Overactive Bladder Q&A Interview with Dr. Angelish Kumar

Posted on: May 7th, 2020 by Angelish Kumar

An overactive bladder (OAB) is an extremely common urologic condition affecting some 33 million people each year. This number is likely higher because many individuals often do not seek treatment for OAB and may feel embarrassed to discuss their symptoms with a urologist. When your bladder doesn’t want to cooperate, it can be more than just annoying. OAB may prevent you from going out and doing the things you enjoy, because you feel you need to be close to a bathroom at all times.

In this question and answer interview, board-certified female urologist Dr. Angelish Kumar answers frequently asked questions about OAB.

What is an overactive bladder? Is it the same as incontinence?

Overactive bladder is a combination of symptoms including frequency of urination, urgency, and often waking up multiple times at night to urinate. When a person feels a sudden urge to urinate, and they feel it is difficult to hold it until they reach the bathroom, this is an overactive bladder. Some people do manage to hold it, but others will actually leak before they reach the toilet. We refer to this type of urinary leakage as urge incontinence.  

Why do I have to pee so much?

Urinary frequency happens because the bladder is no longer storing urine very well. If the symptoms suddenly came on, we have to rule out organic causes like a urinary infection, inflammation, or a tumor. When the bladder is irritated or there is a tumor or a stone in the bladder, a person can experience severe urinary frequency. There also be neurologic causes for OAB, such as stroke, diabetes, or multiple sclerosis. But often, OAB occurs because the bladder nerves become more sensitive due to aging, hormonal changes, or giving birth. So it’s really important to see a urologist for evaluation of these symptoms because you need to figure out if the overactive bladder is the result of another problem, such as a urinary infection, or if it is the primary problem. 

What are the main causes of overactive bladder?

We typically group OAB into 2 categories. One is “neurogenic,” which means there is a disease affecting the brain or spinal cord, such as Multiple Sclerosis, or Parkinson’s Disease, or a spinal cord injury. The other category is “idiopathic,” which means we can’t be exactly sure what is causing the OAB, but we don’t believe it is from a neurologic injury. Idiopathic overactive bladder can happen from hormonal changes, such as menopause, aging, or weak pelvic floor muscles. Many women also experience overactive bladder symptoms after childbirth. We are also recognizing that the bladder has it’s own microbiome, and there are ongoing studies to determine whether disruption of the bladder microbiome, or “dysbiosis,” can actually lead to OAB symptoms. This is a very interesting area of urologic research.

I have to pee at night, and it interrupts my sleep. What can I do?

This is a common problem for many people, especially as they get older. We call this, “nocturia.” The best way to evaluate nocturia is to do a bladder diary. For some folks, they are urinating pretty frequently during the day as well, and it just doesn’t bother them, but at night it becomes more of a nuisance. For others, they are actually producing more urine at night, and we call this problem “nocturnal polyuria.” First, we try things like limiting fluid intake in the evenings and seeing if there are adjustments that can be made with your medications. Then we go through medication options to help the bladder store urine more effectively, or prevent the kidneys from producing so much urine at night. We also go through other potential issues, like anxiety, insomnia, or sleep apnea, that could be causing you to wake up, instead of just the need to urinate.

Can my diet cause an overactive bladder?

If you are drinking excessive fluids, or fruits and vegetables with a very high water content, then diet can definitely contribute. Also, I have seen OAB in some people who drink a lot of soda. The caffeine, artificial sweeteners, and the chemicals in soda can irritate the bladder. So, diet can cause an overactive bladder, but more often I see women who are avoiding drinking water because they are afraid they will need to urinate often.

Can an overactive bladder be prevented or avoided?

For most people, it is difficult to prevent getting an overactive bladder, unless you have very bad diabetes and are not controlling your blood sugars well, you are drinking an excessive amount of soda or coffee, or you defer urinating for very long periods of time. There are also some people who urinate very often by habit, and their bladders become trained to signal the need to urinate to the brain with low volumes. Things you can do to keep your bladder healthy are to drink about 1-2 liters of water a day, urinate once every 3-4 hours, maintain good pelvic floor muscle strength, and avoid processed foods and drinks, artificial sweeteners and excess caffeine. For some people alcohol is a major trigger of OAB symptoms. But I will be the last person to ever tell anyone not to have their morning coffee and evening glass of wine. I do tell patients who smoke or vape to quit or at least try to cut down, as these are both risk factors for bladder cancer.

I leak urine when I sneeze, cough or laugh too hard, and sometimes when I stand up, I have a sudden urge to urinate. Is this overactive bladder?

Leaking with sneeze, cough or laugh is not OAB. This is stress incontinence. This happens because the pelvic floor muscles are weak and the urethra, the small tube that urine exits from, is not doing a good job of staying closed when you bear down. The sudden urge to urinate when you stand up can be from OAB, and often it is from a combination of an OAB and a weak pelvic floor. Some women have both types of incontinence, urge and stress.

After I urinate, within a few minutes I find I need to go again. What is wrong with me?

This can be from OAB, where the bladder is inappropriately signaling to the brain that there is an urge to urinate, even though it is not very full, or from the bladder contracting involuntarily. It can also happen if you are not emptying your bladder completely, and this is something that can be checked by a urologist. I see this a lot in women when they are in a place where they have to squat to urinate. It is very difficult to empty your bladder completely if you are squatting!

How is overactive bladder diagnosed?

OAB is diagnosed by a patient describing the symptoms of bothersome urinary frequency and urgency, with or without incontinence. We do some tests to rule out urinary infection, blood in the urine, and to make sure you are emptying the bladder completely. We take a thorough history and do a physical exam to find out if there have been any neurologic issues, or if you currently have any symptoms that could suggest underlying neurologic disease. If there is blood detected in the urine sample, even if you cannot see it, we do further tests to rule out cancer or stones in the urinary tract. We look at medications that you take and make sure the OAB symptoms didn’t start with the onset of taking a diuretic or other medication. Once we get a complete picture, we can make the diagnosis.

What are the treatments for overactive bladder?

The treatment can range from behavioral modifications and pelvic floor physical therapy to medication, an injection of botox into the bladder in the office, or a procedure called sacral neuromodulation. Medication can work well but many people don’t like the idea of taking medication indefinitely. Botox also works well for overactive bladder and it helps prevent involuntary contractions in the same way it works for the facial muscles. Sacral neuromodulation involves direct stimulation of the bladder nerve, and this helps to calm the signaling from the bladder that is telling you need to urinate so often. We also do an office procedure that is similar to acupuncture, called posterior tibial nerve stimulation. This is also a way of stimulating the bladder nerve, but we utilize a nerve that passes close to the skin near the ankle and place a very tiny acupuncture needle.

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