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Overactive bladder

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</style><table class="infobox infobox-has-images-with-white-backgrounds"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Overactive bladder</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Overactive bladder syndrome</td></tr><tr><td colspan="2" class="infobox-full-data"></td></tr><tr><th scope="row" class="infobox-label"><a href="Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="Urology" title="Urology">Urology</a></td></tr><tr><th scope="row" class="infobox-label"><a href="Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data">Frequent feeling of needing to <a href="Urinate" class="mw-redirect" title="Urinate">urinate</a>, <a href="Urinary_incontinence" title="Urinary incontinence">incontinence</a></td></tr><tr><th scope="row" class="infobox-label"><a href="Complication_(medicine)" title="Complication (medicine)">Complications</a></th><td class="infobox-data">UTIs, anxiety</td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data">More common with age<a href="#cite_note-AUA2014-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label">Duration</th><td class="infobox-data">Chronic</td></tr><tr><th scope="row" class="infobox-label">Types</th><td class="infobox-data">Age-related, or Secondary to other illness</td></tr><tr><th scope="row" class="infobox-label"><a href="Cause_(medicine)" title="Cause (medicine)">Causes</a></th><td class="infobox-data">Old age; <a href="Detrusor_muscle" title="Detrusor muscle">detrusor muscle</a> injury; over-consumption of water and caffeine; UTI; pelvic injury</td></tr><tr><th scope="row" class="infobox-label"><a href="Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data">Old age, obesity, caffeine, constipation</td></tr><tr><th scope="row" class="infobox-label"><a href="Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Based on symptoms after ruling out other possible causes<a href="#cite_note-AUA2015-2">[2]</a><a href="#cite_note-AUA2014-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="Differential_diagnosis" title="Differential diagnosis">Differential diagnosis</a></th><td class="infobox-data">Other <a href="Neurogenic_bladder_dysfunction" title="Neurogenic bladder dysfunction">neurological conditions</a><a href="#cite_note-AUA2015-2">[2]</a><a href="#cite_note-AUA2014-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data"><a href="Pelvic_floor_exercise" class="mw-redirect" title="Pelvic floor exercise">Pelvic floor exercises</a>, <a href="Bladder_training" title="Bladder training">bladder training</a>, drinking moderate fluids, <a href="Weight_loss" title="Weight loss">weight loss</a>,<a href="#cite_note-AUA2012-3">[3]</a> medications, Botox, surgery</td></tr><tr><th scope="row" class="infobox-label"><a href="Medication" title="Medication">Medication</a></th><td class="infobox-data"><a href="Anticholinergic" title="Anticholinergic">Anticholinergic</a> drugs, β3 agonists</td></tr><tr><th scope="row" class="infobox-label"><a href="Prognosis" title="Prognosis">Prognosis</a></th><td class="infobox-data">Often but not always incurable</td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">~40% of elderly adults, increasing with age</td></tr></tbody></table><style data-mw-deduplicate="TemplateStyles:r1236303919">

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Overactive bladder (OAB) is a common condition where there is a frequent feeling of needing to <a href="Urinate" class="mw-redirect" title="Urinate">urinate</a> to a degree that it negatively affects a person's life.<a href="#cite_note-AUA2015-2">[2]</a> The frequent need to urinate may occur during the day, <a href="Nocturia" title="Nocturia">at night</a>, or both.<a href="#cite_note-4">[4]</a> <a href="Urinary_incontinence" title="Urinary incontinence">Loss of bladder control</a> (urge incontinence) may occur with this condition.<a href="#cite_note-AUA2014-1">[1]</a> This condition is also sometimes characterized by a sudden and involuntary contraction of the bladder muscles, in response to excitement or anticipation. This in turn leads to a frequent and urgent need to urinate.

Overactive bladder affects approximately 11% of the population and more than 40% of people with overactive bladder have incontinence.<a href="#cite_note-Ron2008-5">[5]</a><a href="#cite_note-:1-6">[6]</a> Conversely, about 40% to 70% of urinary incontinence is due to overactive bladder.<a href="#cite_note-7">[7]</a> Overactive bladder is not life-threatening,<a href="#cite_note-AUA2014-1">[1]</a> but most people with the condition have problems for years.<a href="#cite_note-AUA2014-1">[1]</a>

