What is overactive bladder?

The bladder is a part of your body's urinary system. Every time you eat and drink, your body absorbs liquids. Your kidneys then filter out the waste products from your body's fluids and make urine, which is stored in your bladder. The bladder expands as it fills with urine, and contracts to empty.¹

Both your brain and your muscles are involved in peeing. When the bladder is full, nerves in your bladder signal the brain. That's when you get the need "to go". Once you reach the toilet, your brain sends a message to the large bladder muscle (the detrusor) to squeeze, or contract. At the same time, your brain tells the sphincter muscles that surround the tube that releases urine from the bladder (your urethra) to relax and let the urine through.²

Normally, the bladder muscle is relaxed during filling and the muscles only contract when the bladder is emptying.¹
"Bladder control" means you urinate only when you want to.

An Overactive Bladder (OAB) is caused when the bladder muscle contracts involuntarily.³ This may result in feelings of urgently having to go to the bathroom - even when the bladder isn't full - as well as making frequent trips to the bathroom. In some instances, accidental leakage of urine occurs.⁴ Overactive Bladder and other bladder control problems are medical conditions that prevent you from being able to control when you urinate.¹

Overactive Bladder is characterized by the following symptoms:⁴

• strong, sudden urges to go to the bathroom
• increased frequency of urination (more than eight times during a 24-hour period, often including two or more times at night)

These feelings may or may not be accompanied by:

• wetting accidents due to a sudden urge to urinate; this is also known as urge urinary incontinence ⁴

You are not alone in living with a bladder control problem. An estimated 1 in 5 Canadians over the age of 35 share these problems⁵. While there is no consensus on all the different causes of OAB, one thing is certain: OAB is not normal in adults of any age, and you don't have to live with it. Most OAB can be successfully treated.⁶ Doctors treat thousands of people with OAB every year.

Loss of bladder control is given many different names, including urinary incontinence, "leaking", and having an Overactive Bladder.¹ These are all medical conditions that prevent you from being able to control when you urinate.¹ However, Overactive Bladder, or OAB, specifically refers to urgency and frequency and is not always linked with leakage.

Some bladder control problems happen when you develop a urinary tract or vaginal infection. Others are a result of medications or a hormone imbalance. These are usually temporary.¹

Ongoing bladder control problems can occur when the bladder and sphincter muscles don't function properly. They may be either too weak or too active. Problems may also occur when the nervous system does not work properly due to disease or injury.¹

The major types of bladder control problems are:

Overactive Bladder

In Overactive Bladder (which is also known as OAB), the large muscle in the bladder - the detrusor muscle - contracts involuntarily.³ This contraction causes a person to feel a sudden and sometimes overwhelming urge to urinate, even if the bladder is not full.

Overactive Bladder usually causes one or more of the following symptoms:⁴

• Urgency - a sudden strong urge to urinate with little or no chance to postpone the urination.
• Frequency - the need to urinate more than 8 times over 24 hours
• Nocturia* - waking up to urinate 2 or more times a night
• Urge urinary incontinence* - involuntary loss of a significant amount of urine

*Most people with OAB experience only the symptoms of urgency and frequency, without nocturia, nighttime urges or urge urinary incontinence (wetting episodes).

Canadian surveys of OAB sufferers indicate that women are more likely to experience OAB than men.⁵

It is important to know that OAB is not normal at any age.⁶ Overactive Bladder is an ongoing condition that is treatable. See your doctor to determine the best treatment options for you.

Treatment of Overactive Bladder may include pelvic floor muscle exercises, bladder retraining, biofeedback, dietary changes, medications and surgery.⁷ Combining two or more of these treatment options may provide the best improvement. Alternatively, some people will manage their urinary incontinence with absorbent products and devices.⁷

Stress urinary incontinence

Stress urinary incontinence often occurs when the support muscles around the urethra (the muscles which keep urine in the bladder) are weak. As a result, even a minor increase in abdominal pressure can cause a small amount of urine to leak. Stress urinary incontinence is associated with leakage that occurs with certain activities, such as coughing, sneezing, laughing, exercising, or lifting a heavy object.⁷ It is not usually preceded by the urge felt with OAB.

Many women experience stress urinary incontinence after either pregnancy or menopause. Men can experience it after prostatic surgery.⁸ Many people manage stress urinary incontinence by wearing pads or diapers.⁷ One treatment option involves the use of pelvic floor muscle exercises to improve the strength of the muscles supporting the bladder.⁹

Mixed urinary incontinence

Mixed urinary incontinence refers to a combination of the symptoms of both stress urinary incontinence and urge urinary incontinence.⁹ It is more common in older women.⁷ The usual course of therapy is to treat the predominant symptom first. Because the symptoms of these two conditions are different, treatment may be a combination of behavioral and drug therapies, together with pelvic floor exercises.⁹

Overflow urinary incontinence

Overflow urinary incontinence occurs when the bladder overfills. People who suffer from this type of incontinence may complain of poor urinary stream, dribbling, or symptoms of stress or urge urinary incontinence.⁷

Other bladder conditions

A urinary tract infection (UTI) can involve infection in any or all parts of the urinary tract, including the ureter, the bladder, the urethra or any combination of these. The infection often exhibits symptoms similar to Overactive Bladder, including frequent urination. However, unlike OAB, a urinary tract infection is usually associated with a burning sensation during urination.² If these are your symptoms, see your doctor as soon as possible. A UTI is an infection that can be cured with proper treatment.

Some men who experience frequent urination and urges may have a condition known as benign prostatic hyperplasia (BPH), or an enlarged prostate. Unlike OAB, BPH can cause hesitancy, decreased flow during urination, and incomplete emptying.¹⁰ Sometimes, a man may have both OAB and BPH. A doctor can tell whether you have OAB, an enlarged prostate, or both conditions and can advise you regarding appropriate treatment.

Frequent urination in large amounts is called polyuria. If you have noticed that you visit the bathroom more frequently and pass a normal amount of urine each time, your doctor may test you for excessive fluid intake or for diabetes, as this is one symptom of that condition.⁸

Some people suffering from OAB experience a profound effect on their lives. Urge urinary incontinence can be associated with emotional problems, reduced social and recreational activity and sexual dysfunction.¹¹

People have reported many ways that Overactive Bladder may be interrupting or limiting their everyday life. Some of the most common are:

Impact on Daily Activities¹²

• seriously interferes with daily activities
• makes it more difficult to do things
• makes it more difficult to do work
• makes it difficult to get a good night's sleep
• has a negative effect on sex life
• every trip away from home has to be planned

Impact on Emotions¹²

• can be very stressful
• can make it uncomfortable being with people you don't know well
• creates concern about the potential of having an embarrassing accident
• creates concern about doing things away from home

There may be other ways that an Overactive Bladder has changed your behavior and affected the way you view yourself. You may even have modified your activities because of your OAB. Or, maybe you're reasonably satisfied with the way you've adapted your life around your symptoms by wearing pads, avoiding sports and changing routines.

It may be difficult to acknowledge that an Overactive Bladder affects so many aspects of your life as well as the lives of those around you. But accepting these facts can help you move toward taking action.

Overactive Bladder is an ongoing and treatable medical condition.⁶ It is estimated that nearly 1 in 5 Canadians over the age of 35 suffers from Overactive Bladder⁵. Doctors treat thousands of patients suffering from OAB every year. You owe it to yourself to see if treatment may help you return to a more normal life - and help relieve the anxiety, embarrassment, and isolation that may result from the symptoms of an Overactive Bladder.