Overactive Bladder

What Is Overactive Bladder?

What Is Overactive Bladder (OAB)?

According to the definition of the International Continence Society (ICS), it is a condition in which, without an underlying disorder, the person experiences a sudden, urgent need to urinate (urgency), frequent urination during the day and at night and, in some patients, urinary incontinence accompanied by a sudden sense of urgency.

How Common Is It?

OAB symptoms are seen in 17% (7–26%) of the population. The condition is more common in women than in men, and its frequency increases with age in both sexes.

Why Is Overactive Bladder Important?

In addition to its physical effects such as frequent urination and urinary incontinence, OAB is a disorder that seriously affects a person's social and psychological well-being and places a considerable burden on healthcare costs. Because of frequent urination at night, these patients may experience daytime sleepiness, difficulty concentrating and reduced work performance. The fear of leaking urine and the need to go to the toilet frequently restrict the person's social life and negatively affect quality of life.

What Causes It?

Involuntary and sudden contractions of the bladder, a more sensitive perception of bladder filling, increased nighttime urine production with age, and a small bladder are among the hypotheses proposed to explain the causes of this condition.

Diagnosis of Overactive Bladder

First, your doctor will take your medical history and perform a physical examination. You will then be asked to keep a bladder diary and, if needed, additional tests (urinalysis, ultrasonography, uroflowmetry, urodynamics, cystoscopy) will be requested to rule out other conditions with similar findings.

What Are the Treatment Options for Overactive Bladder?

Lifestyle Changes

Regulating fluid intake: adequate (at least 1.5 L/day) and regular fluid intake
Limiting fluid intake before long journeys and before going to bed at night
Limiting drinks with a diuretic effect such as tea, coffee and alcohol
Removing bladder irritants such as artificial sweeteners (aspartame, etc.), carbonated drinks and certain foods (very spicy foods, citrus fruits, tomatoes, etc.) from the diet
Weight control is particularly effective for urinary incontinence
Exercises that strengthen the pelvic floor muscles (Kegel exercises)

Medication

Medication aims to prevent sudden contractions of the bladder muscle, increase bladder capacity and, as a result, reduce frequent urination and the urgent need to urinate.

Muscarinic receptor antagonists: darifenacin, fesoterodine, oxybutynin, propiverine, solifenacin, tolterodine, trospium chloride
Beta-3 agonists: mirabegron

Intravesical (Bladder) Botox Injection

This is a treatment method we use for overactive bladder and neurogenic bladder. In this procedure, which we usually perform under local anesthesia, Botox is injected into 20–30 points of the bladder using a special needle.

With an effect lasting approximately 6–12 months, this procedure aims to reduce involuntary bladder contractions and increase bladder capacity, thereby improving complaints such as frequent urination and urinary incontinence.

Neuromodulation (Nerve Stimulation)

This is a treatment that uses electrical current to stimulate the sacral nerves that control the bladder. There are two types of nerve stimulation:

Tibial Nerve Stimulation: A needle for the electrical current is placed near the ankle. The needle passes through the skin and stimulates the tibial nerve, which runs from the inner side of the ankle up the leg to the sacral nerves. Treatment with tibial nerve stimulation usually consists of 12 sessions. Each session lasts 30 minutes and is given once a week.

Sacral Neuromodulation (Bladder Pacemaker): This method is used to treat urinary incontinence, urinary retention, refractory overactive bladder and painful bladder syndrome. In this procedure, electrodes placed in the sacrum stimulate, with the help of a battery, the nerves that control bladder function, relieving the patient's complaints.

Bladder Augmentation Surgery: This is a method used very rarely in severe and refractory cases where other treatment options have failed.