Introduction
Overactive bladder (OAB) is a problem that can occur in both men and women of any age but tends to become more prevalent as we get older. It remains unclear why overactive bladder occurs. OAB is a combination of symptoms that includes frequency, urinary urgency and urge incontinence. (1) Frequency is simply an increased number of trips to the restroom throughout the day and night, urinary urgency is a strong sudden desire to urinate and urge incontinence is an uncontrolled, undesired loss of urine.
Urinary frequency, urgency and incontinence can greatly disrupt the lives of the individual with OAB. A survey of 483 people with OAB demonstrated that even those without incontinence had a poorer quality-of-life than the healthy people who took the same survey. This included lower scores in mental health, how they perceived their own health and intensity of pain. (2) OAB can disrupt an individual’s social life and ability to work. It has been reported that as many as 60 percent of women with urinary incontinence avoid leaving the house. (3) OAB can also affect a person psychologically, physically and sexually. Many people who suffer from OAB are very reluctant to discuss their problem with a healthcare provider, and thus do not receive the help that is available to them. (4) Many find ways to cope with their problem by adjusting their lifestyle or using sanitary protection such as pads designed for incontinence.
The bladder is a membrane sac that serves as a temporary collection reservoir for urine to be held before it is released from the body by urination. The bladder is capable of shrinking or expanding depending on the amount of urine that it contains. The outside wall of the bladder is covered with the detrusor muscle, a muscle that automatically contracts or relaxes depending upon the amount of fluid inside the bladder. The nervous system is also involved in the urination process. It is able to sense when the bladder is full, send a signal for the detrusor muscle to contract and also helps control the sphincter that allows the person to initiate urination. (5)
For unknown reasons, in OAB the body inappropriately senses the volume of urine contained within the bladder and the detrusor muscle tends to contract and relax in an uncontrolled, sporadic manner. The increased frequency is likely a combined result of the decreased function of the bladder as well as a way in which the person adapts to try to avoid leaking urine. Urgency is the uncontrolled contraction of the detrusor muscle leading to an increased urge to urinate. The urinary incontinence occurs when the contraction of the detrusor muscle cannot be overcome.
There are multiple causes for bladder incontinence. With OAB the person is limited by the symptoms and generally the bladder or urinary tract does not deteriorate any further. Other causes for urinary incontinence include problems with the sphincter on the urethra, birth defects, blockages in the bladder or urinary tract infections. A condition known as neurogenic bladder has the same symptoms as OAB and can be classified as OAB, but generally results from a disease of the nervous system such as multiple sclerosis, Parkinson’s disease or even a spinal cord injury. (6) It is important to have a healthcare professional determine why the urine incontinence exists so that the proper treatment can be given.
Statistic
World Health Organization, 1998.
-
Overactive bladder (OAB) and urinary incontinence (UI) affect 200 million people worldwide.
Overactive bladder affects greater than 17 million individuals in the United States. (7) But, since many individuals do not seek medical care for the problem it is impossible to predict how many individuals are affected by OAB with estimates ranging from 3 to 43 percent of the population. (8)
Increasing prevalence of OAB with increasing age.OAB is more common in women than in men. (9)
Signs and Symptoms
The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.
The overactive bladder is generally associated with three symptoms. These symptoms include:
- Frequency – frequency simply means urinating more than usual. Though no set guidelines for urinary frequency exists, The National Counsel on the Aging has noted that urinating more than 8 times per 24 hours, including 2 or more times during the night can be considered an increased frequency.
- Urgency – urgency is a strong sudden urge to urinate. These urges can be hard to control.
- Urinary incontinence – incontinence is simply wetting accidents. These strong urges can lead to small amounts of uncontrolled urine leaking to uncontrolled complete emptying of the bladder.
General
- Frequent trips to the restroom for urination
- Sudden, strong urges to urinate
- Wetting accidents
Treatment Options
Conventional
Treatment for overactive bladder ranges from the use of protective equipment to surgery. The use of incontinence pads or protective equipment simply helps to prevent urine from soaking through the clothes. Bladder training is a means of teaching the body to urinate at specific times throughout the day in order to avoid unwanted leaking and accidents. Bladder training has been shown to be effective for managing OAB, but takes a lot of work, motivation and discipline. Another technique that has been used is intermittent catheterization. A person suffering from OAB can be taught to insert a tube into the bladder to drain the urine. This would have to be done several times a day. Catheterization should only be used by those who cannot completely empty their bladder when they urinate. Surgery can be performed, but it is very rare and is used in only extreme cases.
