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Overactive Bladder (OAB)

Urology

Overactive Bladder (OAB) is a common urinary condition characterized by involuntary bladder muscle contractions, leading to a sudden urge to urinate even without a full bladder. It occurs without infection or structural abnormalities and significantly affects quality of life, especially in older adults and women.

Symptoms

The bladder is an organ responsible for storing urine. Under normal conditions, it can hold approximately 400 to 500 ml of urine. When the volume reaches 100 to 150 ml, a person typically begins to feel the urge to urinate, although it is not yet urgent. As the bladder continues to fill, the urge to urinate becomes progressively stronger, a normal physiological response.

In patients with an Overactive Bladder (OAB), the bladder may become abnormally sensitive and contract suddenly even when it contains only 50 to 100 ml of urine. It causes a rapid increase in bladder pressure, triggering an urgent and sudden need to urinate. It often occurs without warning and, in severe cases, may lead to urinary incontinence, affecting the patient's quality of life.

Common symptoms may include one or more of the following:

Frequent urination (Urinary frequency): Urinating more than 8 times during the day
Urgency: A sudden, strong urge to urinate that isn't easy to control
Urgency urinary incontinence: Involuntary leakage of urine due to an inability to reach the toilet in time
Nocturia: Needing to wake up at night to urinate more than once

Causes and Risk Factors

The exact cause of Overactive Bladder (OAB) is still not fully understood in the medical community. However, it is generally believed to be related to dysfunction of the bladder nerves or muscles.

Risk Factors:

Advancing age (more common in individuals over 50 years old)
Men with benign prostatic hyperplasia (BPH)
Frequent consumption of irritating or diuretic beverages, such as coffee, soft drinks, and alcohol

Diagnostic Methods

Overactive Bladder Symptom Score (OABSS): This questionnaire serves as a preliminary assessment tool. A high score may indicate the need for further medical evaluation.
Medical history and bladder diary: track urination habits and leakage events
Urinalysis: to rule out infection or hematuria
Ultrasound: – to assess bladder capacity and post-void residual
Urodynamic studies: to evaluate bladder pressure and muscle activity
Cystoscopy (if needed): to rule out tumours or abnormalities

Overactive Bladder Symptom Score (OABSS)

Questions	Frequency
1. How many times do you typically urinate from waking in the morning to going to sleep at night?	7 or less		8-14 times		15 or more
	0		1		2
2. How many times do you typically wake up to urinate at night?	None		1		2	3 or more
	0		1		2	3
	None	Less than once a week	About once a day	About once a day	2-4 times a day	5 times a day or more
3. How often do you have a sudden desire to urinate that is difficult to defer?	0	1	2	3	4	5
4. How often do you leak urine because you cannot defer the sudden desire to urinate?	0	1	2	3	4	5
Total Score (OABSS)： Score With symptoms of overactive bladder: score ≥ 2 on Q3 and total score ≥ 3.
Symptom level	Total score 3 to 5 Mild		Toral score 6-11 Moderate		Toral score ≥12 Severe

Treatments

Non-Pharmacological Treatment (First-Line)	Behavioral therapy and dietary adjustments: Reduce intake of caffeine, spicy foods, carbonated and diuretic beverages. Pelvic floor muscle training (Kegel exercises) and bladder training: A structured program to progressively increase the interval between urination and strengthen bladder control.
Medication Treatment	Behavioral therapy and dietary adjustments: Reduce intake of caffeine, spicy foods, carbonated and diuretic beverages. Pelvic floor muscle training (Kegel exercises) and bladder training: A structured program to progressively increase the interval between urination and strengthen bladder control.
Electrical Stimulation Therapy	Percutaneous Tibial Nerve Stimulation (PTNS): A form of neuromodulation therapy that uses low-level electrical currents to stimulate the tibial nerve in the lower leg to improve symptoms.
Urological Surgery	Botulinum toxin (Botox) injection: Injected into the bladder wall to relax overactive muscles. A form of neuromodulation therapy that uses low-level electrical currents to stimulate the tibial nerve in the lower leg to improve symptoms.
Urological Surgery	Augmentation Cystoplasty: The bladder is surgically opened, and a segment of the small intestine is sewn into the bladder to increase its capacity. Sacral Nerve Stimulation: Another type of neuromodulation therapy where electrodes are implanted near the sacral nerves; a stimulator delivers mild electrical pulses to modify nerve signals and reduce bladder contractions.

FAQ

No. OAB is a functional disorder and not related to cancer.

No, it affects both genders, though it is more common in women aged below 50.

Anticholinergics may cause dry mouth or constipation. β3-Adrenergic Agonists may raise blood pressure—monitoring by a doctor is recommended.

While not always curable, most patients experience significant improvement with behavioural therapy and/or medication. Long-term symptom control is achievable.