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Overactive Bladder

2024/05/30

What is Overactive Bladder (OAB)?

Overactive bladder or OAB in short is diagnosed mainly by the symptoms of:

urgency (a sudden compelling desire to pass urine that is difficult to delay)
with or without urge incontinence (uncontrollable leakage of urine accompanied by or immediately preceded by urgency)
usually with frequency (the need to pass urine too often in the day time) and nocturia (the need to wake up at night more than once to pass urine)

How frequent is the condition?

OAB affects 11-22% of adults over 40 years old, the incidence increases with age

What are the causes?

Physiological: Increased intake of fluids (especially, coffee, tea, carbonated drinks containing caffeine), alcohol, fruits, vegetables; cool/rainy weather, indoors (especially with air-conditioning)
Psychological: Anxiety, stress, habit or social voiding and psychiatric conditions (e.g., obsessive compulsive neurosis)
Pharmacological: Certain medications like diuretics used to treat high blood pressure, heart, kidney or liver conditions, will increase urine production and cause frequent urination
Endocrinological: Diabetes mellitus and diabetes insipidus - deficiency or absence of the hormone insulin and anti-diuretic hormone respectively, resulting in increased urine production and output
Pathological: Urinary tract infection, menopause, pelvic organ prolapse, pelvic mass (uterine fibroid, ovarian cyst), bladder stone, bladder cancer, radiation treatment to bladder and pelvis, untreated heart failure, chronic cystitis, stress urinary incontinence, abnormal bladder contractions

What are the investigations?

These would depend on the cause/s of OAB from your history and physical examination:

Simple intake chart and urinary diary to record your fluid intake, urinary output and incontinence episodes
Urine test/s to diagnose urinary tract infection
Bladder scan to diagnose high residual urine after you have just passed urine
Pelvic scan to diagnose uterine fibroid or ovarian cyst
Urodynamics: Specialised computerised bladder tests to diagnose stress and/or urge incontinence of urine with or without abnormal bladder contractions; different types of voiding difficulty. The results would determine the treatment options, especially when surgery is planned for stress urinary incontinence and/or pelvic organ prolapse

Can it be treated?

The treatment is tailored according to the cause/s of OAB:

Conservative treatment with sensible fluid intake, reduction of coffee, tea and alcohol; regular voiding; pelvic floor (Kegel) exercises to strengthen the pelvic floor muscles
Local oestrogen cream and/or vaginal pessaries for post-menopausal women
Prevention and treatment of urinary tract infection
Medical treatment with various drugs to relax the bladder and reduce/stop abnormal bladder contractions
Appropriate surgical treatment whenever indicated