FAQ (Frequently Asked Questions) about Overactive Bladder

Overactive bladder (OAB) is a chronic medical condition that is marked by the sudden and sometimes uncomfortable need to urinate. This can occur at any time during the day or night, and it may or may not result in the leakage of urine.

Overactive bladder occurs when the bladder's smooth muscle, known as the detrusor muscle, squeezes while the bladder is still filling instead of when it is completely full. When this muscle squeezes, signals are sent to your brain resulting in the urge to urinate.

This urgency sometimes leads to more trips than normal to the bathroom and for some people, an involuntary loss of urine. Overactive bladder can be both frustrating and embarrassing. For patients who experience urge incontinence - the involuntary leakage of urine accompanied or preceded by urgency, this can be distressful and sometimes debilitating.

The main symptom of an overactive bladder are urgencyUrgency
The sudden and compelling need to urinate which is difficult to defer., a strong need to urinate which is often difficult to defer or put off. Rushing to make it to the bathroom in time is common for people with overactive bladder. Other common symptoms can include:

Frequency: The need to urinate more often than usual during the day

Nocturia: Waking up at night one or more times to urinate

Urge incontinence: The involuntary leakage of urine

Leakage of urine caused by physical activity, laughing, sneezing or coughing, is often confused with overactive bladder. This is actually a separate condition called stress urinary incontinence (SUI).

For many patients, the cause of overactive bladder is unknown. It is not a condition related to getting older nor is it limited to women.

There are various underlying risk factors that can contribute to an overactive bladder condition. Some risk factors are common and may include: urinary tract infectionsUrinary tract infection
A bacterial infection of the urethra, bladder, ureters or kidneys (part of the urinary tract)., side effects of medications, obesity, pregnancy and menopause. Others are more severe and less common, such as: nerve damage caused by spinal cord lesions, neurological disease (e.g. Multiple Sclerosis, Parkinson's disease, etc.), stroke, and blocked urethra due to enlarged prostate or prostatic surgery in men.

You will probably be a little relieved to know that you are not alone - between 12 to 18 per cent of Canadians suffer from overactive bladder. Approximately two thirds have dry overactive bladder (overactive bladder without urge incontinence), while the remaining one third have wet overactive bladder (overactive bladder with urge incontinence). Even though overactive bladder affects all ages, it tends to be increasingly common with age. Both men and women are equally at risk of developing overactive bladder. However, women are more likely than men to discuss their condition and seek treatment.

Overactive bladder is a difficult and embarrassing condition to talk about. However, it is a very real situation. Give yourself permission to speak to your doctor about symptoms you are experiencing and how this is affecting your life. It is up to you to start the conversation.

Once the discussion starts with your doctor, there are a few steps that can take place.

Your physician can perform an initial assessment of your symptoms, including asking questions about how overactive bladder affects your daily life. They will also take a detailed medical history and conduct a physical exam, including a pelvic examination. Urine and blood tests may be conducted to rule out infection and other diseases such as diabetes.

• Reduced social activity: You may not go out as much or stop doing things you enjoy.
• Stress, frustration and anxiety: You often worry about having a wetting accident.
  
• Sleep disturbances: You may find yourself getting up frequently during the night to make trips to the bathroom.
  
• Skin rashes and urinary tract infections: These problems can occur due to frequent wetting accidents and over-washing with soap and water to prevent odour.
  
• Increased risk of falls and fractures: The risk of injury and accidents can increase because of rushing to the bathroom, particularly at night.
• Work-related issues: Overactive bladder can negatively affect your work productivity, which has both direct and indirect financial implications (e.g., time off work, loss of earning, pad usage)

Other than the obvious physical symptoms, overactive bladder can profoundly affect a person’s quality of life. People with an overactive bladder often cope with the physical symptoms by:

• Mapping out bathroom locations to ensure they know where a bathroom is at all times;
• Limiting daily travel to places and routes where they know bathroom locations;
• Reducing fluid intake;
• Avoiding sexual intimacy;
• Wearing adult incontinence pads, diapers, or sanitary protection;
• Avoiding staying with friends or family because of concern over leakage of urine
• Carrying a change of clothes at all times;
• Wearing dark, often baggy clothing to hide wet spots;
• Sitting on the aisle in theatres or on airplanes; and
• Sitting closest to the door during business meetings or in the theatre for easy access to the bathroom.

