Overactive Bladder

Overactive bladder is a pattern of bladder symptoms in which a sudden strong need to pass urine is the main problem. It usually comes with needing a washroom more often during the day and waking at night, and for some people urine leaks before they can get there. The bladder muscle contracts when it is not meant to, and in most cases no single underlying cause is found.

What overactive bladder is, and what it is not

Overactive bladder is not a normal part of getting older. Symptoms do become more common with age, but they are a medical condition with a range of treatments, not something that simply has to be accepted. Canadian survey data show that among people reporting urinary symptoms, close to a quarter had lived with them for more than eleven years, which says more about how rarely they are raised than about how treatable they are.

It is also not the same thing as urinary incontinence, although the two overlap. Overactive bladder is defined by urgency: the sudden, hard to defer need to go. Leakage may or may not be part of it. Nor is it a urinary tract infection, though the symptoms can resemble one, which is why a urine test is part of the first assessment.

Signs and symptoms

• A sudden, strong need to pass urine that is hard to put off
• Needing a washroom more often than usual during the day
• Waking one or more times at night to pass urine
• Urine leaking when the urge comes on, before reaching a washroom
• Planning outings around where washrooms are
• Passing only small amounts each time despite the strong urge
• Broken sleep, and tiredness during the day as a result

Symptoms vary between people and from week to week. Some notice urgency mainly at home or on the way in from outside, while others find it constant.

What raises the risk

Some risk factors cannot be changed:

• Older age, as symptoms become more common later in life
• Being female, with slightly higher rates reported in Canadian surveys
• Neurological conditions such as Parkinson disease, multiple sclerosis, or a previous stroke
• An enlarged prostate in men, and pelvic surgery or radiation in either sex

Others can often be worked on, usually with support from a health care team:

• Carrying extra body weight
• Caffeine, alcohol and carbonated drinks, and the timing and volume of fluids
• Constipation, smoking, and some medicines including diuretics, which should only be changed with the prescriber who started them

How overactive bladder is diagnosed in Canada

Assessment starts with your symptom history, a physical examination, and a urine test to rule out infection or blood in the urine. A bladder diary kept over a few days is central to it. You record what you drink, when you pass urine, roughly how much, and any urgency or leakage, and HealthLink BC suggests keeping one before you see a doctor, because patterns are hard to recall accurately in an appointment. Blood work and a post void residual measurement by ultrasound are often added. Urodynamic testing, which measures bladder pressure and flow, is kept for unclear cases or for before certain procedures, and is usually arranged by a urologist.

Treatment and day-to-day management

Clinical research for Overactive Bladder is enrolling. See the current studies ↓

Care in Canada generally works through behavioural approaches first, then medicines, then specialist procedures for symptoms that persist. Depending on your assessment, your other conditions and what matters to you, a health care team may discuss:

• Bladder training and timed voiding, gradually extending the interval between washroom visits, with urge suppression techniques
• Pelvic floor physiotherapy, including pelvic floor muscle training with or without biofeedback, from physiotherapists with pelvic health training
• Adjustments to fluids and daily habits, including caffeine and alcohol reduction, fluid timing, weight management, and treating constipation
• Prescription medicines, including the antimuscarinic and beta-3 agonist classes, chosen with attention to your other conditions and medicines
• Options offered by urologists when earlier steps have not been enough, including onabotulinumtoxinA injection into the bladder wall, sacral neuromodulation, and percutaneous tibial nerve stimulation

Many people try more than one option before finding what works for them. These are decisions for you and your own clinician, and nothing on this page is a recommendation about any of them.

When to talk to a doctor

• Blood in the urine, whether you can see it or it is found on a urine test
• Fever with pain in the flank or back, which can mean a kidney infection and needs prompt assessment
• New difficulty passing urine, an inability to empty the bladder, unintended weight loss, or new leg weakness or numbness alongside bladder changes, all of which warrant prompt assessment

Why clinical research matters for overactive bladder

Many people stop bladder medicines within a year, because of side effects or limited benefit, and there is no test that predicts who will respond to which treatment or who should move on to injections or neuromodulation. Studies now recruiting are testing drug targets beyond the antimuscarinic and beta-3 classes, longer acting and combination therapies, refined neuromodulation devices and implant techniques, digital bladder training and physiotherapy programs, and treatments for the overlap between overactive bladder, nocturia and sleep. Researchers are also examining the role of the bladder microbiome and of urinary markers.

Clinical studies are how those questions get answered. Some studies are designed for people who have not used bladder medicine before, and others specifically for people whose symptoms persist despite treatment. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any time without affecting the care you get from your own doctor. No one can say in advance whether a study will help you personally.

Learn more from Canadian sources

• Canadian Continence Foundation
• Canadian Continence Foundation: tips for bladder control
• Canadian Urological Association: guideline on adult overactive bladder
• HealthLink BC: overactive bladder