The cause of overactive bladder is unknown.<a href="#cite_note-AUA2014-1">[1]</a> Risk factors include obesity, caffeine, and <a href="Constipation" title="Constipation">constipation</a>.<a href="#cite_note-Ron2008-5">[5]</a> Poorly controlled <a href="Diabetes_mellitus" class="mw-redirect" title="Diabetes mellitus">diabetes</a>, poor <a href="Activities_of_daily_living#Basic_ADLs" title="Activities of daily living">functional mobility</a>, and <a href="Chronic_pelvic_pain" class="mw-redirect" title="Chronic pelvic pain">chronic pelvic pain</a> may worsen the symptoms.<a href="#cite_note-AUA2014-1">[1]</a> People often have the symptoms for a long time before seeking treatment and the condition is sometimes identified by caregivers.<a href="#cite_note-AUA2014-1">[1]</a> Diagnosis is based on a person's signs and symptoms and requires other problems such as <a href="Urinary_tract_infection" title="Urinary tract infection">urinary tract infections</a> or <a href="Neurogenic_bladder_dysfunction" title="Neurogenic bladder dysfunction">neurological conditions</a> to be excluded.<a href="#cite_note-AUA2015-2">[2]</a><a href="#cite_note-AUA2014-1">[1]</a> <a href="Uroflowmetry" class="mw-redirect" title="Uroflowmetry">Uroflowmetry</a> is also a good diagnostic aid.<a href="#cite_note-”Nowakowski_2016”-8">[8]</a>

The amount of urine passed during each urination is relatively small.<a href="#cite_note-AUA2014-1">[1]</a> Pain while urinating suggests that there is a problem other than overactive bladder.<a href="#cite_note-AUA2014-1">[1]</a>

Specific treatment is not always required.<a href="#cite_note-AUA2014-1">[1]</a> If treatment is desired <a href="Pelvic_floor_exercise" class="mw-redirect" title="Pelvic floor exercise">pelvic floor exercises</a>, <a href="Bladder_training" title="Bladder training">bladder training</a>, and other behavioral methods are initially recommended.<a href="#cite_note-AUA2012-3">[3]</a> <a href="Weight_loss" title="Weight loss">Weight loss</a> in those who are <a href="Overweight" title="Overweight">overweight</a>, decreasing <a href="Caffeine" title="Caffeine">caffeine</a> consumption, and drinking moderate fluids, can also have benefits.<a href="#cite_note-AUA2012-3">[3]</a> Medications, typically of the <a href="Anti-muscarinic" class="mw-redirect" title="Anti-muscarinic">anti-muscarinic</a> type, are only recommended if other measures are not effective.<a href="#cite_note-AUA2012-3">[3]</a> They are no more effective than behavioral methods; however, they are associated with side effects, particularly in older people.<a href="#cite_note-AUA2012-3">[3]</a><a href="#cite_note-9">[9]</a> Some non-invasive electrical stimulation methods appear effective while they are in use.<a href="#cite_note-:0-10">[10]</a> Injections of <a href="Botulinum_toxin" title="Botulinum toxin">botulinum toxin</a> into the bladder is another option.<a href="#cite_note-AUA2012-3">[3]</a> <a href="Urinary_catheters" class="mw-redirect" title="Urinary catheters">Urinary catheters</a> or <a href="Surgery" title="Surgery">surgery</a> are generally not recommended.<a href="#cite_note-AUA2012-3">[3]</a> A diary to track problems can help determine whether treatments are working.<a href="#cite_note-AUA2012-3">[3]</a>

Overactive bladder is estimated to occur in 7–27% of men and 9–43% of women.<a href="#cite_note-AUA2014-1">[1]</a> It becomes more common with age.<a href="#cite_note-AUA2014-1">[1]</a> Some studies suggest that the condition is more common in women, especially when associated with loss of bladder control.<a href="#cite_note-AUA2014-1">[1]</a> Economic costs of overactive bladder were estimated in the United States at US$12.6 billion and 4.2 billion Euro in 2000.<a href="#cite_note-11">[11]</a>

<div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2></div>

Overactive bladder is characterized by a group of four symptoms: urgency, urinary frequency, <a href="Nocturia" title="Nocturia">nocturia</a>, and urge incontinence. Urge incontinence is not present in the "dry" classification.<a href="#cite_note-Lightner2019-12">[12]</a>

<a href="Urinary_urgency" class="mw-redirect" title="Urinary urgency">Urgency</a> is considered the hallmark symptom of OAB, but there are no clear criteria for what constitutes urgency and studies often use other criteria.<a href="#cite_note-AUA2014-1">[1]</a> Urgency is currently defined by the International Continence Society (ICS), as of 2002, as "Sudden, compelling desire to pass urine that is difficult to defer." The previous definition was "Strong desire to void accompanied by fear of leakage or pain."<a href="#cite_note-Can_Urol_2011-13">[13]</a> The definition does not address the immediacy of the urge to void and has been criticized as subjective.<a href="#cite_note-Can_Urol_2011-13">[13]</a>

<a href="Frequent_urination" title="Frequent urination">Urinary frequency</a> is considered abnormal if the person urinates more than eight times in a day. This frequency is usually monitored by having the person keep a voiding diary where they record urination episodes.<a href="#cite_note-AUA2014-1">[1]</a> The number of episodes varies depending on sleep, fluid intake, medications, and up to seven is considered normal if consistent with the other factors.

