Fardod O’Kelly
Consultant Urologist, Clinical Associate Professor UCD & Senior Lecturer in Postgraduate Surgical Education RCSI
Overactive bladder (OAB) is a prevalent but frequently underdiagnosed medical condition impacting an estimated 17% of the adult population in Europe.
Defined by the International Continence Society as ‘urgency, with or without urge incontinence, usually accompanied by frequency and nocturia,’ OAB disrupts daily routines and quality of life for millions.
This condition also affects approximately 5–10% of children, may occur with enuresis (bedwetting) and is often part of an overall complex of dysfunction with both voiding and stooling. Many childhood cases resolve and can respond well to bladder retraining, behavioural therapy and physiotherapy, prior to resorting to medication.
Understanding overactive bladder symptoms
Urgency — the sudden, compelling need to urinate — is the cornerstone symptom of OAB. This may be accompanied by urge incontinence, where leakage occurs before reaching the bathroom, as well as frequent urination and nocturia (waking up at night to urinate). Notably, individuals may also experience mixed urinary incontinence, which includes both urge and stress symptoms, though this is not classified under OAB syndrome.
OAB typically results from detrusor overactivity, where the bladder muscle contracts involuntarily during filling. This can stem from neurological conditions or be idiopathic (without an identifiable cause). Diagnosis does not always require invasive testing; however, urodynamic studies, cystoscopy (camera into the bladder) or imaging may be necessary if symptoms are severe, atypical or resistant to treatment.
Conservative management is the first
line of treatment and includes
lifestyle modifications.
Approaches to OAB treatment
Conservative management is the first line of treatment and includes lifestyle modifications such as reducing fluid intake, avoiding caffeine and alcohol and practising bladder retraining. When behavioural strategies fall short, pharmacological therapies — particularly antimuscarinic agents — are employed.
Antimuscarinic drugs can help control bladder contractions but often lead to side effects like dry mouth, constipation and drowsiness, contributing to low patient adherence. There are also newer treatments that offer alternative mechanisms with potentially fewer side effects. In refractory cases, advanced options like botulinum toxin injections or sacral nerve stimulation are considered. These approaches have shown promising outcomes, though cost and access remain challenges.
Timely care can improve quality of life
With effective treatments available, awareness and timely diagnosis of OAB are crucial. Individuals experiencing symptoms should consult their healthcare provider. Addressing this condition can significantly improve physical comfort, emotional wellbeing and daily functioning.