It is not uncommon for people with an overactive bladder to stop physical or public activities altogether and put their lives on hold.

While people often refer to ‘overactive bladder’ and ‘incontinence’ as if they are the same thing, it is important for you to understand that they are two different conditions. Incontinence is a more general term defined as the accidental, involuntary or unwanted leakage of urine. Urinary incontinence can develop at any age, but as we age, it can become more common because of changes in the body and illness that affect our bladder function. While leakage can be a symptom of an overactive bladder, not everyone has this symptom. There are also various forms of incontinence, such as:

Stress urinary incontinence: Involuntary leakage on effort or exertion, such as sneezing or coughing

Mixed incontinence: Involuntary leakage associated with both urgency and exertion or effort

Urge incontinence: Involuntary leakage accompanied by or preceded by urgency

Overactive bladder is a chronic medical condition characterized by urgency – the sudden and sometimes uncomfortable need to urinate, which is difficult to put off or defer. This can occur at any time during the day or night, and may or may not result in leaking of urine.

A urinary tract infection (UTI) is an infection of the bladder or the kidneys.

While both overactive bladder and UTI sufferers experience a strong and persistent urge to urinate, the difference is that overactive bladder is a chronic medical condition and a UTI is generally an acute and uncomfortable infection that is curable with a course of antibiotics.

Treatment for overactive bladder and a UTI is different. For patients experiencing symptoms of a UTI, the recommended first-line treatment is a course of antibiotics. Treatment options for overactive bladder may include lifestyle and behavioural changes, exercise, and if required, medications.

Overactive Bladder is a chronic medical condition. Overactive bladder can be managed by using treatments such as: diet and fluid management, behavioural therapy, exercise and drug therapy. These treatments can be used alone or in combination with each other.

While there may be no complete cure for an overactive bladder, fortunately, an overactive bladder can be successfully managed with behavioural therapy and/or prescription medication. Together, you and your healthcare professional can come up with the best strategy to improve your overactive bladder symptoms. This may require you to make lifestyle changes and/or use prescription medication. Talk to your healthcare professional about what treatment options will allow you to take control of your overactive bladder and your life!

Yes – overactive bladder is a condition that can be managed and symptoms can be significantly reduced. As overactive bladder is a chronic medical condition, it cannot be cured.

It is recommended that people who have symptoms of overactive bladder undergo a medical and physical examination by their doctor to evaluate their medical history, severity of symptoms, the impact of the condition on their lifestyle and assessment of treatment options.

There are different treatment options available to manage an overactive bladder and these vary from person to person.

Making lifestyle changes is generally the first step in treating an overactive bladder because it is non-invasive, poses little threat of side effects, and often provides positive outcomes. The aim of this type of treatment is to educate patients on how to improve their overactive bladder symptoms. Behaviour therapy, if performed correctly and adhered to, have been shown to successfully reduce overactive bladder symptoms. A specialized health professional such as a nurse continence advisor or a uro-physio therapist are able to provide these therapies. Behavioural therapies and modifications which have been found to positively improve the symptoms of an overactive bladder include:

Diet and fluid management

• Reducing intake of caffeine, including coffee, tea and soft drinks
• Avoiding caffeinated beverages in the evening
• Limiting intake of alcohol as it can interfere with bladder control
• Maintaining and drinking ‘bladder friendly’ liquids including water, apple or grape juices
• Stopping or reducing smoking
• Weight reduction