<a href="Nocturia" title="Nocturia">Nocturia</a> is a symptom where the person complains of interrupted sleep because of an urge to void and, like the urinary frequency component, is affected by similar lifestyle and medical factors. Individual waking events are not considered abnormal. One study in Finland established two or more voids per night as affecting quality of life.<a href="#cite_note-14">[14]</a>

Urge incontinence is a form of urinary incontinence characterized by the involuntary loss of urine occurring for no apparent reason while feeling urinary urgency as discussed above. Like frequency, the person can track incontinence in a diary to assist with diagnosis and management of symptoms. Urge incontinence can also be measured with pad tests, and these are often used for research purposes. Some people with urge incontinence also have <a href="Stress_incontinence" title="Stress incontinence">stress incontinence</a> and this can complicate clinical studies.<a href="#cite_note-AUA2014-1">[1]</a>

It is important that the clinician and the person with overactive bladder both reach a consensus on the term, 'urgency.' Some common phrases used to describe OAB include, 'When I've got to go, I've got to go,' or 'When I have to go, I have to rush, because I think I will wet myself.' Hence the term, 'fear of leakage,' is an important concept to people.<a href="#cite_note-15">[15]</a>

<div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2></div>

The cause of OAB is usually unclear, and indeed there may be multiple causes.<a href="#cite_note-16">[16]</a> It is often associated with overactivity of the <a href="Detrusor_urinae_muscle" class="mw-redirect" title="Detrusor urinae muscle">detrusor urinae muscle</a>, a pattern of bladder muscle contraction observed during <a href="Urodynamic_testing" title="Urodynamic testing">urodynamics</a>.<a href="#cite_note-Treatment-17">[17]</a> It is also possible that the increased contractile nature originates from within the urothelium and lamina propria, and abnormal contractions in this tissue could stimulate dysfunction in the detrusor or whole bladder.<a href="#cite_note-Moro_et_al._2011-18">[18]</a>

<div class="mw-heading mw-heading3"><h3 id="Catheter-related_irritation">Catheter-related irritation</h3></div>

If bladder spasms occur or there is no urine in the drainage bag when a <a href="Catheter" title="Catheter">catheter</a> is in place, the catheter may be blocked by blood, thick sediment, or a kink in the catheter or drainage tubing. Sometimes spasms are caused by the catheter irritating the bladder, <a href="Prostate" title="Prostate">prostate</a> or <a href="Penis" title="Penis">penis</a>. Such spasms can be controlled with medication such as <a href="Butylscopolamine" class="mw-redirect" title="Butylscopolamine">butylscopolamine</a>, although most people eventually adjust to the irritation and the spasms go away.<a href="#cite_note-19">[19]</a>

<div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2></div>

Diagnosis of OAB is made primarily on the person's signs and symptoms and by ruling out other possible causes such as an infection.<a href="#cite_note-AUA2014-1">[1]</a> <a href="Urodynamics" class="mw-redirect" title="Urodynamics">Urodynamics</a>, a <a href="Cystoscopy" title="Cystoscopy">bladder scope</a>, and ultrasound are generally not needed.<a href="#cite_note-AUA2014-1">[1]</a><a href="#cite_note-AUSFive-20">[20]</a> Additionally, urine culture may be done to rule out infection. The frequency/volume chart may be maintained and <a href="Cystourethroscopy" class="mw-redirect" title="Cystourethroscopy">cystourethroscopy</a> may be done to exclude tumor and <a href="Kidney_stone" class="mw-redirect" title="Kidney stone">kidney stones</a>. If there is an underlying metabolic or pathologic condition that explains the symptoms, the symptoms may be considered part of that disease and not OAB.

Psychometrically robust self-completion questionnaires are generally recognized as a valid way of measuring a person's signs and symptoms, but there does not exist a single ideal questionnaire.<a href="#cite_note-21">[21]</a> These surveys can be divided into two groups: general surveys of lower urinary tract symptoms and surveys specific to overactive bladder. General questionnaires include: American Urological Association Symptom Index (AUASI), Urogenital Distress Inventory (UDI),<a href="#cite_note-pmid7841963-22">[22]</a> Incontinence Impact Questionnaire (IIQ),<a href="#cite_note-pmid7841963-22">[22]</a> and Bristol Female Lower Urinary Tract Symptoms (BFLUTS). Overactive bladder questionnaires include: Overactive Bladder Questionnaire (OAB-q),<a href="#cite_note-23">[23]</a> Urgency Questionnaire (UQ), Primary OAB Symptom Questionnaire (POSQ), and the International Consultation on Incontinence Questionnaire (ICIQ).

