Overactive bladder

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Overactive bladder
Other names	Overactive bladder syndrome
Specialty	Urology
Symptoms	Frequent feeling of needing to urinate, incontinence
Complications	UTIs, anxiety
Usual onset	More common with age[1]
Duration	Chronic
Types	Age-related, or Secondary to other illness
Causes	Old age; detrusor muscle injury; over-consumption of water and caffeine; UTI; pelvic injury
Risk factors	Old age, obesity, caffeine, constipation
Diagnostic method	Based on symptoms after ruling out other possible causes[2][1]
Differential diagnosis	Other neurological conditions[2][1]
Treatment	Pelvic floor exercises, bladder training, drinking moderate fluids, weight loss,[3] medications, Botox, surgery
Medication	Anticholinergic drugs, β3 agonists
Prognosis	Often but not always incurable
Frequency	~40% of elderly adults, increasing with age

Overactive bladder (OAB) is a common condition where there is a frequent feeling of needing to urinate to a degree that it negatively affects a person's life.^[2] The frequent need to urinate may occur during the day, at night, or both.^[4] Loss of bladder control (urge incontinence) may occur with this condition.^[1] This condition is also sometimes characterized by a sudden and involuntary contraction of the bladder muscles, in response to excitement or anticipation. This in turn leads to a frequent and urgent need to urinate.

Overactive bladder affects approximately 11% of the population and more than 40% of people with overactive bladder have incontinence.^[5][6] Conversely, about 40% to 70% of urinary incontinence is due to overactive bladder.^[7] Overactive bladder is not life-threatening,^[1] but most people with the condition have problems for years.^[1]

The cause of overactive bladder is unknown.^[1] Risk factors include obesity, caffeine, and constipation.^[5] Poorly controlled diabetes, poor functional mobility, and chronic pelvic pain may worsen the symptoms.^[1] People often have the symptoms for a long time before seeking treatment and the condition is sometimes identified by caregivers.^[1] Diagnosis is based on a person's signs and symptoms and requires other problems such as urinary tract infections or neurological conditions to be excluded.^[2][1] Uroflowmetry is also a good diagnostic aid.^[8]

The amount of urine passed during each urination is relatively small.^[1] Pain while urinating suggests that there is a problem other than overactive bladder.^[1]

Specific treatment is not always required.^[1] If treatment is desired pelvic floor exercises, bladder training, and other behavioral methods are initially recommended.^[3] Weight loss in those who are overweight, decreasing caffeine consumption, and drinking moderate fluids, can also have benefits.^[3] Medications, typically of the anti-muscarinic type, are only recommended if other measures are not effective.^[3] They are no more effective than behavioral methods; however, they are associated with side effects, particularly in older people.^[3][9] Some non-invasive electrical stimulation methods appear effective while they are in use.^[10] Injections of botulinum toxin into the bladder is another option.^[3] Urinary catheters or surgery are generally not recommended.^[3] A diary to track problems can help determine whether treatments are working.^[3]

Overactive bladder is estimated to occur in 7–27% of men and 9–43% of women.^[1] It becomes more common with age.^[1] Some studies suggest that the condition is more common in women, especially when associated with loss of bladder control.^[1] Economic costs of overactive bladder were estimated in the United States at US$12.6 billion and 4.2 billion Euro in 2000.^[11]