Overactive Bladder

What is an overactive bladder? 

An overactive bladder (OAB) is a disorder of the bladder where involuntary contractions of the bladder result in a frequent and urgent need to urinate, causing multiple restroom visits, even throughout the night – a condition known as nocturia. In Singapore, some women with OAB also experience urge incontinence (UI), where they unintentionally leak urine shortly after feeling a strong urge to urinate. This can lead to difficulty reaching the toilet in time when the urge to urinate arises.

What is the cause of an 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.

What are the symptoms of an overactive bladder?

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

Is overactive bladder painful?

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.

Who is at risk of overactive bladder in Singapore?

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.

How is an overactive bladder diagnosed?

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.

What are the treatment options for an overactive bladder in Singapore?

You may not be fully cured of this persistent condition, but there are effective methods to manage your symptoms and prevent them from dominating your daily life.

Conservative/non-invasive treatments

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. 

Medications

If lifestyle changes show insignificant results, medications are often prescribed alongside the aforementioned modifications. These drugs relax bladder muscles, allowing for longer intervals between urination. It is important to note that these medications require several months before results are noticeable.

Side effects may include dry eyes, mouth, skin, and constipation. Finding the right medication may require experimentation, and certain medical conditions may limit their suitability.

Invasive options

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.

Frequently asked questions

What tests do I need to diagnose OAB?

It is crucial to consult with a urogynecologist, a specialist concerning female urinary issues to determine a correct diagnosis and to discuss available treatment options. During this consultation, your medical history will be reviewed, and a pelvic examination will be conducted to assess the presence of any pelvic organ prolapse and the condition of your pelvic floor muscles. Further evaluations may be suggested based on your symptoms, such as ultrasound scans to examine your uterus and ovaries, urine tests, bladder scans to measure the residual urine post-void, and potentially a urodynamic study to assess your bladder function and muscle stability.

Can an overactive bladder be cured?

An overactive bladder cannot go away on its own. Treatment for an overactive bladder is necessary to prevent symptoms from worsening. Make an appointment with us today and get treated for your overactive bladder.