OAB causes similar symptoms to some other conditions such as <a href="Urinary_tract_infection" title="Urinary tract infection">urinary tract infection</a> (UTI), <a href="Bladder_cancer" title="Bladder cancer">bladder cancer</a>, and <a href="Benign_prostatic_hyperplasia" title="Benign prostatic hyperplasia">benign prostatic hyperplasia</a> (BPH). Urinary tract infections often involve pain and <a href="Hematuria" title="Hematuria">hematuria</a> (blood in the urine) which are typically absent in OAB. Bladder cancer usually includes hematuria and can include pain, both not associated with OAB, and the common symptoms of OAB (urgency, frequency, and nocturia) may be absent. BPH frequently includes symptoms at the time of voiding as well as sometimes including pain or hematuria, and all of these are not usually present in OAB.<a href="#cite_note-Can_Urol_2011-13">[13]</a> <a href="Diabetes_insipidus" title="Diabetes insipidus">Diabetes insipidus</a> causes high frequency and volume, though not necessarily urgency.

<div class="mw-heading mw-heading3"><h3 id="Classification">Classification</h3></div>

There is some controversy about the classification and diagnosis of OAB.<a href="#cite_note-AUA2014-1">[1]</a><a href="#cite_note-24">[24]</a> Some sources classify overactive bladder into two different variants: "wet" (i.e., an urgent need to urinate with involuntary leakage) or "dry" (i.e., an urgent need to urinate but no involuntary leakage). Wet variants are more common than dry variants.<a href="#cite_note-25">[25]</a> The distinction is not absolute; one study suggested that many classified as "dry" were actually "wet" and that people with no history of any leakage may have had other syndromes.<a href="#cite_note-26">[26]</a>

OAB is distinct from <a href="Stress_incontinence" title="Stress incontinence">stress urinary incontinence</a>, but when they occur together, the condition is usually known as mixed incontinence.<a href="#cite_note-27">[27]</a>

<div class="mw-heading mw-heading2"><h2 id="Management">Management</h2></div>

The usual first suggested treatment for a person with overactive bladder is a combination of lifestyle changes, exercises to strengthen the person's pelvic floor, and manage how much the person drinks and when during the day ("fluid management"). Patients who continue to experience incontinence episodes, or who express a desire for medication along with therapy, may be treated with several classes of drugs, notably <a href="Anticholinergic" title="Anticholinergic">anticholinergics</a>. Patients who prove resistant to medications and therapy may then be treated with <a href="Neurology" title="Neurology">neurological</a> interventions, such as treatment with <a href="Botulinum_toxin" title="Botulinum toxin">botulinum toxin</a> (Botox) and other minimally-invasive surgical procedures, such as <a href="Sacral_neuromodulation" class="mw-redirect" title="Sacral neuromodulation">sacral neuromodulation</a>. As a last resort if all other treatment options fail, invasive surgical procedures may be performed.<a href="#cite_note-:5-28">[28]</a><a href="#cite_note-29">[29]</a>

<div class="mw-heading mw-heading3"><h3 id="Lifestyle_and_behavioral_therapy">Lifestyle and behavioral therapy</h3></div>

Behavioral and lifestyle changes are commonly recommended as the first-line option for treating overactive bladder. These include bladder training, which involves scheduled voiding (urination) and gradually increasing the time between bathroom visits. Pelvic floor exercises, known as <a href="Kegel_exercise" title="Kegel exercise">Kegel exercises</a>, can help strengthen the muscles that control urination. Fluid management, which focuses on avoiding excessive caffeine and alcohol intake, is advised to reduce the rate at which the bladder fills and minimize irritation to the bladder. Weight management and maintaining a healthy diet contribute to overall bladder health, especially when weight loss is able to reduce abdominal compression of the bladder. Adopting these behavioral and lifestyle changes can often improve the condition and enhance the effectiveness of other treatment approaches.<a href="#cite_note-:5-28">[28]</a><a href="#cite_note-:3-30">[30]</a>

Most patients are not able to eliminate incontinence and other symptoms of OAB with lifestyle and behavioral modifications alone. However, numerous studies have demonstrated that these therapies are effective in improving quality of life, and some data shows that they increase the likelihood that medications can keep the OAB under control.<a href="#cite_note-:5-28">[28]</a>

<div class="mw-heading mw-heading3"><h3 id="Medications">Medications</h3></div>

Medications are a common treatment option for people with overactive bladder syndrome. A number of <a href="Antimuscarinic" class="mw-redirect" title="Antimuscarinic">antimuscarinic</a> drugs (e.g., <a href="Darifenacin" title="Darifenacin">darifenacin</a>, <a href="Hyoscyamine" title="Hyoscyamine">hyoscyamine</a>, <a href="Oxybutynin" title="Oxybutynin">oxybutynin</a>, <a href="Tolterodine" title="Tolterodine">tolterodine</a>, <a href="Solifenacin" title="Solifenacin">solifenacin</a>, <a href="Trospium" class="mw-redirect" title="Trospium">trospium</a>, <a href="Fesoterodine" title="Fesoterodine">fesoterodine</a>) are frequently used to treat overactive bladder.<a href="#cite_note-Treatment-17">[17]</a> Long term use, however, has been linked to <a href="Dementia" title="Dementia">dementia</a>.<a href="#cite_note-31">[31]</a> <a href="Beta-3_adrenergic_receptor" title="Beta-3 adrenergic receptor">β3 adrenergic receptor</a> agonists (e.g., <a href="Mirabegron" title="Mirabegron">mirabegron</a>, <a href="Vibegron" title="Vibegron">vibegron</a>) may be used, as well.<a href="#cite_note-32">[32]</a>