Behavioural therapy

• Bladder management and training – this involves scheduled toileting to gradually increase the length of time between bathroom visits
• Emptying the bladder before going to sleep

Exercise

• Regular exercise and physical activity
• Kegel exercises (pelvic floor exercisesPelvic Floor Exercises
  Repetitive exercises involving contraction and relaxation of specific pelvic floor muscles. Performed to strengthen muscles that support the urethra, bladder, uterus and rectum.) to increase your bladder strength and endurance

Drug therapy options

• Overactive bladder medications are commonly used to treat symptoms such as the “urge to go”
• Patients may experience less urgencyUrgency
  The sudden and compelling need to urinate which is difficult to defer. and less need to use the bathroom and fewer accidents

Surgery

• Surgery to correct an overactive bladder are rarely used. This option should only be considered after less invasive options have been explored with your physician. The main goal of surgery is to increase the bladder's ability to hold urine.
  
• In patients where overactive bladder symptoms cause severe disruptions to their quality of life and who do not respond to behavioural therapy and medication, treatment is possible with neuromodulation (a surgical procedure that involves the implantation of an electronic device into the lower part of  your spine to regulate the nerves that control the bladder, shincter, and pelvic muscles) and other more invasive surgical techniques.
• Surgery, including bladder lifts and newer minimally invasive procedures, may be an option for some patients who experience stress urinary incontinenceStress Urinary Incontinence
  Leakage of urine caused by physical activity, laughing, sneezing or coughing, is often confused with overactive bladder.. It is important to determine whether you are experiencing OAB or stress urinary incontinence.

Behavioural therapy, where available, has been used for many years to treat symptoms of an overactive bladder. One example of behavioural therapy includes the bladder drill: an exercise designed to increase the period of time between periods of going to the bathroom, until the bladder becomes accustomed to the reduced frequency of going to the bathroom. The bladder drill is one of the earliest forms of behavioural therapies for an overactive bladder.

Although behavioural therapy is known to be highly effective for reducing overactive bladder symptoms, people with an overactive bladder will often explore other options in combination with behavioural therapy to treat their symptoms.

Bladder control depends on how well all of your muscles are working together: the bladder muscle should be relaxed and pelvic floor muscles should be tight. Exercises that strengthen pelvic floor musclesPelvic Floor Muscles
Muscles that form a sling or hammock across the opening of the pelvis to keep all of the pelvic organs (bladder, uterus and rectum) in place and functioning correctly. can help hold urine inside the bladder, preventing leakage. These types of exercises are commonly called "Kegel" or pelvic floor muscle exercises, named after the doctor who developed them.

The aim of Kegel exercises (also known as Kegels) is to strengthen the pelvic muscles that support your bladder. If the muscles of the pelvic floor are weak, the urethra cannot be completely closes and urine may leak.

Strengthening this muscle group allows the urethra to be properly closed, keeping urine in.

Kegel exercises can be very helpful in reducing symptoms of an overactive bladder. As many as 75 per cent of women with incontinenceIncontinence
The involuntary leaking of urine. (especially stress incontinenceStress Incontinence
Leakage of urine caused by physical activity, laughing, sneezing or coughing, is often confused with overactive bladder.) can improve their bladder control with Kegel exercises.

Many people think that the only way to relieve the uncomfortable sudden feeling of urgency is to empty the bladder, but this is not necessarily true. “Urges” can come and go without emptying the bladder, as an “urge” is a message telling you that eventually you will need to urinate.

In someone with an overactive bladder, the “urge” may be a false message that you need to go now. “Urges”, however, do not need to be commands. They should function as an early warning system, getting you ready to find a place to urinate.

Learning to do Kegel exercises can help with symptoms such as the “urge" to go. When the pelvic floor muscles are contracted, the bladder outlet is strengthened and tightened. One example is constricting your pelvic floor muscles for 5 to 10 seconds at a time. Kegel exercises need to be practiced consistently. Women need to be patient as it can take up to six weeks before Kegel exercises become very effective.

