When nature calls too often, too suddenly and too urgently—and it's a feeling that cannot be denied or deferred—you may have overactive bladder syndrome (OAB).
Some people with OAB make it to the bathroom in time without having an accident; others aren't so lucky. Either way, it's estimated that up to 34 million people in the United States have overactive bladdera condition that encompasses a constellation of symptoms including a sudden, strong need to urinate right away (urgency), or more times per day (frequency) and the need to get up at least twice a night to use the bathroom.
But it's the urgency—the feeling that you have to get to the bathroom immediately—that's the critical component of OAB. Sometimes people with OAB feel the need to urinate even if they've just gone to the bathroom, or they might take many trips to the bathroom only to void just a little bit each time.
Yes, the condition can be incredibly frustrating and life-altering, but it's nothing to be ashamed of—especially since help is readily available. By talking to your doctor, describing your symptoms accurately and working together to find the right treatment, you can stop living at your bladder's mercy. The first step: Understanding what OAB really is.
When Nerves Send the Wrong Signal to the Bladder
Filling, holding and emptying your bladder requires complex coordination among your kidneys, bladder, brain, spinal cord, ureters and urethra (which both transport urine) and the muscles in your bladder and pelvic floor.
When just one thing in that system breaks down, symptoms of overactive bladder or urinary incontinence can occur. For instance, when nerves send an abnormal signal to the bladder, the muscles may suddenly contract more often than normal, resulting in OAB. "It's like a bad phone signal between the bladder and the brain," says Linda Brubaker, M.D., director of the division of Female Pelvic Medicine and Reconstructive Pelvic Surgery at Loyola University Health System in Chicago. "The bladder and the brain should be able to talk to each other easily and quietly. Patients who have overactive bladder will tell me, 'It's almost like my bladder has a mind of its own.'"
Overactive Bladder Isn't Always Incontinence
“Someone with an overactive bladder isn't necessarily incontinent,” notes Jill Maura Rabin, M.D., head of urogynecology at the Long Island Jewish Medical Center, North Shore-LIJ Health System in New Hyde Park, NY, and co-author of Mind Over Bladder: A Step-by-Step Guide to Achieving Continence (iUniverse, 2008). In fact, there are two forms of OAB—the dry version and the wet version: “With dry OAB, you can make it to the bathroom without leaking; with wet OAB, there's a huge contraction and the bladder empties,” Dr. Rabin explains. In other words, wet OAB and urge incontinence are one and the same.
Why We Don't Seek Help—and Should
"Because of the shame and stigma, people often suffer in silence for a very long time," notes Dr. Brubaker. Indeed, only 46 percent of people with OAB symptoms had discussed the problem with their healthcare provider, according to a recent nationwide survey of 162,906 people. All of this embarrassment and silence takes its toll. "Many start to live around their bladder, limiting social interactions or avoiding trips, which can really erode personal relationships, self-image and confidence," says Dr. Brubaker.
For instance, 32 percent of OAB sufferers say their symptoms make them feel depressed, according to a study at the University of North Carolina at Chapel Hill. The same research found that those with OAB accompanied by incontinence are significantly more worried than other women about participating in activities away from home.
But speaking up can bring relief. Take Gail Stein, 63. “I had to urinate all the time, especially after dinner,” says Stein, a writer in Port Washington, NY. “I couldn't go anywhere without finding out where the bathroom was. I was miserable.”
Then about 15 years ago, when Stein had to rush to the bathroom twice during an hour-long massage, Stein's massage therapist referred her to the urogynecologist who had treated her daughter for the same problem. Under the doctor's care, Stein was properly diagnosed and able to tame her rebellious bladder with a combination of physical therapy and biofeedback exercises. "Within two months, I was much better and didn't have to go to the bathroom nearly as often," Stein says.
Know the Overactive Bladder Risk Factors
OAB can strike anyone, but certain people are more likely to be affected. For instance, some 30 percent of pregnant women and new moms suffer, thanks to weakened pelvic floor muscles. Plus, 20 percent of adults who've reached the north side of 40 and about 33 percent of people over 65 are affected by OAB, according to the National Association for Continence. This, in part, is likely due to the natural muscle-weakening effects of aging. But that doesn't mean OAB is a normal or inevitable part of getting older.
For many people, the direct cause of their OAB is unknown. But a few risk factors have been identified. They are:
Being overweight puts undue pressure on the bladder and the pelvic floor muscles that support it, which can result in leakage. Heavy women (particularly those with a BMI of 35 or higher) were 66 percent more likely to develop urge incontinence (wet OAB) at least once a month than lean women, found a study from Brigham and Women's Hospital and Harvard Medical School in Boston.
The nicotine in cigarettes decreases blood flow to the bladder muscles, which can cause abnormal contractions and leaks, notes Samuel Badalian, M.D., Ph.D., director of the Gynecology and Urogynecology Center at SUNY Upstate Medical University in Syracuse, NY. Moreover, a chronic cough, whether it's from smoking or another condition, puts extra pressure on the bladder as well.
"Vaginal dryness that occurs with menopause can irritate the bladder and affect bladder contractions, leading to symptoms of OAB," Dr. Badalian says. Menopause also ups your chances of pelvic organ prolapse, where one or more pelvic organs move, putting pressure on other organs, like the bladder.
Certain over-the-counter and prescription drugs can affect the muscles or nerves in your pelvic area. For example, sleep aids may dull the nerves in the bladder, keeping them from signaling your brain when your bladder is full, causing the bladder to overflow. Other possible culprits: diuretics, antidepressants and muscle relaxants.
A variety of problems may reduce the quality of nerve signals that go from your brain to your bladder, resulting in urine leakages. These include diabetes, Parkinson's disease, multiple sclerosis and spinal cord injuries.