Patients taking oxybutynin and other anticholinergic drugs experience a 70% reduction of incontinence episode frequency, on average. Approximately 1 in 4 patients experience complete dryness while taking oxybutynin. Therefore, medication management alone is sufficient for a substantial minority, but not the majority, of patients with overactive bladder.<a href="#cite_note-33">[33]</a>

<th colspan="4" style="background-color: #CCEEEE;">Comparison of overactive bladder medication

</th></tr>

<tr>

<th>Agent

</th>

<th>Traits

</th></tr>

<tr>

<td><a href="Oxybutynin" title="Oxybutynin">Oxybutynin</a> (short-acting)

</td>

<td>

<ul><li>well known by physicians</li>

<li>available in market longer than other drugs for OAB</li>

<li>many studies provide support of effectiveness</li>

<li>available as generic in places including the United States</li>

<li>more side effects than alternatives, including <a href="Dry_mouth" class="mw-redirect" title="Dry mouth">dry mouth</a> and <a href="Constipation" title="Constipation">constipation</a></li>

<li>severe dry mouth more often reported</li>

<li>user takes 2-3 pills a day</li></ul>

</td></tr>

<tr>

<td><a href="Oxybutynin" title="Oxybutynin">Oxybutynin</a> (<a href="Time_release_technology" class="mw-redirect" title="Time release technology">extended release</a>)

</td>

<td>

<ul><li>fewer side effects than short-acting Oxybutynin</li>

</td></tr>

<tr>

<td><a href="Oxybutynin" title="Oxybutynin">Oxybutynin</a> (<a href="Transdermal_patch" title="Transdermal patch">transdermal patch</a>)

</td>

<td>

<li>patch changed every 3–4 days</li>

<li>lower rate of dry mouth as compared to pill form</li>

<li>patch commonly causes skin irritation which can be severe</li></ul>

</td></tr>

<tr>

<td><a href="Oxybutynin" title="Oxybutynin">Oxybutynin</a> (<a href="Topical_medication" title="Topical medication">Topical medication</a>)

</td>

<td>

<ul><li>fewer side effects than short-acting Oxybutynin</li>

<li><a href="Topical_gels" title="Topical gels">topical gel</a> applied to abdomen, arms, or thighs daily</li>

<li>new on market</li>

<li>little existing research on this drug</li></ul>

</td></tr>

<tr>

<td><a href="Tolterodine" title="Tolterodine">Tolterodine</a> (short-acting)

</td>

<td>

<ul><li>fewer side effects than short-acting Oxybutynin</li>

<li>2 pills per day</li>

<li>10% of Caucasians and 19% of black people have a genetic difference which causes them to lack a certain enzyme. Lack of this enzyme makes the drug less effective.</li></ul>

</td></tr>

<tr>

<td><a href="Tolterodine" title="Tolterodine">Tolterodine</a> (<a href="Time_release_technology" class="mw-redirect" title="Time release technology">extended release</a>)

</td>

<td>

<ul><li>fewer side effects than short-acting Oxybutynin</li>

<li>10% of Caucasians and 19% of black people have a genetic difference which causes them to lack a certain enzyme. Lack of this enzyme makes the drug less effective.</li></ul>

</td></tr>

<tr>

<td><a href="Solifenacin" title="Solifenacin">Solifenacin</a>

</td>

<td>

<li>More effective for some symptoms than Tolterodine</li>

<li>higher rates of constipation and dry mouth than tolterodine</li>

<li>less researched for safety and efficacy than Tolterodine and Oxybutynin</li></ul>

</td></tr>

<tr>

<td><a href="Trospium" class="mw-redirect" title="Trospium">Trospium</a> (short acting)

</td>

<td>

<ul><li>severe dry mouth less common than with oxybutynin</li>

<li>less researched for safety and efficacy than Tolterodine and Oxybutynin</li></ul>

</td></tr>

<tr>

<td><a href="Trospium" class="mw-redirect" title="Trospium">Trospium</a> (<a href="Time_release_technology" class="mw-redirect" title="Time release technology">extended release</a>)

</td>

<td>

<li>little existing research on this drug</li></ul>

</td></tr>

<tr>

<td><a href="Darifenacin" title="Darifenacin">Darifenacin</a>

</td>

<td>

<li>less researched for safety and efficacy than Tolterodine and Oxybutynin</li></ul>

</td></tr>

<tr>

<td><a href="Fesoterodine" title="Fesoterodine">Fesoterodine</a>

</td>

<td>

<ul><li>same metabolite as <a href="Tolterodine" title="Tolterodine">Tolterodine</a>, but does not require that enzyme to be active</li>

