OAB and Talking with Your Doctor

If your daily schedule is becoming dictated by frequent and sudden urinary urges that leave you scrambling for the nearest bathroom, it might be time to ask a doctor about overactive bladder.

Overactive bladder is a broad term that describes certain symptoms: urinary urgency, frequent urination, waking up at least twice a night to urinate, or urge incontinence (leakage of urine).

“It’s pretty straightforward. It’s really a diagnosis based on symptoms,” says Donna Y. Deng, MD, MS, a urologist and associate professor at the University of California-San Francisco who also serves on the board of directors at the National Association for Continence. But patients need not have all four signs to be diagnosed, she says. 

How is OAB diagnosed?
Many types of doctors can diagnose and treat overactive bladder. “The majority that come across this will be primary care doctors, internal medicine, and obviously, urologists and gynecologists,” Deng says.

Treatment is important because overactive bladder can seriously interfere with activities, Deng says. Patients may need to pull off the freeway immediately to find a restroom, or they will map out every public bathroom before they run errands. Some fear leaving their homes and become isolated. “People really redefine themselves,” Deng says. “They really plan their lives around the bathroom. It’s definitely a great detriment to quality of life.”

In some cases, the urge is so strong that people can’t reach a toilet in time. “There’s very little warning time,” Deng says.

Talking about overactive bladder
Talking about such personal issues can be uncomfortable, but worthwhile, experts say. “Patients often don’t volunteer information,” says Tomas L. Griebling, MD, MPH, professor and vice chair of the department of urology at the University of Kansas and a faculty associate in the Landon Center on Aging. “A lot of people…stop being sexually active because of incontinence and leaking and often are reluctant to discuss that.”

Tell your doctor about such problems, he says. “There are usually things that we can do to try to help people.”

Urge incontinence versus stress incontinence

Not everyone with overactive bladder will have incontinence, a problem in which urine leaks. But doctors do check for symptoms of stress incontinence and urge incontinence. If a patient has urge incontinence, it’s more likely to point to overactive bladder.

Also, “you need to make a clear distinction because the treatments are very different,” Deng says.

With stress incontinence, people leak urine when they cough, laugh, or sneeze. “People leak urine with physical activities that increase the pressure inside the abdomen,” Griebling says. Stress incontinence can begin when pelvic muscles weaken, for example, after pregnancy and childbirth.

With urge incontinence, “people actually have that sensation of needing to go very quickly, but leak urine before they can reach the toilet,” Griebling says. Typically, the sense of urgency stems from involuntary contractions of the bladder muscles.

Voiding diary

To prepare for a doctor’s visit, consider keeping a voiding diary for a few days. Record each time you urinate, how much urine you pass, how much leakage you have, what you were doing when the leakage occurred, and what you drink and eat each day. Not only will the diary help you with accurate recall, it might provide your doctor important clues.

Questions Your Doctor Will Ask You

During a first visit, doctors ask several questions to help rule out or narrow the possible cause of your bladder problems.

• How often do you urinate each day?
• How much liquid do you drink each day (with meals and between meals)?
• Do you leak urine? Do you leak urine when you sneeze, cough, or exercise?
• Do you feel an urge when you have to urinate or have a sudden urge to urinate at inappropriate times? Do you have to rush to the toilet and sometimes not make it?
• Do you have trouble starting your urine stream? Is your urine stream like it always has been, or does it seem “slow” or “weak”?
• Do you feel like you empty your bladder? Do you have to strain or push? Do you dribble or leak urine after you think you have finished urinating?
• How many times do you get up at night to use the toilet?
• Does it ever hurt or burn when you urinate? Does your urine have a bad odor, contain blood, or appear dark yellow or concentrated?
• If you wear pads, are there a few drops of urine in the pad or a bladder-full?
• How often do you have a bowel movement? What’s the consistency of your stools? Are they easy or hard to pass?

Doctors ask about bowel movements because constipation can put pressure on the bladder.

Also, “patients with bowel problems often have urinary problems and vice versa,” Griebling says. Nerves that control the bladder also control the sigmoid colon, and some patients leak both urine and stool, he says.

Amy Rosenman, MD, a urogynecologist in Santa Monica, Calif., and a clinical assistant professor at the David Geffen School of Medicine at UCLA, also asks her female patients when they had their last bladder infection “because that can cause urgency and frequency,” she says.  

During the exam, doctors also take a thorough medical history to rule out problems that can cause overactive bladder symptoms. These disorders include multiple sclerosis, Parkinson’s disease, stroke, diabetes, kidney problems, enlarged prostate, or a bladder tumor or bladder stones. “There are many things that cause the bladder to behave badly,” Rosenman says.   

If other conditions have been ruled out, doctors often don’t know exactly what causes an overactive bladder. The problem becomes more common with aging, but experts say that it’s not a normal or inevitable part of growing older. However, even if doctors don’t know the cause, they can still treat the symptoms.

Don’t hesitate to seek out a specialist if your symptoms aren’t under good control, Rosenman says. Not all doctors are well-versed in the multitude of treatment options, such as biofeedback or electrical nerve stimulation, she says.

Usually, patients are first treated with medications, she says, often effectively. “But if that doesn’t work, then we want [patients] to know that that’s not the end.”

Questions to Ask Your Doctor

Patients can also take part in educating themselves and decision-making. Some questions to ask your doctor:

• What might be causing my overactive bladder?
• What are my treatment options?
• Do I need medication? Why?
• Does the medication have side effects?
• Are there any special instructions regarding the drug?
• How soon should my symptoms improve?
• Besides medication, can other treatments or products help me? (For example, absorbent pads, bladder training, Kegel or pelvic floor exercises, exercises, biofeedback, sacral nerve stimulation)
• What other steps can I take (for example, dietary changes) to cope with overactive bladder in my daily life?

Testing and surgery

If your doctor recommends any testing, make sure that you understand the reasons:

• What will this test show?
• How accurate is it?
• How will it affect my treatment?
• Are there any risks or side effects?
• Do I need to do anything special before or after the test?

If you’ve been diagnosed with overactive bladder and have a severe case that doesn’t respond to non-surgical treatments, your doctor might recommend surgery. If so, ask the following:

• What are the risks and benefits of surgery?
• How much improvement can I expect? How soon?
• Will I be hospitalized? How long is the recovery time?
• Can you refer me to another physician for a second opinion?