The A-Z of OAB
Professor Barry O’Reilly, obstetrician and gynaecologist at Cork University Hospital, describes a condition that affects up to 350,000 people in Ireland – many of whom worry about stigma and social anxiety.
Overactive bladder (OAB) is a treatable medical condition in which the bladder is more active than usual. Instead of staying at rest as urine fills the bladder, the muscle contracts frequently and spontaneously. This causes a person to feel a sudden and sometimes overwhelming urge to urinate, which cannot be suppressed even when the bladder is not full. OAB is different to stress urinary incontinence which is caused by weakened pelvic floor muscles and results in leakage through coughing, sneezing or exercise for example.
OAB is a common problem that can affect men, women and children of any age, although sufferers are predominately women. Incidents of OAB increase with age - one-quarter of Irish women aged 40-70 have experienced overactive bladder (OAB) symptoms, according to research.*
People affected by OAB do not always seek medical help or advice due to embarrassment, the belief that there is no help available or because they feel it is a natural consequence of ageing. We know from recent national data that 28%** of undiagnosed sufferers don’t present to a doctor because they feel they can ‘cope’ with their symptoms. Of those that do seek medical attention, most wait over a year before they actually go to see their doctor.
Some, or all of the following symptoms, may be present in those with OAB:
- Frequency - having to go to the toilet more than eight times over 24 hours. If you wake up to go to the toilet more than once during the night you may have a problem called nocturia i.e. frequency at night.
- Urgency - strong, sudden need to go to the toilet that necessitates rushing to the toilet.
- Urge incontinence - this is an overwhelming urgency to urinate but not having enough time to get to the toilet resulting in leakage of urine.
Quality of life
Incontinence impacts not only on the physiological but also the psychological realms of a person’s life. The condition can have significant impact on self-esteem and general wellbeing, for example:
- Sleep disturbance & falls - People experiencing OAB generally need to get up frequently at night to go to the toilet. This disrupts sleeping patterns, can lead to sleep deprivation and increase the risk of falls which is a leading cause of elderly admissions to hospital with premature admission to long term care.
- Self-image and social isolation - Studies have shown that people experiencing difficulties with incontinence suffer from anxiety regarding the odour or staining of clothes and tend to feel more isolated from peers as a result of the condition. Social contact with friends is often avoided also because of embarrassment or concerns that people might comment. Furthermore, mental health issues, including depression and anxiety, commonly co-present in people experiencing difficulties with continence.
- Employment - Incontinence may impact on productivity and wellbeing in the workplace, for example work can be interrupted by the need to take frequent toilet breaks.
- Interpersonal relationships - Studies have found that up to 50% of women who suffer from incontinence avoid sexual intercourse.** This is mainly due to low self-esteem and the risk of embarrassment.
- Leisure activities - OAB symptoms can prevent people from participating in active pursuits such as sports because of anxiety regarding potential leakages. This tends to have knock- on impacts in terms of obesity.
Diagnosis can be made by your doctor who will take a careful medical history, perform a physical examination and test a urine sample provided by you. Other tests may be required including urodynamic studies which looks at the pressure changes in the bladder and telescopic examination of the bladder.
Bladder control problems and urinary incontinence are not normal no matter how old you are. It is not necessary to learn to live with the problem, as there are many treatments available that will either cure or significantly improve the problem in the vast majority of people. If you are experiencing a lack of bladder control, you owe it to yourself to seek help and to discuss your symptoms with your doctor.
My top tips for managing the condition if diagnosed include:
Fluid intake: Normal fluid intake in this climate should be 1.5-2 litres/day or 6-8 glasses of fluid. Simply avoiding excessive fluid intake may help symptoms. Caffeine is a potent bladder stimulant so it is important to avoid caffeinated drinks – in particular, it is important to remember that tea contains as much caffeine as coffee. Alcohol has a similar effect on the bladder and should be moderated.
Smoking: Nicotine can irritate the bladder muscle, causing bladder contraction and urgency. Coughing, as a result of smoking, may cause urinary leakage also.
Diet and exercise: Some people may suffer from sensory urgency due to artificial sweeteners and certain acidic foods. Being overweight can cause pressure on the bladder, which may increase the symptoms of overactive bladder. Try to adopt a healthy diet, which should assist with weight loss as well as regulating bowel movement.
Constipation: This increases pressure on the bladder. If constipation is a constant problem, you should contact your practice nurse or GP.
The aim of this exercise is to increase the length of time between your trips to the toilet. This involves changing your daily schedule of toileting over a period of weeks and months so that you are slowly building up the time between visits. For example, if you are going to the toilet every 2 hours, try increasing the time of your next trip by 15 minutes and so on.
Pelvic Floor Exercises
Pelvic floor exercises can help to reduce urge and frequency in OAB. These movements, usually taught by a physiotherapist, involve repeated contractions of the pelvic floor muscles to build strength.
In cases of overactive bladder drug therapy can often be effective in restoring bladder control in many sufferers. However, for best results we recommend a “package of care” which includes lifestyle changes, a bladder re-training program with pelvic floor exercises and a complete course of medication.
*Astellas / Accuracy OAB General Public Survey conducted in June 2017 among 301 women aged 40-70
**Astellas Understanding the OAB patient journey – Ireland country report December 2017