<li>it may avoid drug interactions of Tolterodine</li>

<li>little existing research on this drug</li></ul>

</td></tr>

</tbody></table>

<div class="mw-heading mw-heading3"><h3 id="Procedures">Procedures</h3></div>

Botulinum toxin A (Botox) is approved by the <a href="Food_and_Drug_Administration" title="Food and Drug Administration">Food and Drug Administration</a> in adults with neurological conditions, including <a href="Multiple_sclerosis" title="Multiple sclerosis">multiple sclerosis</a> and <a href="Spinal_cord_injury" title="Spinal cord injury">spinal cord injury</a>.<a href="#cite_note-34">[34]</a> Botulinum Toxin A injections into the bladder wall can suppress involuntary bladder contractions by blocking nerve signals and may be effective for up to 9 months.<a href="#cite_note-35">[35]</a><a href="#cite_note-36">[36]</a> The growing knowledge of pathophysiology of overactive bladder fueled a huge amount of basic and clinical research in this field of pharmacotherapy.<a href="#cite_note-37">[37]</a><a href="#cite_note-38">[38]</a><a href="#cite_note-39">[39]</a>

Overactive bladder may be treated with electrical stimulation, which aims to reduce the contractions of the <a href="Detrusor_urinae_muscle" class="mw-redirect" title="Detrusor urinae muscle">muscle that tenses around the bladder</a> and causes urine to pass out of it. Both invasive and non-invasive electrical stimulation procedures may be used to treat overactive bladder.<a href="#cite_note-:0-10">[10]</a>

<div class="mw-heading mw-heading4"><h4 id="Invasive_surgeries">Invasive surgeries</h4></div>

If non-invasive and pharmacological approaches are not helpful, some people may be eligible for a surgical procedure to treat overactive bladder. Surgical options may include <a href="Urinary_diversion" title="Urinary diversion">urinary diversion</a>, <a href="Sacral_neuromodulation" class="mw-redirect" title="Sacral neuromodulation">sacral neuromodulation</a>, or augmentation cystoplasty.<a href="#cite_note-:2-40">[40]</a>

One surgical intervention, called a cystoplasty, involves the enlargement of the bladder using tissue taken from the patient's <a href="Ileum" title="Ileum">ileum</a>, which is part of the small intestine. This procedure is rarely performed, and is only done for patients who have proven resistant to all other forms of treatment. This procedure can greatly enlarge urine volume in the bladder.<a href="#cite_note-41">[41]</a>

<div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2></div>

Because overactive bladder is most commonly associated with aging, the majority of patients experience symptoms (with or without incontinence) for the rest of their lives. A minority of age-related OAB cases may be cured or indefinitely suppressed by medications and behavioral modification. If the OAB is due to a different condition, such as a <a href="Urinary_tract_infection" title="Urinary tract infection">urinary tract infection</a>, then symptoms should resolve after the underlying problem has been treated.<a href="#cite_note-:3-30">[30]</a>

<div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2></div>

Earlier reports estimated that about one in six adults in the <a href="United_States" title="United States">United States</a> and <a href="Europe" title="Europe">Europe</a> had OAB.<a href="#cite_note-NOBLE_survey-42">[42]</a><a href="#cite_note-Milsom_et_al._2001-43">[43]</a> The number of people affected with OAB increases with age,<a href="#cite_note-NOBLE_survey-42">[42]</a><a href="#cite_note-Milsom_et_al._2001-43">[43]</a> thus it is expected that OAB will become more common in the future as the average age of people living in the <a href="Developed_world" class="mw-redirect" title="Developed world">developed world</a> is increasing. However, a recent Finnish population-based survey<a href="#cite_note-Tikkinen_et_al._2007-44">[44]</a> suggested that the number of people affected had been largely overestimated due to methodological shortcomings regarding age distribution and low participation (in earlier reports). It is suspected, then, that OAB affects approximately half the number of individuals as earlier reported.<a href="#cite_note-Tikkinen_et_al._2007-44">[44]</a>

The American Urological Association reports studies showing rates as low as 7% to as high as 27% in men and rates as low as 9% to 43% in women.<a href="#cite_note-AUA2014-1">[1]</a> Urge incontinence was reported as higher in women.<a href="#cite_note-AUA2014-1">[1]</a> Older people are more likely to be affected, and the number of symptoms increases with age.<a href="#cite_note-AUA2014-1">[1]</a>

<ul><li><a href="National_Association_For_Continence" class="mw-redirect" title="National Association For Continence">National Association For Continence</a></li>

<li><a href="Underactive_bladder" title="Underactive bladder">Underactive bladder</a></li></ul>

<div class="mw-heading mw-heading2"><h2 id="References">References</h2></div>

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<li id="cite_note-Tikkinen_et_al._2007-44">^ <a href="#cite_ref-Tikkinen_et_al._2007_44-0">a</a> <a href="#cite_ref-Tikkinen_et_al._2007_44-1">b</a> <cite id="CITEREFTikkinenTammelaRissanenValpas2007" class="citation journal cs1">Tikkinen KA, Tammela TL, Rissanen AM, Valpas A, Huhtala H, Auvinen A (February 2007). Madersbacher S (ed.). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1805814">"Is the prevalence of overactive bladder overestimated? A population-based study in Finland"</a>. PLOS ONE. 2 (2): e195. <a href="Bibcode_(identifier)" class="mw-redirect" title="Bibcode (identifier)">Bibcode</a>:<a rel="nofollow" class="external text" href="https://ui.adsabs.harvard.edu/abs/2007PLoSO...2..195T">2007PLoSO...2..195T</a>. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1371%2Fjournal.pone.0000195">10.1371/journal.pone.0000195</a>. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1805814">1805814</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/17332843">17332843</a>.</cite> <a href="Open_access" title="open access publication – free to read"></a>

</li>

</ol></div></div>

<div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2></div>

<ul><li><cite id="CITEREFSaccoBientinesiMarangiD'Addessi2011" class="citation journal cs1 cs1-prop-foreign-lang-source">Sacco E, Bientinesi R, Marangi F, D'Addessi A, Racioppi M, Gulino G, Pinto F, Totaro A, Bassi P (2011). "[Overactive bladder syndrome: the social and economic perspective]". Urologia (in Italian). 78 (4): 241–56. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.5301%2FRU.2011.8886">10.5301/RU.2011.8886</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/22237808">22237808</a>. <a href="S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:36693916">36693916</a>.</cite></li>

<li><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://medlineplus.gov/overactivebladder.html">"Overactive Bladder"</a>. MedlinePlus. U.S. National Library of Medicine.</cite></li></ul>

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</style><div id="Diseases_of_the_urinary_tract96" style="font-size:114%;margin:0 4em">Diseases of the <a href="Urinary_tract" class="mw-redirect" title="Urinary tract">urinary tract</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Ureter" title="Ureter">Ureter</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Ureteritis" title="Ureteritis">Ureteritis</a></li>

<li><a href="Ureterocele" title="Ureterocele">Ureterocele</a></li>

<li><a href="Megaureter" title="Megaureter">Megaureter</a></li>

<li><a href="Ureteric_stricture" title="Ureteric stricture">Ureteric stricture</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Urinary_bladder_disease" title="Urinary bladder disease">Bladder</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Urinary_tract_infection" title="Urinary tract infection">Cystitis</a>

<ul><li><a href="Interstitial_cystitis" title="Interstitial cystitis">Interstitial cystitis</a></li>

<li><a href="Hunner's_ulcer" title="Hunner's ulcer">Hunner's ulcer</a></li>

<li><a href="Trigonitis" title="Trigonitis">Trigonitis</a></li>

<li><a href="Hemorrhagic_cystitis" title="Hemorrhagic cystitis">Hemorrhagic cystitis</a></li></ul></li>

<li><a href="Neurogenic_bladder_dysfunction" title="Neurogenic bladder dysfunction">Neurogenic bladder dysfunction</a></li>

<li><a href="Bladder_sphincter_dyssynergia" title="Bladder sphincter dyssynergia">Bladder sphincter dyssynergia</a></li>

<li><a href="Vesicointestinal_fistula" title="Vesicointestinal fistula">Vesicointestinal fistula</a></li>

<li><a href="Vesicoureteral_reflux" title="Vesicoureteral reflux">Vesicoureteral reflux</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Urethra" title="Urethra">Urethra</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Urethritis" title="Urethritis">Urethritis</a>

<ul><li><a href="Non-gonococcal_urethritis" title="Non-gonococcal urethritis">Non-gonococcal urethritis</a></li></ul></li>

<li><a href="Urethral_syndrome" title="Urethral syndrome">Urethral syndrome</a></li>

<li><a href="Urethral_stricture" title="Urethral stricture">Urethral stricture</a></li>

<li><a href="Meatal_stenosis" title="Meatal stenosis">Meatal stenosis</a></li>

<li><a href="Urethral_caruncle" title="Urethral caruncle">Urethral caruncle</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Any/all</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Urologic_chronic_pelvic_pain_syndrome" title="Urologic chronic pelvic pain syndrome">Urologic chronic pelvic pain syndrome</a></li>

<li><a href="Obstructive_uropathy" title="Obstructive uropathy">Obstructive uropathy</a></li>

<li><a href="Urinary_tract_infection" title="Urinary tract infection">Urinary tract infection</a></li>

<li><a href="Retroperitoneal_fibrosis" title="Retroperitoneal fibrosis">Retroperitoneal fibrosis</a></li>

<li><a href="Urolithiasis" class="mw-redirect" title="Urolithiasis">Urolithiasis</a>

<ul><li><a href="Bladder_stone" title="Bladder stone">Bladder stone</a></li>

<li><a href="Kidney_stone_disease" title="Kidney stone disease">Kidney stone</a></li>

