Overactive Bladder

Overactive bladder (OAB) is not a disease. It is the name used for urinary symptoms which is most often characterized by a sudden, strong urge to urinate that is very difficult to postpone. This feeling of urgency is caused by sudden, involuntary contractions of the bladder muscle, which is called the detrusor.

Typical Symptoms of OAB:

• Urgency: The urge to urinate is sudden, strong, and seemingly impossible to postpone.
• Frequency: Voiding (urinating) more frequently than is considered normal (more than 8 times a day).
• Urinary Incontinence (also called OAB-wet): Leakage of urine associated with the overwhelming urge to urinate.
• Nocturia: Waking up at night due to the urge to urinate.

Ineffective (But Common) Management Strategies:

Below are some common strategies that men and women with OAB tend to employ to help manage their symptoms:

• Toilet Mapping: Knowing where all the bathrooms are in the places you go like the mall, the route to and from work, the grocery store, etc. Anxiety may be felt when treading new territory over whether a bathroom will be easily accessible or not.
• Fluid Restricting: Limiting the amount of fluid you consume, thinking that the frequency, urgency, and leakage may be less if you consume less fluid. Unfortunately, restricting the amount of non-caffeinated fluid can have the opposite effect and can actually irritate the bladder, causing more urgency and frequency.
• Pre-Emptive Urination: Urinating “just in case” instead of only when you feel a strong urge to go. This often happens before leaving the house, before a meeting or appointment, or before getting in the car or on the bus. The rationale behind this strategy is that if there is less urine in the bladder, there will be less urgency, frequency, and the likelihood of urinary leakage. However, because the strong urge to urinate experienced in OAB is not correlated with the amount of urine in the bladder, this technique is not helpful. In fact, it can actually lead to increased frequency and urgency as the bladder becomes accustomed to being emptied far more often than it needs to be.

Effective Treatment Strategies

As explained above, some of the strategies people commonly implement in efforts to manage their OAB symptoms are not helpful and can even contribute to continued symptoms. So, what is recommended for those dealing with OAB? The most effective treatment options include lifestyle and behavioural changes with or without the use of pharmaceuticals such as:

Lifestyle and Behavioural Treatment Approach:

A large component of the behavioural approach to OAB treatment includes bladder retraining, which teaches one to suppress the urge to urinate for progressively longer periods of time with greater control. A physiotherapist can develop an individualized plan for you, but what follows is an outline of bladder retraining:

• Based on current voiding pattern, as determined by a bladder diary, your therapist will make appropriate recommendations.
• For example, if you currently void once every hour, your therapist may suggest you void once every hour and 15 minutes.
• If you feel the urge to urinate before the next scheduled time, you will be encouraged to implement urge suppression techniques and strategies.
• Urge Suppression May Include:
  • Staying calm
  • Sitting down
  • Deep breathing
  • Pelvic floor muscle relaxation or reverse Kegels
  • Mental distraction (counting backwards, making a phone call)
  • Sensory distraction (digging your nail into your hand)
• If you are able to suppress the urge until the next scheduled void, great! If not, make your way to the bathroom in a slow, calm manner.
• When you are successful, your therapist will ask you to gradually increase the amount of time between voids, likely by 15 minute increments, until you reach your goal of a normal voiding schedule (voiding once every 3-4 hours).
• Bladder retraining can be very successful but takes time and patience.

In addition to bladder retraining, the following suggestions may also be helpful:

• Ensure your pelvic floor muscles are as healthy as possible. A pelvic health physiotherapist can assess your pelvic floor muscles and determine if your muscles are weak or tight, and develop an individualized treatment plan specific to your symptoms and your body. Sometimes pelvic floor muscles are weak and require strengthening to decrease OAB symptoms. Often, however, the pelvic floor muscles are too tight, contributing to urgency and frequency. In this case, treatment and exercises to help relax and lengthen the pelvic floor muscles will help to lessen your OAB symptoms.
• Address constipation as it can have many negative effects on the function of the bladder. Frequent straining to evacuate the bowels can put undue pressure on the pelvic floor muscles, potentially weakening them. Also, if the bowels are very full, this may limit the ability of the bladder to both fill and empty properly, leading to increased urinary frequency.
• Implement mindfulness, meditation, or conscious relaxation into your regular routine as anxiety and stress exacerbate OAB symptoms.
• Decrease and/or eliminate potential bladder irritants from one’s diet (caffeine, spicy food, acidic food, alcohol, carbonated beverages).
• Stay hydrated, sipping fluids throughout the day instead of chugging large amounts of liquid at once.
• Decrease or eliminate fluids 2-3 hours before bedtime.
• Review your medication list with your physician or pharmacist to ensure none of your evening medications are acting as diuretics, contributing to the urge to urinate in the middle of the night.
• Lie down and elevate your feet above your heart for half an hour in the evening in order to help your body get rid of some excess fluid before bedtime. Your heart most effectively eliminates fluid from your legs when lying down versus standing up, producing more urine. Therefore, if you lie down before bed, void your bladder, and then go to bed for the night, you may not get up to void as frequently throughout the night.

Medical/Pharmaceutical Treatment Approach

Several medications are used to treat OAB, with the goals of reducing urinary urgency/frequency, increasing the bladder’s capacity to hold urine, and decreasing urinary leakage. It has been shown that medication used in conjunction with the lifestyle and behavioural modifications discussed above often produces better results than medication used alone. Also, keep in mind that some people experience side effects with these medications. Speak with your physician to discuss if any of the following common medications for OAB may be appropriate for you:

• Anticholinergics: Ditropan, Vesicare, Detrol, Enablex, Toviaz
• B-3 Agonists: Myrbetriq

In the event that pharmaceuticals and lifestyle and behavioural treatments do not work sufficiently, there are other options. A non-surgical intervention offered by some physiotherapists called percutaneous tibial nerve stimulation involves stimulating the tibial nerve in the lower leg, which communicates with nerves responsible for bladder function. In rare cases, surgical options including injection of Botox into the bladder wall and sacral neuromodulation are the treatments of choice for OAB symptoms. 

Remember that OAB is treatable and often responds well to non-invasive treatment. A pelvic health physiotherapist can provide education, guidance, and a personalized treatment plan to help you manage your symptoms and regain your quality of life.