Overactive Bladder: Get me to a bathroom, PRONTO!

Overactive Bladder: Get me to a bathroom, PRONTO!

Do you….

HAVE to go to the bathroom first thing every time you come home?

Have all the bathrooms mapped out in the mall?

Go to the bathroom even if you don’t have to, but “just in case”?

Find yourself telling co-workers excuses for how often you go to the bathroom (drank too much water today, had to check your hair, must be the cold weather, etc.)

Put your keys in the lock and feel like you have to run in to the bathroom?

Have to go to the bathroom or feel you might lose your urine when you hear running water?

If you are consistently answering yes to the above questions and/or find yourself urinating more than 5-7x/day and 0-1x/night (a little more at 1-2x/night for >50 years old); you may have an overactive bladder (OAB), also known as detrusor overactivity (DO).

First off, I know what you’re thinking. OAB? Not me. That’s the commercial with the old ladies, wearing diapers and pushing bladder pills. It’s true that OAB affects more women than men, but not by much! The NOBLE (National Overactive Bladder Evaluation) Study by the NIH evaluated the prevalence of OAB in the US and it’s impact on quality of life. They found the prevalence in men as high as 16% and 16.9% in women. Also, while it’s more common in the aging population, its not just an old lady problem. As much as 18% of women and 9% of men with OAB are under 50 years old. Most articles report that OAB is severely under reported in persons under the age of 50.

So, what exactly is OAB? Its defined by the International Continence Society (ICS) in 2010 as “urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence (UUI), in the absence of urinary tract infection or other obvious pathology.” Urgency is that overwhelming sensation of having to get to the bathroom immediately often with fear that you will lose urine. Urinary frequency is the amount of times you void (aka pee) in a day with 5-7x in the waking hours being “normal”. Nocturia is increased frequency of voids which wake you at night with 0-1x being normal for <50 years old and 1-2x for >50 years old. Urge urinary incontinence (UUI) is the loss of urine, either partially or complete, associated with a strong urge to go to the bathroom or inability to make it in time.

OAB is caused by an over activity of the detrusor, which is the muscle of the bladder wall. Often with OAB, the brain and nerves communicating with the bladder are sending a bad signal. Instead of telling the bladder, “oh – you’re just filling, no biggie, keep going”, it says, “your full and going to leak, get to a bathroom now!” – even though the bladder is only half full.

Treatment of OAB, if severe enough, often includes medications (antimuscarinics) which unfortunately have multiple side effects, including severe dry mouth. A lot of patients I have seen don’t think the drugs are worth it. There is also behavioral training, which is usually taught by a pelvic floor physical therapist. Here is a list of some different techniques for which physical therapists educate patients:

Education on normal bladder function

Bladder retraining

Urge deference techniques

Pelvic floor muscle coordination exercises

Proper bladder habits (such as avoiding the “just in case” void and straining to void)

Dietary and fluid intake changes including eliminating bladder triggers such as caffeine

If you have an OAB, I strongly urge (no pun intended) you to talk to your health care provider about seeing a physical therapist for help. OAB is not typically associated with bladder/pelvic pain or bleeding – these may be signs of another condition. It is important to discuss this with your doctor.

If you suspect you have an overactive bladder, you can start conservative treatment by retraining the brain to have better bladder habits. One way to do this is with urge deference techniques. If you find you are voiding more than every 3-4 hours, you can work on delaying or deferring the void. One technique to do this is using diaphragmatic breathing (belly breathing) and distraction techniques (such as counting backwards by 100 to allow the brain to focus on something other than the bladder).

There are many other tools that can help with treating OAB, which is why seeing a pelvic floor physical therapist is important whether you are male or female, young or old. This conservative treatment works well and can help improve your quality of life!

Here’s a reference to a good article describing the different behavioral techniques in more detail, if you are interested.

Newman DK, Wein AJ. Office-based behavioral therapy for management of incontinence and other pelvic disorders. Urol Clin N Am 2013;40:613-635.

This article was written by:

Elayne Geba PT, DPT, WCS

Pelvic Floor and Orthopedic Physical Therapist and Women Health Certified Specialist