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What is the bladder?

The bladder is the organ which stores urine produced by the kidneys. It is a muscle in the shape of a bag which can hold around 400 millilitres of urine (Fig. 1a and 1b).

Most people become aware their bladder is filling when it is half full. In order to empty the bladder, you have to be able to relax. This usually means being in a socially convenient environment, such as a toilet or a private space. The brain will then send a signal to the bladder to start squeezing out the urine.

How often you urinate depends on many factors, but one in particular is how much you drink. Most people urinate less than 8 times during the day, and either not at all or once during the night.

Fig. 1a: The male lower urinary tract.
Fig. 1a: The male lower urinary tract.
Fig. 1b: The female lower urinary tract.
Fig. 1b: The female lower urinary tract.

Symptoms of overactive bladder syndrome

Overactive bladder syndrome (OAB) is a common condition and can affect both men and women. Between 10 and 20% of people suffer from it at some stage in their lives. This syndrome is characterised by the presence of urinary symptoms that include:

  • The sudden need to urinate and having trouble postponing it, also called urgency, that can be followed by an involuntary loss of urine
  • The need to urinate more often than usual, called increased daytime frequency
  • The need to wake up at night to urinate, also called nocturia

Diagnosis of overactive bladder syndrome

When OAB symptoms are present, your doctor might need to rule out other possible explanations for the symptoms, such as urinary infection or diabetes.

First, the doctor or nurse might take your medical history and do a physical examination. If needed, other tests will be performed.

This section offers general information about the diagnosis of OAB and situations can vary from country to country.

Medical history

The doctor might take a detailed medical history and ask questions about your symptoms. You can help your doctor by preparing for the consultation:

  • Describe your current symptoms
  • Note how long you have had the symptoms for
  • Make a list of the medication you are taking
  • Make a list of previous surgical procedures
  • Mention other diseases or conditions you suffer from
  • Describe your lifestyle (exercising, smoking, alcohol, and diet)

Physical examination

Your doctor or nurse will do a general physical examination focussing on:

  • Your abdomen
  • Your genitals
  • The nerves in your back

Urine test

You will need to give some of your urine for testing. The test will show if you have a urinary tract infection and if there are traces of blood or sugar in the urine.

Bladder diary

Your doctor may ask you to keep a bladder diary. Here you can note down how much you drink, how often you urinate, and how much urine you produce. The bladder diary is important because it helps your doctor to understand your symptoms better.

Uroflowmetry

Uroflowmetry is a simple test that electronically records the rate of urine flow. It is easily done in privacy at the hospital or clinic. You will urinate into a container, called a uroflowmeter. This test helps your doctor to check whether there is any obstruction to the flow of urine.

Imaging of the bladder

You might get an ultrasonography (also known as ultrasound), which uses high-frequency sounds to create an image of your bladder. The doctor or nurse will scan your bladder to check how much urine is left in the bladder after urinating. This information helps to see if your symptoms are caused by urine retention in the bladder after urinating.

Cystoscopy

With a cystoscopy, the doctor can look inside the urethra and the bladder with the help of a small camera, usually under local anaesthesia. It may be needed when you suffer from other symptoms, such as blood in the urine.

Urodynamic evaluation

A urodynamic test is done to get more information about your urination cycle and how your bladder muscles work.

During the test, your doctor or nurse inserts small catheters in your urethra and rectum to measure the pressure in your bladder and abdomen. The bladder is slowly filled with sterile water through the catheter in the urethra. This is done to simulate the filling of the bladder with urine. When your bladder is full, you will urinate into a uroflowmeter. The test results are shown on a screen which is connected to the catheters.

Treatment of overactive bladder syndrome

Bladder surgery

In case your symptoms have not improved with drug or other treatments, you may need surgery on your bladder. The goal of the procedure is to increase the capacity of the bladder. This will reduce the pressure in the bladder as it fills so that it can hold more urine.

The doctor makes an incision in your lower abdomen and uses a piece of your bowel to increase the size of the bladder. This procedure is called bladder augmentation or clam cystoplasty, and is rarely performed nowadays. If this surgery is recommended you will need to discuss its implications and side effects with your doctor because they can be significant.

