This site is intended for Healthcare Professionals only

Let's look at...overactive bladder

In-depth bookmark icon off

Let's look at...overactive bladder

Overactive bladder (OAB) is a common problem that affects around seven million people in the UK. What does it mean for sufferers and what advice can you offer?

What is overactive bladder?

People with overactive bladder (OAB) experience a need to pass urine with little warning, which can result in urinary incontinence. The condition occurs because the bladder muscle (the detrusor) contracts spontaneously or too frequently, often when the bladder is not full.

What causes it?

Causes of OAB can include urinary tract infections, benign prostatic obstruction in men, spinal injuries or tumours, Parkinson’s disease, stroke, multiple sclerosis or certain medication (e.g. diuretics or opioids). Where there is no obvious underlying cause, it is known as overactive bladder syndrome, or irritable bladder.

50 per cent of women with OAB don’t feel comfortable talking to family and friends

Who is affected?

OAB affects around one in six people in the UK. It is more common as people grow older, and around 30-40 per cent of those aged over 75 years are affected. Women are more likely to suffer than men.

What are the symptoms?

  • Urgency – a sudden need to pass urine with little warning
  • Frequency – a need to pass urine more often than normal. For most people, it’s at least seven times a day
  • Nocturia – waking up to go to the toilet more than once in the night
  • Urge incontinence – a third of people with OAB have urine leakage before they can make it to the toilet
  • Coital incontinence – leaking urine during sex

Symptoms can be worsened by certain irritants, such as caffeine and alcohol, and during times of stress.

What is the impact?

People with OAB are often hugely embarrassed about their condition. For example, more than 50 per cent of women with OAB don’t feel comfortable talking to family or friends and one-third don’t feel comfortable talking to their GP.

From a practical perspective, it can mean an increased amount of clothes to wash and dry due to uncontrolled urine leakage, and there may be concerns over travelling and being far away from a toilet.

How is OAB treated?

Where the underlying cause is known, treating it can help. For example, antibiotics can be prescribed for urinary tract infections or treatment given for benign prostatic hyperplasia. Antimuscarinic drugs (e.g. oxybutinin) inhibit contractions of the bladder muscle, reducing the feeling of needing to pass urine urgently and increasing bladder capacity. However, side effects, such as dry mouth, constipation and blurred vision, are common with these drugs, which are only available on prescription.

Mirabegron is a selective beta-3 agonist that reduces the frequency of bladder contractions as the bladder fills, helping to decrease urinary frequency, urgency and urge incontinence. It may be prescribed for those who cannot take antimuscarinics or who have found them ineffective.

Self care support

Medication is often not enough on its own and should be used in addition to self care. The primary measure here is bladder training, which works in up to 50 per cent of sufferers. This involves stretching the bladder so that it gets used to holding more urine, making the detrusor muscle less overactive.

Patients should be advised to keep a diary for a couple of days, noting how often they go to the toilet, how much urine they pass and if there is any incontinence. Then they should try to hold on for as long as possible before going to the toilet to train their bladder to stretch and get used to holding larger volumes of urine. The aim is to gradually train the bladder over a period of months so that urine is passed only every three to four hours.

Pelvic floor exercises may also be recommended to strengthen the muscles that run underneath the bladder.

General lifestyle tips that can help include:

  • Avoiding caffeine as it has a diuretic effect and can directly stimulate the bladder
  • Avoiding alcohol as it makes symptoms worse
  • Drinking normal amounts of fluid (around two litres a day) as cutting down can concentrate urine, which then irritates the bladder muscle
  • Using the toilet only when needed (i.e. not going in advance as the bladder gets used to holding small amounts of fluid)

Signposting

  • The Association for Continence Advice (www.aca.uk.com) – an organisation for health and social care professionals interested in continence
  • The Cystitis and Overactive Bladder Foundation (www.cobfoundation.org) – a patient organisation offering information, advice, ‘can’t wait’ cards and a virtual chat room
  • The Bladder and Bowel Foundation (www.bladderandbowelfoundation.org) – provides information, advice, forums and a bladder diary for patients
  • Bladder Problem (www.bladderproblem.co.uk) – a patient information site sponsored by Astellas in partnership with the Bladder and Bowel Foundation
Copy Link copy link button

In-depth

Share: