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Overactive bladder

Overactive bladder (OAB) is a common urological syndrome defined by the International Continence Society as urinary urgency, usually accompanied by increased daytime frequency and/or nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology.^[1] This condition arises from involuntary contractions of the bladder muscle (detrusor), leading to sudden and difficult-to-control urges to urinate, often resulting in frequent voiding—typically eight or more times per day—and nighttime awakenings (nocturia, more than twice per night).^[2] While not a disease itself, OAB significantly impacts quality of life, causing embarrassment, anxiety, sleep disturbances, and limitations in daily activities for affected individuals.^[1] Recent estimates (as of 2020) indicate OAB affects approximately 18% of adults in the United States (about 47 million people), with higher rates in women (22.1%) than men (14.5%), prevalence increasing with age and over time, and similar global prevalence of 20% (95% CI: 0.18–0.21), showing a rising trend over the past two decades, particularly among women (21.9%) and older populations.^[3]^[4]^[5] Risk factors include advancing age, female sex (due to factors like menopause and pregnancy), neurological disorders (e.g., stroke or Parkinson's disease), diabetes, and prostate enlargement in men; however, in many cases, no specific cause is identified.^[2] Pathophysiological mechanisms may involve altered neural signaling, heightened bladder sensitivity, or detrusor overactivity, often without structural abnormalities.^[1] Diagnosis typically involves a detailed medical history, voiding diary, physical examination, urinalysis to exclude infection, and sometimes urodynamic testing to assess bladder function.^[6] Management begins with conservative behavioral therapies, such as bladder training, pelvic floor muscle exercises (e.g., Kegels), lifestyle modifications (e.g., fluid management, weight loss), and dietary adjustments to avoid bladder irritants like caffeine.^[6] For those unresponsive to first-line approaches, pharmacological options include anticholinergic medications (e.g., oxybutynin) to relax the bladder or beta-3 adrenergic agonists (e.g., mirabegron) to increase bladder capacity; advanced interventions like botulinum toxin injections, nerve stimulation (e.g., sacral neuromodulation), or rarely surgery may be considered for refractory cases.^[1] Early intervention is crucial, as untreated OAB can lead to complications like depression, social isolation, and increased fall risk in the elderly.^[2]^[7]

Clinical Presentation

Signs and Symptoms

Overactive bladder (OAB) is defined by a constellation of lower urinary tract storage symptoms, with urinary urgency as the hallmark feature—a sudden and compelling desire to urinate that is difficult to defer. This urgency is typically accompanied by increased daytime urinary frequency, often exceeding eight voids per 24-hour period, and nocturia, characterized by awakening more than once per night to void. These core symptoms reflect the bladder's inability to store urine adequately for normal intervals, leading to frequent and unpredictable urges.^[2]^[1] A subset of individuals with OAB experiences urgency incontinence, defined as the involuntary loss of urine immediately following an urgent sensation, which differentiates OAB-wet (incontinent) from OAB-dry (continent) presentations. Without incontinence, the condition still impairs daily activities due to the persistent fear of leakage or accidents. These symptoms often occur in combination, with urgency driving the frequency and nocturia patterns.^[8]^[9] Symptom severity in OAB is commonly evaluated using validated instruments like the Overactive Bladder Symptom Score (OABSS), a self-reported questionnaire comprising four items that assess daytime frequency, nocturia, urgency, and urgency incontinence, yielding a total score to quantify overall burden. Patients may also report occasional associated non-urinary symptoms, such as mild pelvic pain or discomfort, though these are secondary and less consistent across cases.^[10]^[11] OAB primarily manifests as storage-related lower urinary tract symptoms (LUTS), distinguishing it from voiding LUTS such as urinary hesitancy or weak stream, which suggest obstructive or underactive bladder issues. These symptoms are frequently attributable to detrusor overactivity, involving involuntary bladder muscle contractions during the filling phase.^[12]^[13]

