What Exactly Is Overactive Bladder? A Urogynecologist Explains

It’s not just needing to pee all the time.

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You go to the bathroom twice before hitting the sheets just to be 100% sure that you won’t have to get up again when you’re cozy in bed. In restaurants and movie theaters, you zoom in on the location of the restroom before you sit, because you know you’ll be paying a couple visits throughout the evening.

If you’re like the other 33 million people in America who have OAB, you may know what the symptoms of an overactive bladderfeel like (and how to MacGyver your life around your often unpredictable urges), but how much do you know about what’sreallygoing on down there?

We talked with Lauri Romanzi, MD, a urogynecologist in New York City, about the physiology behind your overactive bladder diagnosis.

Normal Bladder Function vs. Overactive Bladder

“Normal bladder function is simple,” says Dr. Romanzi. “The bladder has to store urine, [and] at an appropriate point, your brain tells your bladder to empty.” Your kidneys produce urine, which drains into your bladder. As your bladder fills, there are sensory nerves in the bladder that tell your brain it’s time to urinate.

With an overactive bladder, however, the set points at which the sensory nerves start to signal the brain reduces and becomes unpredictable, she says. “The bladder will suddenly send a signal that you have to go right away as if your bladder is completely full and an ounce or two comes out. The sensation of urgency was completely out of proportion to what was actually in your bladder.”

“Anyone who waits long enough with a very, very full bladder can have urgency. This is not necessarily a problem," says Dr. Romanzi.

Signs and Symptoms of Overactive Bladder

The textbook definition of overactive bladder is urinary urgency with or without urge incontinence; there are four basic symptoms:

  • Urgency: Needing to go to the bathroom suddenly
  • Frequency: Needing to go to the bathroom often
  • Nighttime voiding: Needing to use the bathroom at night
  • Urge incontinence: Leaking urine because you couldn’t get to the bathroom fast enough

“The root is always urgency,” says Dr. Romanzi. “Which can cause frequency, nighttime voiding, and if it can’t be controlled, urge incontinence.”

Overactive Bladder Treatment Options

If your OAB is bothering you and affecting your quality of life, see your doctor. There are many treatment options for OAB, from behavior modifications (such as avoiding bladder-irritating foods, starting a bladder diary, and doing kegel exercises) to medications and, in more severe cases of OAB, Botox or surgery.

“OAB with or without urgency incontinence needs to be evaluated and treated earlier rather than later. You’re not helping yourself by waiting. You’re simply making yourself resistant to more and more therapeutic options,” says Dr. Romanzi.