Overactive bladder is a urological condition that involves more frequent urination than usual, such that it inhibits the individual’s normal daily activities.
Epidemiology
It is a relatively common condition with varying severity and is estimated to affect approximately one in six adults. It is more common in the elderly population and is, therefore expected to rise in worldwide prevalence with the aging populations among developed nations.
However, the actual prevalence is not clear, particularly as a recent Finnish study casted doubt on the methods used in previous research in regards to age distribution of the research population. This suggested that the prevalence is significantly lower than previously thought.
Nonetheless, the condition is reported to affect between 7% and 43% of the population, with women experiencing more problems than males.
Symptoms
There are four symptoms that characterize overactive bladder: urgency, urinary frequency, nocturia and urge incontinence.
Urgency is the most predominant symptom and is described as a “sudden compelling desire to pass urine that is difficult to defer” by the International Continence Society.
Urinary frequency is classed as significant if an individual urinates more than eight times in one day. The number usually depends on fluid intake, sleep habits and medications and can vary greatly between individuals. Keeping a urination diary is an effective way to record habit and determine if they are normal.
Nocturia involves interrupted sleep due to the urge to void urine as is related to high urinary frequency. This is considered to affect quality of life if the individual needs to urinate two or more times per night and disrupts sleep.
Urge incontinence is the involuntary loss of urine that occurs without an apparent reason. It is common for individuals to feel a sudden need to urinate and be unable to stop urine from voiding. A diary to record urinary habits can also help to diagnose urge incontinence and make therapeutic decisions.
Causes
The cause of the condition is unclear, although it has been linked to over activity of the detrusor urinae muscle.
Additionally, some other health conditions may predispose people to an overactive bladder. For example, characteristic symptoms of diabetes are increased thirst and urination.
There are also some substances that may lead to an overactive bladder. Medical diuretics are designed to increase urination and if this occurs to an exaggerated extent, could cause problems related to an overactive bladder. Caffeine and alcohol are both substances that lead to more frequent urination and may cause the condition.
Management
An overactive bladder does not always need treatment, as it does not pose serious complications but may, rather, be an inconvenience.
In the diagnostic process, it is beneficial for individuals suspected to have an overactive bladder to keep a diary to record their urination habits. This can then be continued if treatment is commenced to keep track of progress. If the quality of life is affected as a result of the overactive bladder, management may be required.
Behavioral therapies may play a role and are usually the first line choice for management, as they are relatively risk-free. This includes modifying lifestyle by restricting fluid intake and avoiding caffeine.
If pharmacological management is needed, anti-muscarinic drugs such as darifenacin, hyoscyamine, oxybutynin, tolterodine, solifenacin, trospium, and fesoterodine may be used. Mirabegon is an alternative choice.
For people with neurological conditions, such as multiple sclerosis or a spinal cord injury, botulin toxin A can help to suppress bladder contractions and offers a long lasting effect of up to 9 months.
Surgery can also be used to modify the spinal nerves to improve symptoms, however this is more invasive that other treatments and should be avoided where possible.
References
Further Reading