Lakeview Health System
Overactive Bladder
What is Overactive Bladder (OAB)?
By definition, OAB is urgency (the sudden desire to void), with or without urge incontinence (leakage) and usually with frequency (voiding >7 times in 24 hrs) and nocturia (getting up to void at night). It can only be diagnosed if there are no infections or other problems - for example a bladder tumor or prostate problem.

How common is OAB?
It is estimated about 17% of Americans over age 18 have OAB, with a sharp rise in incidence over age 40. The overall prevalence is equal between men and women, but women are 3 times more likely have OAB with leakage (can’t make it to the bathroom in time). Although it is so common, only about 1 in 3 with bothersome symptoms seek treatment. Reasons given for this are “it is not bad enough to need to see a doctor or take pills” or “it is a natural part of getting older" and "I just have to live with it.” For this reason, it can lead to a diminished quality of life.

What causes OAB?
This is unknown, and it is doubtful that there is only a single cause. Simply put, it is a “miscommunication” between the nerves and muscles of the bladder that results in the bladder sensing that it is full, even at small volumes of urine.

How is OAB treated?
Initially behavioral adaptations are done, including fluid restriction, intentional increase in frequency of voiding, wearing pads and even restriction of social activities. There are medications that can help, and newer formulations are more potent, better tolerated with just once a day dosing. These medications, known in general as anticholinergics, can cause a dry mouth or constipation but are generally considered quite safe. They should be used with caution in patients with a rare type of glaucoma.

Painful Bladder (PBS)

What is PBS?
Formerly known as Interstitial Cystitis, PBS is a condition of urgency, frequency, nocturia and lower abdominal or pelvic pain. The pain can vary from a mild burning or discomfort to more severe pain in the pelvis, lower back or abdomen, or thighs -often relieved with urination. In women the pain can be worsened with intercourse (dyspareunia). It can only be diagnosed if there are no infections or other problems - for example a bladder tumor or prostate infection.
                    
How is it different than OAB?
While urinary symptoms can be similar to OAB, with PBS pain is always present. Fortunately, PBS is much rarer than OAB, but women are affected 9 times more than men. PBS symptoms are often more severe than OAB, thus it can have a more drastic effect on quality of life. PBS tends to be more difficult to diagnose and treat.

What causes PBS?
While there are many theories, the true cause of PBS is not known. There appears to be a neurogenic inflammation of the bladder and pelvic sensory nerves.  

How is PBS diagnosed?
Simply put, diagnosis is usually based upon appropriate symptoms in the absence of any ‘mimicking’ disease. Because the symptoms can be so vague, often a variety of specialists are seen before the diagnosis is made, including primary caregivers, gynecologists, urologists, gastroenterologists, physical therapists, psychiatrists and others. It should be suspected when a female patient has a complaint of chronic pelvic pain, especially when there are associated bladder symptoms. It should be suspected in a man if he has failed therapy for chronic prostatitis. It needs to be differentiated from OAB, and the key question is “when your bladder is full, does it hurt and does it go away with emptying?” If yes, IC is more likely.

How is PBS treated?
It is important to realize there can be different sources of the pelvic pain. If there is bowel, pelvic or vaginal pain, other specialists may be necessary. For bladder symptoms, a patient is usually referred to a urologist. In general, the basic concept for treatment of PBS is to treat the “triggers” - which usually means patients need to change their diets. Foods best avoided by most PBS patients include food/drink containing caffeine, acidic foods (citrus, tomatoes, vinegar), alcohol, carbonated drinks and highly spiced foods, especially with hot pepper. Calcium glycerophosphate or Prelief (available in health food stores) seems helpful. If someone has a lot of allergies, treatment with an antihistamine(Vistaril) may help, and sometimes an antidepressant amitriptyline may be helpful. Pentosan (Elmiron) may help also, by treating the delicate lining of the bladder wall, but may take 3 to 6 months to be effective. Sometimes bladder hydrodistention, or the instillation of heparin and lidocaine can be helpful. If all conventional treatments fail, sacral neuromodulation (a bladder “pacemaker”) may be necessary. Rarely, a portion or all the bladder may need to be removed.