It is recommended that non-drug, behavioural modification techniques should first be used to manage OAB. However, behavioural techniques alone might not be enough in overactive bladder management; in which case, prescription medicine is required. In fact, higher rates of treatment success have been attributed to using behavioural and prescription therapies in combination.

A class of drugs called anticholinergic agents is commonly used to treat patients suffering from an overactive bladder. These agents work by stopping the bladder muscle from contracting too early, allowing the bladder to fill completely. Consequently, you may experience less urgency, fewer accidents and make fewer trips to the bathroom.

Medications already approved for OVERACTIVE BLADDER  in Canada include:

• Vesicare^® (solifenacin succinate);
• Detrol LA^® (tolterodine tartrate extended-release capsules);
• Ditropan XL^® (oxybutynin chloride extended-release tablets);
• Oxytrol^™ (oxybutynin transdermal system);
• Trosec^™ (trospium chloride);
• Enablex^™ (darifenacin);
• Uromax^® (controlled release oxybutynin); and
• Generic oxybutynin.

While these medications can be effective at controlling an overactive bladder, they can have some side effects. Common side effects of anticholinergic medications are dry mouth, constipation and blurred vision.

The most common side effect of overacitve bladder medications is "dry mouth" - caused by a reduction in the production of saliva and not linked to your intake of fluids. Larger doses of prescription medications may cause blurred vision, constipation, a faster heartbeat, flushing, fatigue, dry mouth, dizziness, nausea, and insomnia. These medications are generally not indicated for use in patients who have glaucoma.

Should you have any questions or concerns about side effects or managing side effects of your medication, be sure to speak with your doctor.

Overactive bladder medications work by blocking chemical transmitters that target the nerves surrounding the bladder. By blocking these chemical transmitters, this means that the bladder muscles can remain relaxed, thereby reducing the urge to go the bathroom. With the bladder muscles relaxed, common symptoms of an overactive bladder, such as urgencyUrgency
The sudden and compelling need to urinate which is difficult to defer., can be reduced.

Your doctor may use one treatment alone or one in combination with other overactive bladder treatments.

There are a number of medications available in Canada to manage an overactive bladder and each one is a little different from the others. In addition, individuals respond differently to medications.

With this in mind, some patients may start to see results as early as one week after starting on an overactive bladder medication. For others, the full effect may not be seen for four to eight weeks. It is important to talk to your healthcare professional about how soon your medication will start to work for you.

It is also important to follow your healthcare professional's exact instructions when taking medication for overactive bladder. Doing so ensures that your doctor can provide you with the best treatment necessary and you will benefit from the full effect of the medication.

Stopping your medication may cause your overactive bladder symptoms to come back. Because there is no cure for an overactive bladder, you must continue taking your medication to control overactive bladder symptoms.

Of course, should you have any questions or concerns about side effects, managing side effects or your medication, be sure to speak with your healthcare professional.

Absolutely not! Taking a medication is just one option when it comes to treating an overactive bladder. Other options can include:

• Behavioural therapy: bladder management and training
• Lifestyle changes: dietary changes such as diet and fluid management (i.e. reducing intake of caffeine, including coffee, tea and soft drinks), stopping or reducing smoking, weight reduction, bowel management or wearing absorbent products
• Physical activity: regular Kegel exercises to increase the strength and endurance of pelvic muscles
• Surgery may be an option for a very small percentage of patients who have an overactive bladder. This option is not generally recommended for the majority of patients who have an overactive bladder. It is important that you discuss this option with your doctor.

Kegel exercises (also known as Kegels) are easy and convenient and can be done anywhere at any time, without anyone knowing. There are two kinds of Kegel exercises and both are described below. When you practice these exercises do the long exercise first, followed by the short exercise.

