What Is Overactive Bladder?

Rebecca McCrery, MD, FPMRSUrogynecologist

What is overactive bladder (OAB)?

Overactive bladder is a term that refers to a condition where patients have a lot of urgency to use the bathroom. They’ll often present with urinary frequency and some patients will also leak urine associated with that urge. Oftentimes patients will say, if they just had a few more seconds to get to the bathroom, they’d be good.

How do you approach treating patients with OAB?

In general, with OAB, we’ll start with conservative therapies: avoiding bladder irritants (such as caffeine and carbonated beverages) and making behavioral modifications (like going to the bathroom on a regular interval, even if somebody doesn’t have an urge to go). Doing some of these different strategies can be very helpful. Oftentimes, we’ll also incorporate a medication into the therapy to see if that gets the patient the results they are looking for. We do have several other options beyond medications that patients can opt to consider, such as Sacral Neuromodulation, tibial nerve stimulation, and Botox therapy.

Kevin Benson, MD, FPMRSUrogynecologist

What symptoms do you commonly see in patients with OAB?

I view OAB as a sensory disorder. It’s a problem where patients have a feeling that they need to void more often than they actually should. They often have urgency incontinence, where they leak urine when they feel an urge to go but can’t control it. This is often a sudden, unpredictable urge that can lead to a very embarrassing experience of urine leakage.

A number of patients with OAB don’t actually deal with incontinence; however, they have a lot of close calls, but it’s the urinary frequency that really bothers them. A lot of these patients are going many times a day, more than what is normal. If we were to say normal would be 7 times in a given day, some of these patients may urinate 12, 14, 20, even 30 times in certain individuals. A lot of patients also have night-time awakenings due to need to urinate, which then interferes with sleep and may lead to daytime fatigue. This can really disrupt their life.

What is the patient care pathway?

As I explain the care pathway to patients, I use the analogy of a ladder.

So, the first tier of care or first rung on that ladder is behavioral modification. It’s reducing fluids, avoiding bladder irritants, and trying to time their voids so they stay ahead of the leaks. These are things patients can do on their own, and they are often just not aware of some of these simple measures.

The next rung on the ladder of care for OAB is medication. These medications have been around for a long time. There are principally two classes: anticholinergic medications and now, more recently, beta-3 agonists. Medications, as I view them, are something that people are either going to respond to or not. I think the key to medication therapy is, if one medication doesn’t work, the probability of second or different medicine working is very small. And that’s why I feel we miss an opportunity when we prescribe a medicine, and then another medicine, and so on.

I think the other great limiting step with medications are the side effects, including dry mouth, dry eyes, and constipation being the most common. Anticholinergics, which is a popular OAB medication, can also cause significant cognitive impairment, which is a big concern, especially for our older patients.

The next (third) rung on the ladder of care would be the advanced therapies, which include Sacral Neuromodulation and percutaneous tibial nerve stimulation, as well as Botox.

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