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Overactive bladder affects around 25% of women and 20% of men.
Overactive bladder is defined by the frequent (pollakiuria) and urgent need to urinate. It occurs when the bladder muscles begin to contract involuntarily even when the volume of urine stored in the bladder is low.
People with overactive bladder may urinate more than 12 times a day or every half hour, and it's common for them to also need to get up frequently to use the bathroom at night (nocturia). This significantly impacts the quality of life of those affected, as it can limit their social and professional lives.
This condition affects around 25% of women and 20% of men. Even so, many cases go undiagnosed because those who have it don't consider it important, think it's normal, or are embarrassed to see a specialist.
To combat the symptoms, those who suffer from it can begin by trying some lifestyle changes, such as dietary modifications, timed voiding strategies, or bladder control techniques using the pelvic floor muscles. Likewise, maintaining a healthy lifestyle can help reduce the risk of developing an overactive bladder.
If these guidelines do not help enough, a doctor can evaluate whether there is a specific cause and prescribe the appropriate treatment.
The main symptoms of overactive bladder are:
These symptoms can affect a person's quality of life, sometimes even triggering:
On the other hand, if you experience an involuntary loss of urine immediately after an urgent need to urinate, we are talking about urge incontinence.
IMPORTANT: Several conditions can present symptoms similar to those of overactive bladder, such as urinary tract infections, prostate disease, or bladder tumors, among others. Therefore, it is important to rule out any other illness before correctly diagnosing overactive bladder.
When the bladder fills, nerve signals are sent to the brain, triggering the urge to urinate. During urination, these signals coordinate the relaxation of the pelvic floor muscles: the bladder muscles contract to expel the urine, and the urethral sphincter opens to allow the urine to flow out. This urge to urinate in humans is triggered by social situations where we can urinate. This is why we can hold our urine.
From a urodynamic perspective, overactive bladder occurs when the bladder muscles (detrusor) begin to contract involuntarily even when the volume of urine stored in the bladder is low. These involuntary contractions create an urgent need to urinate.
The cause of overactive bladder is not always known, but there are multiple factors that can contribute to the presence of compatible symptoms:
Overactive bladder is characterized by urinary urgency—with or without urinary incontinence—associated with increased daytime and nighttime urination frequency. For diagnosis, the physician must document all the patient's symptoms and signs and rule out other conditions that could be causing them.
The initial evaluation of patients with overactive bladder should include:
It is essential in the initial assessment and should record the type, duration, and severity of symptoms, as well as the presence or absence of urinary incontinence. Furthermore, it should allow for differentiation between urge urinary incontinence, stress urinary incontinence, and mixed urinary incontinence.
It is important to describe symptoms clearly and avoid ambiguous terms to prevent confusion. For example, you should record daytime urination frequency, time between urinations, nighttime urination frequency, and the number of times you get up to urinate at night.
Likewise, the medical history should include any pathology that the patient may present, as well as the pharmacological treatments he receives to check if they may have any impact on the symptoms of overactive bladder or cause them.
On the other hand, any symptoms and/or history that might suggest the need for referral for further evaluation should be identified. If lower abdominal or perineal pain is present before, during, or after urination, the patient should not be diagnosed with overactive bladder syndrome.
It includes abdominal examination to detect increased bladder volume or the presence of other abdominal masses.
In men, a digital rectal examination should be performed, and in women, estrogen status and the possible presence of prolapse (descent of the pelvic organs due to weakening of the pelvic floor) should be evaluated.
This test is performed to rule out urinary tract infection or hematuria. Urine sediment analysis is necessary to ensure there is no underlying organic abnormality in the bladder causing the symptoms: urinary tract infection, hematuria, leukocyturia, or suspected bladder stones.
Voiding diaries are a reliable tool for measuring urine volume, urinary frequency, and episodes of urinary urgency and incontinence. They are also useful for monitoring progress and outcomes after treatment.
Based on validated Spanish-language symptom scoring scales and questionnaires that have proven useful for measuring changes in patients' conditions, this tool allows for measuring symptom severity, screening or classifying urinary incontinence if present, and helping to determine if a change in treatment is needed.
