What is overactive bladder syndrome (OBS)

Overactive bladder syndrome is a problem with bladder-storage function that causes a sudden urge to urinate. The urge may be difficult to stop, and overactive bladder may lead to the involuntary loss of urine (incontinence). If you have an overactive bladder, you may feel embarrassed, isolate yourself, or limit your work and social life.

In South-Africa, 12-17% of the population suffer from OBS and the prevalence increases with age.

The good news is that a brief evaluation can determine whether there’s a specific cause for your OBS and then treatment is available to manage the condition.

What are the symptoms of OBS

Symptoms of an overactive bladder include:

• Frequency: Urinary frequency means you need to urinate more often than usual. This can be variable but a good benchmark is “could you hold for 4 hours if you planned it?”
• Urgency: Urinary urgency is a sudden, compelling need to urinate. It is often associated with discomfort in your bladder.
• Nocturia: Nocturia is when you are awoken at night by the need to urinate. Most people can sleep for 6 to 8 hours without having to urinate.

What are the consequences of OBS

When compared with demographically matched controls, patients with OBS have:

• Significantly less work productivity
• Less sexual satisfaction and more erectile dysfunction
• Higher rates of depressive symptoms
• Significantly poorer mental health
• Poorer quality of sleep.
• Postmenopausal women with urge incontinence have a significantly higher risk of falling and sustaining a fracture than women without urge incontinence.

What are the risk factors for OBS

Risk factors for OBS include

• Childbirth, especially vaginal delivery
• Prostatic enlargement
• Urethral strictures
• Older age
• Obesity
• Chronic constipation
• Childhood urinary symptoms
• Family history

What are the causes of an overactive bladder?

The exact cause of OBS is unknown however it is important to exclude other conditions, which cause similar symptoms. These include:

• Infection
• Bladder cancer
• Spinal cord lesions (spina bifida, cancer, cord compression)
• Neurological disorders (multiple sclerosis, parkinsons disease etc)
• Benign prostatic hyperplasia
• Painful bladder syndrome

How is OBS diagnosed?

Overactive bladder syndrome is a diagnosis of exclusion. Investigations may include:

• History
• Bladder diary
• Physical examination
• Urine specimen
• Renal tract ultrasound
• Flow study
• Urodynamics
• Cystoscopy