What Is Overactive Bladder?

Introduction

Bladder is an organ which functions as a storage tank and excretion center of the urine.¹ The overactive bladder symptom (OAB) is a condition which triggers urgent urination.² However, it should be highlighted that the overactive bladder symptom is completely different from having an infection and subsequently over urinating.

This medical condition of OAB is highly prevalent in the society and seen in all ages and genders, whereas, the most common occurrence has been observed in people over their 40s.² 

Healthy Functioning of the Bladder

The two main stages happening inside a healthy bladder are the storage and voiding phases. 

Storage Phase

The main muscles of the bladder are detrusor muscles.¹ They play a role in the storage phase by changing their smooth muscle cells into a flattened share to allow the filling and storing of the urine. Furthermore, there are internal urethral sphincter muscles lying across the neck of the bladder to urethra. Those muscles have receptors which get stimulated for the contraction of the muscles. This action supports the filling of the urine into the bladder and storing it.

Voiding Phase

For the excretion of the urine, internal sphincter muscles relax whereas external sphincter muscles contract.¹ Healthy individuals, who get the toilet training when they are infants, can control involuntary voiding to prevent leakage of the urine. 

Neuronal Control

Both the storage and voiding phase are controlled by the neurons in the brain. The area of the brain responsible for the action of bladder muscles is called the micturition center. Parasympathetic neurons, which are responsible for the involuntary actions of the body,³ initiate the contraction of detrusor muscles whereas they stimulate the relaxation of internal urethral sphincter muscles.¹ As a result, the urine is excreted out of the bladder. On the other hand, Sympathetic neurons trigger the relaxation of detrusor muscles while promoting the constriction of internal urethral sphincter muscles for the filling of the bladder with urine. Sympathetic.⁴ 

Causes & Risk Factors of Overactive Bladder

Causes: Muscle and Nerve Dysfunction

For the pathological perspective of the causes, there are many theories proposed by different study groups.⁵ The definite answer is yet to be explored. The first theory, which is known as myogenic theory, accuses detrusor muscle of being too over reactive to stimuli. The second one, which is called urotheliogenic, proposes a urothelium related-problem as an underlying cause of OAB. The third theory, arthrogenic, puts forward the urethra as the source of OAb. The fourth one, advocates the deterioration in white matter part of the brain (responsible for the communication of signals), as the cause of the condition. The final theory suggests the hypofunction of the detrusor muscles. 

Age and Gender Factors

Age is a highly common risk factor. People over the age of 40 tend to develop OAB at higher risk compared to lower age groups. Especially, in postmenopausal women, reduced levels of estrogen increases the risk of the occurrence of OAB.⁵ All the risk factors can be summarized as the following:

• Obesity
• Mental disorders
• Functional gastrointestinal disorders (such as irritable bowel syndrome)
• Gender 
• Age 
• Autonomic nervous system dysfunction (regulates parasympathetic and sympathetic nerves)
• Ethnicity (African-American and Hispanic people have higher risk of developing the OAB)
• Sleep apnea
• Alcohol consumption
• Over consumption of coffee

Symptoms of Overactive Bladder 

Urinary Frequency

This refers to the situation when you need to urinate with an increased frequency relative to normal. This also includes both day and night urination

Nocturia 

Nocturia is a condition when you need to wake up from your sleep to urinate at least one time.

Urinary Urgency

Urinary urgency is the situation when you feel an immediate, unexpected and intense urgency of urination.

Diagnosis of Overactive Bladder

For the diagnosis of overactive bladder, patient story is highly crucial to determine the symptoms and duration of the symptoms.⁶  Moreover, simple urine and urine culture tests should be carried out for evaluation of the infection. If there is any infection, treatment is required. Later on, the symptoms should be re-evaluated to confirm whether the complaints were associated with the overactive bladder or presence of urinary tract infections.

Then, physical examination is carried out on the area covering abdominal, pelvic and perineal examination. Also, evaluation of voluntary pelvic floor muscle contraction is among the diagnostic methods for the AOB.

Treatment of Overactive Bladder

The treatment methods can be subdivided into two main categories; non-pharmacological and pharmacological treatment options:²

Non-pharmacological treatment options

• weight loss and exercise
• dietary and fluid intake changes (restriction of fluids)
• bowel regulation
• cessation of smoking
• bladder training (habit-training schedules)
• Kegel exercises
• vaginal weight training
• pelvic floor exercise with biofeedback
• pelvic-floor electrical stimulation

Pharmacological Treatment Options

Anticholinergic drugs are in use for the treatment of overactive bladder symptoms. However, side-effects such as mouth dryness and constipation are highly concerning by the patients and eventually, they stop using the medication.²

On the other hand, Β3-agonists can also be used for the treatment of OAB.⁵ The side-effects of this drug are less concerning, however, in some patients, the change in heart rate and increase in blood pressure have been observed. Only one drug called Mirabegron has a license and it is in use as a second line treatment for the patients who cannot tolerate the anticholinergic drugs. As a result, the drug medication is not a highly effective method and alternative treatments are yet to be explored.⁵

Coping Strategies for OAB

Coping with overactive bladder (OAB) involves a combination of lifestyle modifications, behavioral strategies, and, in some cases, medical interventions. Here are some coping strategies for managing overactive bladder:

• Bladder Training:
  • Gradually increase the time between bathroom visits, extending the time you can comfortably wait before urinating. This can help improve bladder control over time.
• Scheduled Voiding:
  • Establish a regular schedule for bathroom breaks, even if you don't feel the urge. This can help retrain the bladder and reduce urgency.
• Pelvic Floor Exercises (Kegel Exercises):
  • Strengthening the pelvic floor muscles can help improve bladder control. Kegel exercises involve contracting and relaxing the muscles that support the pelvic organs.
• Fluid Management:
  • Adjust your fluid intake, avoiding excessive consumption close to bedtime. Limiting caffeine and alcohol, which can irritate the bladder, may also be beneficial.
• Healthy Diet:
  • Maintain a balanced diet rich in fiber to prevent constipation, which can exacerbate OAB symptoms. Certain foods and drinks, like spicy foods, citrus, and artificial sweeteners, may irritate the bladder and should be consumed in moderation.
• Weight Management:
  • Maintaining a healthy weight can reduce pressure on the bladder and improve overall bladder function.
• Avoiding Bladder Irritants:
  • Identify and minimize consumption of substances that can irritate the bladder, such as caffeine, alcohol, and certain acidic or spicy foods.
• Behavioral Techniques:
  • Relaxation techniques, such as deep breathing and meditation, may help manage stress and anxiety, which can contribute to OAB symptoms.
• Clothing Choices:
  • Wear loose, comfortable clothing to minimize pressure on the bladder. Avoid tight belts or waistbands.
• Portable Urinals/Incontinence Products:
  • Carry portable urinals or incontinence products when you're away from home to manage unexpected urges.
• Medical Interventions:
  • In some cases, medications may be prescribed to relax the bladder or reduce its contractions. Consult with a healthcare professional to discuss suitable options.
• Biofeedback and Physical Therapy:
  • Biofeedback techniques and physical therapy may be recommended to improve pelvic floor muscle function and control.
• Support Groups:
  • Joining a support group can provide a forum for sharing experiences, tips, and emotional support with others who have OAB.

Summary

The overactive bladder (OAB) is a condition which leads to urgent urination, more than normal. OAB is an elderly disorder and the intense effects have been observed in old people. Nevertheless, there is no complete cure currently. The symptoms should be well aware of and possible treatments should be applied immediately to improve the quality of life of the patients as much as possible. The physiological support for the patients are highly important for their wellbeing.