On the other hand, the impact of overactive bladder symptoms on quality of life is an important aspect in its management.
As a first step in treating overactive bladder, it is recommended to implement a behavior modification program that includes hygiene and dietary guidelines.
These treatments can be adapted to the needs and abilities of the patients. In most cases they are effective and not associated with adverse effects, but active patient participation is necessary.
If necessary, the above guidelines can be combined with pharmacological treatment.
Bladder relaxant medications can be helpful in relieving overactive bladder symptoms and reducing episodes of urge urinary incontinence: mirabegron, vibegron, solifenacin, fesoterodine, desfesoterodine, tolterodine, oxybutynin, trospium.
These medications can have side effects such as dry eyes and mouth (drinking water to quench thirst can worsen overactive bladder symptoms) or constipation (which can worsen bladder symptoms). Extended-release forms of these medications, such as skin patches or gels, may have fewer side effects.
Your doctor may recommend sipping small amounts of water, sucking on a sugar-free candy, or chewing sugar-free gum to relieve dry mouth, as well as using eye drops to keep your eyes moist. To prevent constipation, your doctor may recommend a high-fiber diet or stool softeners.
On the other hand, women going through menopause may be prescribed vaginal estrogens, usually applied topically, to help strengthen the muscles and tissues of the urethra and vaginal area, significantly improving the symptoms of overactive bladder.
Onabotulinum toxin type A, also known as "Botox," is a protein produced by the bacteria that cause botulism. This protein is used in small doses injected directly into the bladder tissue to relax the muscles.
The effects typically last six months or more, requiring repeated injections. Side effects can include urinary tract infections and urinary retention. If you are considering Botox treatment, you must be able to catheterize yourself and be prepared to do so if urinary retention occurs.
In cases that do not respond to other treatments, nerve modulation may be considered. This includes percutaneous stimulation of the posterior tibial nerve. A thin needle is inserted through the skin near the ankle to send electrical stimulation from a nerve in the leg (tibial nerve) to the spinal cord, where it connects with the nerves that control the bladder. Another alternative is the placement of a sacral nerve root neuromodulator.
When previous treatments have been ineffective, the definitive treatment is bladder augmentation using small bowel tissue. Currently, this procedure is performed using minimally invasive robotic surgery.
We treat our patients at the ROC Chamberí clinic and in the HM Hospitals network of centers in Madrid: Sanchinarro, Montepríncipe, Madrid Río, Rivas, Puerta del Sur, Nuevo Belén, Policlínico HM Moraleja and Nuevo Norte.
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We treat our patients at the ROC Chamberí clinic and in the HM Hospitals network of centers in Madrid: Sanchinarro, Montepríncipe, Madrid Río, Rivas, Puerta del Sur, Nuevo Belén, Policlínico HM Moraleja and Nuevo Norte.
Coming soon
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NIF: B-21958988
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ROC CLINIC UROLOGY GROUP COMPANY, SLP
NIF: B-21958988
Address: Paseo General Martínez Campos, 17 · 28010 Madrid (Spain)
Contact: privacy@rocclinic.com
To respond, in the first instance, to inquiries, requests, comments, doubts, complaints or any other concerns that you have sent us through the contact form.
The legal basis is the consent given when completing the form, as well as the legitimate interest in answering your questions correctly.
During the time your consultation is open and during the legally established periods for the defense of claims.
Your data will not be disclosed to third parties not authorized to know it.
You may access, rectify, delete, oppose certain processing, exercise your right to restriction of processing, to data portability and no longer be subject to a decision based solely on automated processing of your data.
Likewise, you may revoke the consents given at any time without such revocation affecting the lawfulness of the processing carried out previously.
You can exercise the rights described above through the following channels:
In writing, by means of an application addressed to Paseo General Martínez Campos, 17 · 28010 Madrid (Spain)
• By email to the following address: privacidad@fundacionroc.com
You can find additional information about exercising your rights and detailed information about Data Protection at the following link: privacy policy
