Identifying overactive bladder syndrome

Thought LeadersDr. Michael KennellyDepartment of Obstetrics & Gynecology andUrology, Carolinas Medical Center

An interview with Dr Michael Kennelly, urologist and Medical Director for the Charlotte Continence Center at Carolinas Medical Center, conducted by April Cashin-Garbutt, MA (Cantab)

What are the main symptoms of overactive bladder syndrome (OAB)?

Symptoms of OAB include leakage, the strong sudden need to "go right away," and going to the bathroom too often.

When should you see a doctor?

Unfortunately, studies show that only about 5 million people living with OAB seek care from a doctor, and only half of those patients seek a specialist like a urologist or urogynecologist for treatment.

It’s time to see a doctor if you’re using multiple leakage pads per day, not doing things you like because of the fear of leakage, planning all your travel around bathroom locations, or are worried about the problem every day.

What causes OAB?

When someone has OAB, affected or damaged nerve cells cause the bladder to contract uncontrollably, creating leakage, the strong sudden need to "go right away," and going too often. In some cases, OAB can be caused by a neurological condition (Neurogenic Detrusor Overactivity).

How many people are thought to be living with OAB?

Almost 15 million Americans are living with OAB.

What general lifestyle measures can help with OAB?

Treatment for OAB begins with lifestyle changes, including:

  • Reduction of fluid intake
  • Decreased amounts of caffeine
  • Bladder control strategies
  • Pelvic floor muscle training

What is bladder training (bladder drill)?

Bladder training is a form of behavior therapy for the treatment of urinary incontinence. Bladder training requires following a fixed voiding schedule, with the goal of increasing the amount of time between emptying your bladder and the amount of fluids your bladder can hold. Bladder training can be effective in reducing leakage and the sense of urgency associated with the problem.

As it is important to follow a fixed schedule with bladder training, if you feel an urge to urinate before the assigned interval, you should use urge suppression techniques like relaxation and Kegel exercises.

What needs to be done to encourage patients to talk to their doctor about OAB symptoms?

Unfortunately, data shows that most people affected by OAB learn to settle and mask their symptoms, rather than seeking help, and those who do seek help may be cycling through treatments that don’t work. It’s important to empower people living with OAB to know that they’re not alone in living with these symptoms, and seeking care from a specialist is the first step to gaining control over their symptoms.

What myths about OAB would you like to dispel?

OAB is more than just a minor annoyance – it can impact every area of a patient’s life, affecting work productivity, social interactions and exercise. Simply masking OAB symptoms, or settling for suboptimal results from medications, doesn’t mean that the situation under control. And even if patients have tried treatments in the past that haven’t worked, there are other options beyond pills.

What further research is needed to understand the causes of OAB?

OAB occurs when nerve signals from your bladder tell your brain that it is time to signal the bladder to empty even when it isn’t full. OAB can also be caused by your bladder muscles being too active. Your muscles will contract to pass urine before your bladder is full causing a sudden, strong need to urinate called “urgency.”

Further research should explore the deficiencies in the interplay of central nervous system and lower urinary tract structures that contribute to OAB while bearing these causes in mind.

Furthermore, research directions should note that although the several different causes lead to similar symptoms, they are not all rooted in the same physiology and may not all respond to the same treatments. New knowledge about lower urinary tract function and possible intervention will enhance our understanding of OAB.

What do you think the future holds for patients with OAB?

The emergence of several newer therapies have opened several new avenues of treatment for OAB patients.

These third line therapies have provided novel options for OAB patients and have successfully been combined with medication and behavioural therapies to drastically improve quality of life.

However, there is no cure for Overactive Bladder and future research that focuses on the treatment goals and root causes of OAB could further improve treatment for OAB patients.

Research that focuses on novel medication delivery methods to reduce medication side effects and therapies are accessible with minimal adverse events may prove particularly helpful.

Do you think it would be possible to prevent OAB one day?

OAB is a huge quality of life issue for so many people. The causes of OAB are so nuanced and difficult to define that it may be a long time before OAB can be prevented entirely. However, regardless of whether prevention may one day be possible, research has and will continue to lead to great improvements in treatment options for OAB patients

About Dr Michael Kennelly

Dr. Michael Kennelly is Professor in the Department of Urology and Department of Obstetrics & Gynecology at Carolinas Medical Center.  His research interests are in the areas of urinary incontinence, voiding dysfunction, pelvic reconstruction surgery, and neurourology.  

He continues to be active in the research community as the principal investigator of several clinical trials in his areas of interest. In addition, he has authored or coauthored several journal articles, book chapters, and educational videos in the areas of urinary incontinence and Neurourology and has lectured regionally, nationally and internationally on these topics.  

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