Long Kegels

1. Stand, sit, or lie down with your knees approximately 25 cm (10 inches) apart
2. Using the muscles that prevent you from releasing rectal gas, squeeze and pull up on these muscles. You should feel your rectal muscle tightening. Do not squeeze your buttock muscles together, or hold your breath, while doing this exercise
3. Hold this position for 5 to 10 seconds
4. Now relax the muscles for 5 to 10 seconds
5. Repeat the above steps 12 to 20 times

Short Kegels

1. Squeeze and hold the pelvic muscles, as described in the long exercise, for 1 second and then relax for 1 second
2. Repeat the above step 5 times
3. Relax for 10 seconds
4. Repeat all of the above steps, in sequence, 3 to 4 times

Kegel exercises should be performed 3 to 5 times a day. It is essential that you remember to do them consistently and properly. Try not to become discouraged if these exercises do not work right away. As with any other muscle group in your body, your pelvic muscles require time (often several weeks) to strengthen. Furthermore, you should continue doing Kegel exercises even when your overactive bladder symptoms improve to ensure that your pelvic muscle stays strong.

Because of where the pelvic muscle is situated, it can be hard to assess whether or not you are working this muscle group correctly. As a result, some people find it helpful to use biofeedback therapy as this increases the effect of Kegel exercises.

Biofeedback therapy, where available, is a procedure typically performed by a healthcare professional in a hospital or clinic. This procedure requires that electrodes be placed either:

• into the vagina of females
• into the anus of males
• on the skin in the perineal area (the area between the anus and genital organs)

These electrodes, which are connected to a monitor, are able to read the activity of the pelvic musclesPelvic Floor Muscles
Muscles that form a sling or hammock across the opening of the pelvis to keep all of the pelvic organs (bladder, uterus and rectum) in place and functioning correctly., while the patient performs Kegel exercises.

Initially, the person may see a flat line on the monitor that represents the activity of the pelvic muscles when at rest and relaxed. When the person begins to contract his/her pelvic muscles, the line will shift upwards, which indicates that the muscle is actively being contracted. By watching the monitor as the patient performs the Kegel exercises, he/she begins to memorize the action that was required to correctly contract the pelvic muscles.

Planning out locations of bathrooms is quite common for people with an overactive bladder. With your physician, there are a number of helpful tips that you can discuss. Some of them might include planning out your bathroom stops, diet and fluid management, and learning how to do Kegel exercises (contracting your urinary or pelvic musclesPelvic Muscles
Muscles that form a sling or hammock across the opening of the pelvis to keep all of the pelvic organs (bladder, uterus and rectum) in place and functioning correctly. to suppress the urge to urinate). Medications may also be helpful for some people when traveling, to relax the bladder and decrease the sense of urgencyUrgency
The sudden and compelling need to urinate which is difficult to defer..

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Regular exercise and physical activity is a good idea for everyone, and can be especially beneficial for people with an overactive bladder! Kegel exercises (also known as Kegels) can help to strengthen the pelvic muscles, and are recommended for people who have been diagnosed with an overactive bladder. In addition, simple exercises such as walking, can improve your physical, emotional and mental health, as well as your outlook on life.

If you have an overactive bladder, it is important to maintain your fluid intake. For example, drinking “bladder friendly” beverages such as water, apple or grape juice is recommended and encouraged. Drinking beverages containing caffeine such as coffee, tea and certain soft drinks, as well as alcohol, should be reduced as they may interfere with bladder control.

It is also a good idea to avoid drinking caffeinated beverages at night. It is important to remember that when you reduce your fluid intake, your urine can become more concentrated and irritating to the bladder. Moderate intake of fluids is recommended and should be maintained.

Yes! Many women do experience leakage of urine during sexual intercourse but their partners are often unaware of this because of the natural fluids released during sexual relations. Remember you may be more aware of leakage than your partner. If you have questions about intimacy and an overactive bladder, please talk to your doctor about your concerns.