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Overactive bladder (OAB) is defined as urinary frequency (going too often) and urgency (feeling a strong urge to go), with or without urgency urinary incontinence. Urgency urinary incontinence is involuntary leakage of urine that occurs with an urge to urinate. This can happen on the way to the toilet, or in response to many triggers. Some common triggers include running water or opening the front door upon arriving home (the “key in the door” phenomenon).
Interstitial cystitis/painful bladder syndrome (IC), on the other hand, is bladder centric pain of at least six weeks in duration, also associated with urinary frequency and urgency. IC often feels like a bladder infection but, by definition, is not due to infection. In fact, many patients with IC are treated with multiple courses of antibiotics before finally being diagnosed with IC. Based on these definitions, the two conditions seem to be distinct. However, here is a great deal of symptom overlap between OAB and IC.
OAB Is classified into two types, OAB-wet and OAB-dry. Patients with OAB-dry have urinary frequency and urgency, but do not have incontinence. On the other hand, patients with OAB-wet have frequency and urgency with urgency urinary incontinence. Many patients with OAB-dry have a similar picture to patients with IC. They may not leak on the way to the toilet. In fact, many have never had an accident, but they are severely bothered by frequency and urgency. To add to the confusion, the majority of patients with IC have urinary frequency and urgency in addition to bladder pain.
So how can we distinguish between OAB and IC? I do like to ask what drives patients to go to the toilet. Is it fear of leakage? If so, this is more consistent with OAB. I then ask the patient if they have pain with bladder filling? If they say yes, their picture is more consistent with IC. But what if it is an uncomfortable urge that drives one to the toilet (not quite pain but not fear of leakage either)? This would technically fall within the definition of OAB-dry, because the patient is experiencing urinary frequency and urgency, and without true bladder pain. However, this type of OAB-dry may better fit on a spectrum between OAB and IC, with characteristics of both conditions.
Fortunately, we have many treatments that can help patients with both conditions. We start with moderating fluid intake and letting go the idea of 8 glasses of water a day. We don’t want patients to be thirsty, but we don’t want them to drink for the sake of drinking either. Overdrinking definitely contributes to frequency and urgency. We often tell patients to go by their thirst. For those who would rather have a set number of glasses to follow, we recommend 4-6 8 oz. glasses a day. One should always make sure to drink when sweating from exercise or heat.
Bladder training is also effective for patients with uncomfortable urinary frequency and urgency. This can help patients who have made it a habit of emptying their bladder whenever possible. Often, they go to the toilet several times right before bed, in order to get out every last drop. However, once they fall asleep, they can stay asleep. For these patients, we often recommend bladder training. We have them start at a certain time frame, say an hour, and they must not go more often than that. Then each week, they add 15 minutes to the time interval, so that in 4 weeks they should be holding it for two hours. In 8 weeks they should be holding it for 3 hours (which is pretty normal). If patients get up at night, I usually let them just go to the toilet, as we all know how hard it is to sleep when we need to go to the toilet.
Also, some patients may notice symptom improvement when they avoid certain “trigger” foods and drinks that are known to worsen bladder symptoms. These include chocolate, tomatoes, citrus foods, spicy foods, coffee, and red wine. Not all patients with bladder symptoms will worsen with trigger foods, and not all trigger foods are the same. Patients with food sensitivities can try the “elimination diet”. This is when you avoid trigger foods for a period of time, usually 2-4 weeks. Then you slowly add back one food at a time to see if symptoms result after eating it. There are also supplements available that will neutralize the acidity of the urine to reduce the symptoms, such as Femetry’s Bladder Acid Control.
Next, we can offer both groups of patients medication for OAB. OAB medications work either by blocking bladder contractions (antichinergic medication) or by stimulating bladder relaxation (beta agonist medication).
Whether you have OAB, IC, or a spectrum of both, help is available. A urologist, gynecologist or a urogynecologist (either a urologist or gynecologist who specializes in the diagnosis and treatment of pelvic floor disorders in women) can help correctly diagnose and treat your condition.
