People who have an overactive bladder (OAB) experience frequent urination, day and night, along with the sudden urge to urinate, which can sometimes involve involuntary leakage of urine. As a result, they often have feelings of shame and embarrassment, prompting them to isolate themselves, withdraw from social activities, and avoid going to locations that don't have a restroom in close proximity. Furthermore, many of these individuals have the mistaken notion that their condition is a natural byproduct of the aging process that they simply have to endure. However, the truth of the matter is, OAB is not a normal part of aging, and once doctors get to the root of the problem, it can usually be treated effectively.
Urologist Ahmed El-Zawahry, MD, medical director of the University of Toledo Medical Center’s Bladder Health and Pelvic Floor Reconstruction Program, explains that OAB is actually a syndrome, or a group of symptoms that occur together. “These symptoms include increased frequency of voiding, in the daytime or nighttime, along with a sensation of urgency, or a feeling that you can’t hold it. Also, about 10 to 15 percent of people with overactive bladder have some amount of leakage associated with the sudden, strong urge. We call this urgency incontinence,” he says.
OAB is very common, affecting between 15 and 30 percent of the population, so people with the condition can rest assured they’re not alone. In fact, OAB is more common than many other chronic diseases. Diabetes, for example, affects 10 to 15 percent of the population. Also, the risk of developing OAB increases with age, and the condition affects both men and women. Dr. El-Zawahry adds, “At younger ages, overactive bladder is more common in women, but as both genders get older, men catch up and surpass women primarily because of enlarged prostate, which can cause a blockage in the bladder.”
Dr. El-Zawahry emphasizes that OAB is not just a quality-of-life issue for patients. It can also put their physical and emotional health at risk. “People with urgency incontinence very frequently try to run to the bathroom, which puts them at risk of falling and potentially fracturing a hip. Not only do hip fractures require a long recovery time, but the mortality rate following a hip fracture can be as high as 50 percent in older adults. In addition, depression is very common in this population. Research shows that about 50 percent of women with urgency incontinence experience depression compared to 24 percent of women who don’t have it.”
Before giving a diagnosis of OAB, doctors must first rule out the possibility of a different underlying cause for the symptoms. The problem could stem from something as simple as excessive intake of fluids, small bladder size, or a dietary habit or behavior that irritates the bladder such as drinking coffee or tea or smoking cigarettes. There are also numerous other disease states and health conditions that can cause OAB-like symptoms. A few examples include bladder stones, some bladder cancers, congestive heart failure, diabetes, kidney failure, dementia, prolapse in women, and, as mentioned, enlarged prostate in men. Why OAB occurs in the absence of these or other underlying conditions is not always known, though different theories suggest there may be a problem with the bladder muscles, nerves, or vasculature.
With so many different conditions and habits potentially causing urinary frequency and urgency, how can people who are experiencing these symptoms determine when it’s time to see a physician? Dr. El-Zawahry advises, “As with any disease, if you’re having symptoms for over six weeks, you need to discuss the problem with your healthcare provider and possibly have a workup to rule out other conditions. Don’t assume it’s something simple that will go away on its own.”
According to Dr. El-Zawahry, treatment of OAB is generally the same for both men and women (though some different testing may be necessary to rule out underlying problems that are specific to one gender or the other) and there have never been more treatment options available to providers. “Treatment follows a specific clinical pathway that starts with addressing any associated conditions or diseases that might be causing the symptoms. If no other problems are identified, we look at any habits that might be contributing to the problem. Approximately 30 percent of cases can be improved through simple behavior modification. If that doesn’t work, we can try various medications, which is effective in about 60 percent of cases. Then, if we still don’t get a good response, we can take a more aggressive approach, for example with Botox injections or sacral neuromodulation,” he says.
When it comes to treating patients with OAB, one of the biggest obstacles Dr. El-Zawahry and his colleagues must overcome is the misconception that OAB is a natural part of aging. He notes, “A lot of people who experience symptoms turn to their friends and neighbors first and find out that many of them are having the same problems, so they assume it’s normal and they don’t come forward and discuss it with their doctor. Another challenge is getting patients to comply with treatment, especially when that involves making behavioral changes. Also, medications are not without side effects and sometimes patients don’t inform their doctor and ask for alternatives when they’re having problems with a drug they’re taking. That’s unfortunate because the vast majority of patients who comply with treatment get relief from their OAB symptoms,” he says.
The physicians of UTMC’s multidisciplinary Bladder Health and Pelvic Floor Reconstruction Program are part of a multidisciplinary team that includes the only urologist in Northwest Ohio who is fellowship-trained in female urology and pelvic reconstruction. The team treats men and women with urinary or fecal incontinence, pelvic organ prolapse, and other urinary symptoms (frequency, burning, infection, and more) and provides expert management of urethral strictures, fistulas, and diverticula. In addition, the team cares for patients with neurogenic bladder as a result of multiple sclerosis, stroke, spinal-cord injuries, and Parkinson’s disease by using the latest minimally invasive technologies, such as sacral neuromodulation, Botox, and tibial nerve stimulation.
To schedule an appointment at the Bladder Health and Pelvic Floor Reconstruction Program, call 419-383-3578. ❦