Overactive Bladder is a very common problem in males and females and is characterised by the severe urgency to empty one’s bladder (frequency) and is sometimes associated with incontinence.

The constellation of symptoms is very non-specific and can be found in many conditions such as UTI’s, bladder cancer or prostate cancer. A diagnosis of Overactive Bladder that is not associated with the conditions like the ones above, is made after investigations like urine tests, blood tests and cystoscopy.

Symptoms

OAB symptoms are non-specific and overlaps with a lot of other conditions. These symptoms include:

Urgency: the feeling that one’s bladder has to be emptied right now

Frequency: the need to empty one’s bladder frequently during the day

Nocturia: waking up multiple times during the night to empty one’s bladder

Incontinence: the occurrence of urinary leakage, frequently associated with a sense of urgency.

Diagnosis

The diagnosis of OAB is made after a consultation, physical examination and the analysis of blood and urine tests. Frequently you will be asked to complete a bladder diary, which is a 48 or 72 hour record of what fluids you take in, how much you expel in the form of urine and whether or not it is associated with urgency and/or leakage. A cystoscopy may also be needed to evaluate the bladder and water tube (urethra). An ultrasound may also be necessary and in some patients a urodynamics test where the pressure in the bladder is evaluated while the bladder is filling and while it is emptied.

Treatment

There are many different treatment options for patients with OAB. It is important to know that this is a condition where treatment needs to be individualised and tailored to the patient and where one size does not fit all. Treatment may include:

Pelvic Floor physiotherapy and Bio Feedback

Bladder training which may include double voiding or timed voiding

Modification of diet and avoiding certain foods, like spicy foods or caffeine.

Medication: typically two classes of medication are used which would include Beta3 Agonists or Anticholinergics. The mechanism of action is by relaxing the bladder wall to reduce the amount of urgency and frequency that the patient experiences.

Botox injections in the bladder wall: This is done via cystoscopy and the aim is to partially paralyse the bladder wall in order to decrease the amount of urgency and frequency episodes a patient experiences. This is typically reserved for patients who are refractory to conservative management as above, especially those with high rates of incontinence. You will require a urodynamics test prior to Botox therapy and it would need to be repeated, usually 6-9 monthly.

Neuromodulation: Small electrodes are placed next to the sacral nerves that supply the bladder. Electrical impulses modulate the signals that are carried to the brain, altering the perception/sensory input from the bladder.