<li><a href="Renal_colic" title="Renal colic">Renal colic</a></li></ul></li>

<li><a href="Malakoplakia" title="Malakoplakia">Malakoplakia</a></li>

<li><a href="Urinary_incontinence" title="Urinary incontinence">Urinary incontinence</a>

<ul><li><a href="Stress_incontinence" title="Stress incontinence">Stress</a></li>

<li><a href="Overflow_incontinence" title="Overflow incontinence">Overflow</a></li></ul></li></ul>

</div></td></tr></tbody></table></div>

<div class="navbox-styles"></div><div role="navigation" class="navbox" aria-labelledby="Signs_and_symptoms_relating_to_the_urinary_system132" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Signs_and_symptoms_relating_to_the_urinary_system132" style="font-size:114%;margin:0 4em"><a href="Signs_and_symptoms" title="Signs and symptoms">Signs and symptoms</a> relating to the <a href="Urinary_system" title="Urinary system">urinary system</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Pain</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Dysuria" title="Dysuria">Dysuria</a></li>

<li><a href="Renal_colic" title="Renal colic">Renal colic</a></li>

<li><a href="Costovertebral_angle_tenderness" title="Costovertebral angle tenderness">Costovertebral angle tenderness</a></li>

<li><a href="Vesical_tenesmus" title="Vesical tenesmus">Vesical tenesmus</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Control</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Urinary_incontinence" title="Urinary incontinence">Urinary incontinence</a>

<ul><li><a href="Enuresis" title="Enuresis">Enuresis</a></li>

<li><a href="Diurnal_enuresis" title="Diurnal enuresis">Diurnal enuresis</a></li>

<li><a href="Giggle_incontinence" title="Giggle incontinence">Giggling</a></li>

<li><a href="Nocturnal_enuresis" title="Nocturnal enuresis">Nocturnal enuresis</a></li>

<li><a href="Post-void_dribbling" title="Post-void dribbling">Post-void dribbling</a></li>

<li><a href="Stress_incontinence" title="Stress incontinence">Stress</a></li>

<li><a href="Overflow_incontinence" title="Overflow incontinence">Overflow</a></li></ul></li>

<li><a href="Urinary_retention" title="Urinary retention">Urinary retention</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Volume</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Oliguria" title="Oliguria">Oliguria</a></li>

<li><a href="Anuria" title="Anuria">Anuria</a></li>

<li><a href="Polyuria" title="Polyuria">Polyuria</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Lower_urinary_tract_symptoms" title="Lower urinary tract symptoms">Lower urinary tract symptoms</a>

<ul><li><a href="Nocturia" title="Nocturia">Nocturia</a></li>

<li><a href="Urinary_urgency" class="mw-redirect" title="Urinary urgency">urgency</a></li>

<li><a href="Frequent_urination" title="Frequent urination">frequency</a></li></ul></li>

<li><a href="Extravasation_of_urine" title="Extravasation of urine">Extravasation of urine</a></li>

<li><a href="Uremia" title="Uremia">Uremia</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="List_of_eponymously_named_medical_signs" class="mw-redirect" title="List of eponymously named medical signs">Eponymous</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Addis_count" title="Addis count">Addis count</a></li>

<li><a href="Brewer_infarcts" title="Brewer infarcts">Brewer infarcts</a></li>

<li><a href="Lloyd's_sign" title="Lloyd's sign">Lloyd's sign</a></li>

<li><a href="Mathe's_sign" title="Mathe's sign">Mathe's sign</a></li></ul>

</div></td></tr></tbody></table></div>

<div class="navbox-styles"></div><div role="navigation" class="navbox" aria-label="Navbox32" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q331231" class="extiw external" title="d:Q331231">D</a></div><div class="hlist" style="text-align:left;"><ul><li><a href="International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="ICD-10" title="ICD-10">10</a>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/N32.8">N32.8</a>, <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/N39.4">N39.4</a></li><li><a href="International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="ICD-10-CM" title="ICD-10-CM">10-CM</a>: <a rel="nofollow" class="external text" href="https://icd10cmtool.cdc.gov/?fy=FY2024&query=N32.81">N32.81</a></li><li><a href="International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=596.51">596.51</a>, <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=788.31">788.31</a></li><li><a href="Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D053201">D053201</a></li><li><a href="Diseases_Database" title="Diseases Database">DiseasesDB</a>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb3612.htm">3612</a></li><li><a href="SNOMED_CT" title="SNOMED CT">SNOMED CT</a>: <a rel="nofollow" class="external text" href="https://browser.ihtsdotools.org/?perspective=full&conceptId1=236633002&languages=en">236633002</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><a href="MedlinePlus" title="MedlinePlus">MedlinePlus</a>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/001270.htm">001270</a></li><li><a href="EMedicine" title="EMedicine">eMedicine</a>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/article/459340-overview">article/459340</a></li></ul></div></div></td></tr></tbody></table></div>

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