Drug therapy is also used to control overactive bladder. Several drugs have historically been used to control overactive bladder including hyoscyamine and oxybutynin. Oxybutynin is effective for OAB and is approved by the FDA to treat bladder instability. Recently an extended release version of oxybutynin has become available allowing for more convenient once-a-day dosing, fewer side effects and approval for OAB. (10)
Drug manufacturers have continued to research new drug products for OAB because of the numerous side effects that make it difficult to use oxybutynin. Some of the more troubling side effects include dry mouth and constipation. A newer product is now available, tolterodine (Detrol), which also has an extended release version (Detrol LA). (11) Human studies have shown oxybutynin and tolterodine to improve urine frequency and incontinence by about the same amount. (12) The advantage of tolterodine over the oxybutynin is fewer side effects, especially dry mouth. A review of the medical studies available concluded that tolterodine is an effective alternative to oxybutynin and causes less frequent and less intense dry mouth which allows the patients to continue on the medication for longer periods of time. (13)
Nutritional Suplementation
The physical problems that exist leading to overactive bladder (OAB) have not been successfully treated with nutritional supplements. L-arginine is available as a supplement that assists in creating nitric oxide in the body. Nitric oxide has demonstrated several benefits in the body, including bladder health and relaxation. The benefit of using L-arginine for OAB has not been proven.
Herbal Suplementation
Several herbal supplements are available to help treat disorders and infections of the urinary tract. These supplements may help with inflammation, urinary tract infections or prostate problems, but are not effective for overactive bladder. It is important to have a proper diagnosis and appropriate treatment options before taking any supplements or medication.
References
- Elliott DS, Lightner DJ, Blute ML. Medical management of overactive bladder. Mayo Clin Proc. Apr2001;76(4):353-5.
- View Abstract: Liberman JN, Hunt TL, Stewart WF, Wein A, Zhou Z, Herzog AR, et al. Health-related quality of life among adults with symptoms of overactive bladder: results from a U.S. community-based survey. Urology. Jun2001;57(6):1044-1050.
- Norton PA, MacDonald LD, Sedgwick PM, Stanton SL. Distress and delay associated with urinary incontinence, frequency, and urgency in women. BMJ. Nov1988;297(6657):1187-9.
- View Abstract: Abrams P, Kelleher CJ, Kerr LA, Rogers RG. Overactive bladder significantly affects quality of life. Am J Manag Care. Jul2000;6(11 Suppl):S580-90.
- Brooks JD. Anatomy of the Lower Urinary Tract and Male Genitalia. In: Walsh PC, et al, eds. Campbell’s Urology. 7th ed. Philadelphia, PA: W.B. Saunders; 1998:107-9.
- Elliott DS, Lightner DJ, Blute ML. Medical management of overactive bladder. Mayo Clin Proc. Apr2001;76(4):353-5.
- View Abstract: Diokno A, Lee P, Zorn BH, Lenderking WR, Grossman MA, Bull SA, Albrecht D. Factors associated with clinical assessment of overactive bladder and selection of treatment. Clin Ther. Sep2001;23(9):1542-51.
- View Abstract: Milsom I, Stewart W, Thuroff J. The prevalence of overactive bladder. Am J Manag Care. Jul2000;6(11 Suppl):S565-73.
- View Abstract: Milsom I, Stewart W, Thuroff J. The prevalence of overactive bladder. Am J Manag Care. Jul2000;6(11 Suppl):S565-73.
- Ditropan XL (oxybutynin, extended release), Product Prescribing Information. ALZA Corp. Mountainview, CA. Jul1999.
- Detrol LA capsules (tolterodine tartrate), Product Prescribing Information. Pharmacia & Upjohn Co. Kalamazoo, MI. Dec2000.
- Elliott DS, Lightner DJ, Blute ML. Medical management of overactive bladder. Mayo Clin Proc. Apr2001;76(4):353-5.
- View Abstract: Crandall C. Tolterodine: a clinical review. J Womens Health Gend Based Med. Oct2001;10(8):735-43.
