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What is Overactive Bladder?
Overactive Bladder (OAB) is not a specific disease, but rather a collection of urinary symptoms that can significantly impact a person’s quality of life.
The hallmark of OAB is a sudden, frequent, and uncontrollable urge to urinate that may be difficult to ignore. In a healthy bladder, the detrusor muscle (the bladder wall muscle) stays relaxed as the bladder fills.
When it’s time to go, the brain signals the muscle to contract. With OAB, these muscles contract involuntarily, even when the bladder isn’t full, creating a “false alarm” of urgency.
The Four Defining Symptoms of OAB
People with OAB typically experience a combination of the following symptoms:
Urgency: A sudden, strong need to urinate that is difficult to ignore or delay.
Frequency: Needing to urinate more than eight times in 24 hours.
Urge Incontinence: The involuntary leaking of urine following a sudden, strong urge.
Nocturia: Waking up two or more times during the night to use the bathroom.
What Causes an Overactive Bladder?
OAB can be triggered by several different factors, ranging from lifestyle habits to neurological conditions.
1. Neurological Factors
Conditions that affect the signals between the brain and the bladder can lead to OAB symptoms:
- Parkinson’s Disease or Multiple Sclerosis (MS).
- History of Stroke.
- Spinal cord injuries or herniated discs.
2. Physical and Medical Obstructions
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Enlarged Prostate (BPH): In men, an enlarged prostate can block urine flow, causing the bladder wall to thicken and become overactive.
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Bladder Stones or Tumors: Physical irritants inside the bladder.
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UTIs (Urinary Tract Infections): Urinary Infections can mimic OAB symptoms by irritating the bladder lining.
3. Lifestyle and Temporary Triggers
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Caffeine and Alcohol: Both act as diuretics and bladder irritants.
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Certain Medications: Diuretics (water pills) used for blood pressure can increase the rate at which the bladder fills.
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Excessive Fluid Intake: Consuming more water than the body requires.
Treatment and Management Options
The treatment is to reduce the frequency and urgency of the symptoms. Most doctors recommend starting with the least invasive options.
Lifestyle & Behavioral Therapy
Bladder Retraining: Here, we try to establish a specific schedule for urination by controlling the urge. Gradually, our brain responds to these signals, and the bladder muscles become accustomed.
Kegels: Kegels or Pelvic Floor Exercises are prescribed to such patients. These exercises improve the strength of bladder muscles to prevent urgency.
Dietary Changes: Here, patients are asked to avoid food items or beverages that can trigger bladder like alcohol, coffee, tea, processed and packaged foods.
Pharmacological Options
Anticholinergics: Medicines like tolterodine and oxybutynin restrict the mismatched signals from the brain to the bladder for compression.
Beta-3 Agonists: Medicines such as mirabegron smooth and relax the bladder muscles, thus increasing the bladder’s ability to hold urine.