex medical problems we are happy to arrange a home visit by one of our consultants and specialist nurse to find the best continence solution.
Urinary leakage can be a complex problem. Patients should rest assured that almost always we can improve symptoms and that surgery is not always required.
How is Overactive Bladder Treated?
OAB is usually treated in a step wise fashion, starting with the most straightforward, least invasive treatment first, and only moving on to more complex treatments after initial treatments have not worked. Treatments include behavioural therapies, drugs (anticholinergic medication), with injection of botox (botulinum toxin) into the bladder muscle, electrical stimulation of the bladder (neuromodulation) and surgery to increase the bladder volume only being reserved for very severe cases which have not responded to other treatments.
Lifestyle changes and behavioural regimens have been shown to improve symptoms. The most
straightforward is decreasing caffeine or alcohol intake. Others include losing weight and stopping smoking. Behavioural regimens range from simple manoeuvres such as timed or prompted urination and fluid management to biofeedback. Pelvic muscle exercises (Kegel exercises) may also help.
Certain drugs can inhibit contraction of the bladder muscle. They are usually called antimuscarinics, and they include: oxybutynin, tolterodine, trospium chloride, darifenacin, and solefenacin. They may improve symptoms for a number of patients, but may have side effects including a dry mouth and constipation.