General information about overactive bladder syndrome

Cause overactive bladder syndrome

  • The precise cause of overactive bladder syndrome is not well understood and is still under investigation. Several factors may be involved and the main one may vary from individual to individual. Some people experience sudden and spontaneous contractions of the bladder muscle
  • Some people are more sensitive to the feeling of their bladder filling
  • Some people have a smaller bladder which is filled to capacity more quickly

Self-management overactive bladder symptoms

The symptoms of overactive bladder are often bothersome but not life-threatening. OAB symptoms can last for a long time and there is no simple cure. There are various treatment options available. In most cases, self-management is offered as the first step of treatment. It is common to try different treatment options to figure out which one works best in your individual situation. You can discuss this with your doctor.

You can actively manage your symptoms. The following self-management measures may help you:

  • Together with your doctor you can discuss adapting when, what, and how much you drink
  • If urine leakage is a problem, your doctor may recommend wearing an absorbent pad to prevent wetting your clothes
  • If recommended by your doctor, encourage yourself to “hold it” longer when you feel the urgency to urinate. This will train your bladder and gradually increase the time between toilet visits
  • Pelvic muscles can weaken with age. Different exercises can help to regain muscle strength and suppress the urgent desire to urinate. A physiotherapist can help you do these exercises the right way.

Read more about continence products, such as different types of pads, at the Continence Product Advisor website

Lifestyle advice

In addition, general lifestyle changes can help manage your symptoms and improve your quality of life.

  • Discuss with your doctor how much you should drink
  • Drink less before and during long trips
  • Drink less in the evening to avoid getting up at night to urinate
  • Reduce alcohol and caffeine because they increase urine production and irritate the bladder
  • Certain foods can irritate the bladder and worsen OAB symptoms. It may be helpful to reduce artificial sweeteners, spicy foods, citrus fruits and juices, caffeine and soft drinks in your diet
  • Maintain a healthy weight (your Body Mass Index should be between 18-25 kg/m2). Reducing your weight may lead to improvement in urine leakage symptoms

Living with overactive bladder syndrome

Although overactive bladder symptoms (OAB) are not life-threatening, they usually have a negative impact on your quality of life. Different people cope differently with their symptoms and the possible side effects of treatment. Your personal preferences and values and the impact of OAB symptoms on your life should not be underestimated.

Quality of life involves both physical and psychological health. It is important not only to feel healthy but also to feel free from the psychological pressure of living with OAB symptoms.

Symptoms such as urgency or the need to urinate frequently are likely to have a negative effect on your quality of life. Someone with OAB symptoms often needs to locate toilets before leaving the house and may avoid certain activities altogether. Also, losing sleep because of waking up at night to urinate may lower your energy levels, which makes it more difficult to maintain your daily activities. Episodes of urgency which result in leakage of urine are embarrassing and may lower your self-esteem.

These problems can also impact your loved ones. For example, your partner might be awoken by night time toilet visits. Because of your OAB symptoms you may avoid social activities. This can also affect your partner’s social life and lead to a feeling of isolation which prevents you and your loved ones from fully enjoying life.

There are many ways to keep the symptoms under control. They should not stop you from being happy in your relationships and participating in the social, cultural, and economic life of your community. Seek help if your symptoms bother you: consult your family doctor, general practitioner, or a urologist.

Seeking help

Overactive bladder symptoms become more common with increasing age. However, they should not be seen as a normal part of ageing or an untreatable problem. If you have bothersome symptoms it is important that you go to your doctor and are not embarrassed to discuss your situation.

It can help and might make you feel more comfortable if your partner, relatives, or friends read the information regarding your condition. Write down all of your questions to remind you of any important points you need to discuss with your doctor or nurse. Let someone accompany you to an appointment to help you remember any questions you may need to ask.

This information was produced by the European Association of Urology (EAU).

  • Prof. Christopher Chapple, Sheffield (UK)
  • Prof. Stavros Gravas, Larissa (GR)
  • Dr. Nadir Osman, Sheffield (UK)

This information was updated by the EAU Patient Information Working Group, January 2020.

The content is in line with the EAU Guidelines on Overactive Bladder 2017.

  • Dr. Jan-Peter Jessen, Sindelfingen (DE)
  • Dr. Marta Sochaj, Warsaw (PL)