Overactive Bladder

The primary cause of overactive bladder and urge incontinence is the involuntary contraction of bladder muscles attempting to expel urine. This can be temporary, such as when caused by a urinary tract infection (UTI) that eventually clears up. However, persistent cases can result from nerve damage due to factors such as ageing or underlying medical conditions such as diabetes, stroke, or dementia.

Other contributing factors include:

• Weakened pelvic floor muscles: this can stem from pregnancy, childbirth, age-related weakening, or obesity.
• Medication: certain medications, such as those for blood pressure or heart conditions, can influence fluid balance in your body and cause an overactive bladder.
• Consuming caffeine and alcohol: these can irritate the bladder, causing it to overreact.
• Oestrogen deficiency: post-menopausal women often have oestrogen deficiency that results in atrophic changes in the lower urinary tract, contributing to symptoms of an overactive bladder. 

Additionally, weakened pelvic floor muscles may also lead to pelvic organ prolapse (POP), characterised by the descent of the bladder, uterus, or rectum into or beyond the vagina. Consequently, it is common for women to experience both urinary incontinence and some degree of POP.

The symptoms of an overactive bladder include:

• Frequent and sudden urge to urinate
• Urinating more than eight times a day
• Waking up multiple times during the night to urinate
• Involuntary leakage of urine
• Difficulty holding in urine when the urge arises
• Feeling like your bladder is never completely empty
• Anxiety or stress related to bathroom availability
• Disruption in daily activities due to frequent bathroom visits
• Impact on social and professional life due to urgency and leakage

Overactive bladder itself is not usually painful, but it can cause discomfort and inconvenience due to the frequent and urgent need to urinate. The sensation of urgency and the frequent trips to the bathroom may disrupt your daily activities and quality of life. However, the condition is primarily characterised by the sudden and strong urge to urinate. If you are experiencing pain along with these symptoms, it could indicate another underlying issue that needs to be addressed. While not inherently painful, an overactive bladder can impact your comfort and daily routine.

In Singapore, various factors can increase the risk of developing an overactive bladder; these are:

• Age: ageing results in weaker signals for bladder control, thus making one more susceptible to an overactive bladder. 
• Gender: both men and women can develop an overactive bladder. However, women are more prone to an overactive bladder due to pregnancy and menopause. 
• Medical conditions: certain medical conditions, such as a stroke or Alzheimer’s disease, can cause cognitive decline, which can lead to an overactive bladder.
• Obesity: extra weight puts additional strain and pressure on the bladder and pelvic muscle, which can lead to an overactive bladder.

If you suspect you have an overactive bladder, your doctor will conduct a thorough evaluation to make a diagnosis.

After going through your medical history, the following tests may be performed: 

• Physical examination: a physical exam of the organs around your pelvis and rectum will be performed to check for abnormalities.
• Urine tests: a urinalysis or urine test will be performed to check all aspects of your urine. This also checks for signs of infection, such as a urinary tract infection, which may cause a temporary overactive bladder.
• Urodynamic test: this determines the amount of urine left in the bladder after you go to the bathroom, also known as post-void residual volume. A urodynamic test also measures the urine flow rate and the stability of your bladder muscle as it fills with urine.
• Cystoscopy: a cystoscope will be used to visualise your bladder from the inside to check for abnormalities. 
• Imaging tests: imaging tests such as an ultrasound or a computed tomography scan (CT scan) may be used to check for abnormalities in your bladder.

The main form of treatment for an overactive bladder involves making lifestyle changes, which can often lead to significant improvement in symptoms. Conservative treatment options for an overactive bladder include:

• Maintaining a healthy body mass index (BMI) reduces pressure on your pelvic floor muscles and improves/enhances their strength.
• Modifying your diet and fluid intake.
• Keeping a bladder diary.
• Reducing consumption of caffeinated beverages.
• Establishing regular toilet schedules.
• Engaging in bladder training to increase its capacity.
• Enhancing the management of underlying medical conditions, like diabetes, may involve adjusting medications.
• Quitting smoking.
• Practising pelvic floor (Kegel) exercises are crucial for muscle tone. 

In more severe cases, secondary options involve more invasive procedures. These include Botox injections directly into your bladder (administered through a scope under local or general anaesthesia) and nerve stimulation (percutaneous tibial nerve stimulation). These methods may need to be repeated every six months due to their temporary effects.