Impact on Quality of Life

Overactive bladder (OAB) profoundly affects psychological well-being, with patients experiencing elevated levels of anxiety, depression, and embarrassment that frequently result in social withdrawal and avoidance of activities.^[14] Studies indicate a strong bidirectional association between OAB severity and depression risk, where more severe symptoms correlate with progressively higher depression rates.^[15] Additionally, urinary incontinence related to OAB is linked to increased stress and lower self-esteem, particularly among women.^[16] The condition disrupts multiple facets of daily life, including work productivity, travel, sleep, and intimate relationships.^[17] Nocturia, a frequent OAB symptom, leads to repeated nighttime awakenings, causing chronic fatigue, impaired concentration, and daytime irritability.^[18] Patients often report limiting social engagements, planning outings around bathroom access, and experiencing tension in relationships due to sleep disturbances affecting partners.^[19] These interruptions extend to professional settings, where OAB symptoms contribute to reduced performance and absenteeism.^[20] OAB imposes a significant economic burden, with annual costs in the United States totaling approximately $82.6 billion as of 2020, driven by direct medical expenses for treatments, absorbent products, and routine care, as well as indirect costs from lost productivity.^[21] This financial strain is particularly acute for working-age adults under 65, who bear higher per-person costs compared to older individuals.^[22] Health-related quality of life (HRQoL) in OAB is commonly measured using patient-reported outcome instruments like the Overactive Bladder Questionnaire (OAB-q), a validated 33-item tool that assesses symptom bother and HRQoL domains such as sleep, social interactions, and emotional well-being.^[23] The OAB-q reliably discriminates between those with and without OAB, highlighting impairments in both continent and incontinent patients.^[23] Gender- and age-specific impacts further compound these effects, with women facing heightened stigma that intensifies embarrassment and social isolation.^[24] In elderly populations, nocturia exacerbates sleep fragmentation, leading to greater overall HRQoL decline and increased fall risk due to nighttime mobility.^[25]

Etiology and Pathophysiology

Risk Factors and Causes

Overactive bladder (OAB) can arise from a variety of risk factors, both modifiable and non-modifiable, that contribute to its development. Neurological conditions represent a significant non-modifiable category, where disruptions in bladder innervation lead to symptoms. Stroke, Parkinson's disease, multiple sclerosis (MS), and spinal cord injury are key contributors; for instance, neurogenic bladder affects 40% to 90% of individuals with MS and 37% to 72% of those with Parkinson's disease, often manifesting as detrusor overactivity. Similarly, spinal cord injury results in neurogenic bladder in 70% to 84% of cases, while stroke commonly impairs central nervous system control over bladder function.^[26]^[27]^[28] Idiopathic OAB, characterized by the absence of identifiable neurological, metabolic, or other underlying causes, is the most common form, accounting for the majority of cases where no specific etiology can be pinpointed. Age and gender also play prominent non-modifiable roles; OAB prevalence increases with advancing age in both sexes, with postmenopausal women particularly affected due to estrogen decline, which alters bladder nerve signaling and tissue integrity. In men, prostate enlargement, such as benign prostatic hyperplasia, heightens risk by causing bladder outlet obstruction, especially after age 60.^[29]^[30]^[31] Modifiable metabolic and lifestyle factors further elevate OAB risk. Obesity, defined as BMI greater than 30 kg/m², independently doubles to triples the likelihood of developing OAB through increased intra-abdominal pressure on the bladder; epidemiological data indicate odds ratios of approximately 2 to 3 for obese individuals compared to those with normal weight. Diabetes mellitus is another strong modifiable risk, with longer disease duration and higher glycosylated hemoglobin levels correlating to 2.4-fold greater OAB prevalence, driven by neuropathy and vascular changes affecting bladder function. Chronic fluid overload, such as excessive intake, can exacerbate symptoms but is less directly linked to OAB onset compared to these metabolic drivers.^[32]^[33]^[34] Iatrogenic factors, often modifiable through preventive measures, include catheter-related bladder irritation and post-surgical changes. Indwelling catheters provoke muscarinic receptor-mediated bladder spasms, mimicking OAB urgency and frequency in up to 50% of long-term users. Procedures like hysterectomy increase OAB risk by 20% or more postoperatively, due to potential nerve damage or pelvic floor alterations, with symptoms emerging soon after surgery in women treated for prolapse or incontinence.^[35]^[36] Recent insights as of 2025 highlight psychological factors as emerging modifiable contributors, where chronic stress and anxiety disorders amplify bodily awareness of bladder sensations, potentially initiating or worsening OAB through heightened stress reactivity and feedback loops. Studies indicate a positive correlation between anxiety severity and OAB symptoms, suggesting that affective disorders like depression may bidirectionally influence bladder control.^[37]^[38]^[39]

Underlying Mechanisms

Overactive bladder (OAB) is primarily characterized by detrusor overactivity (DO), which involves involuntary contractions of the detrusor muscle during the bladder filling phase, leading to symptoms such as urgency and frequency.^[40] This phenomenon is typically confirmed through urodynamic studies that demonstrate these uncoordinated contractions, distinguishing OAB from normal bladder function where the detrusor remains relaxed until voluntary initiation of micturition.^[41] DO arises from disruptions in the normal inhibitory control mechanisms that maintain bladder compliance during storage.^[29] OAB can be classified as neurogenic or non-neurogenic based on underlying pathophysiology. In neurogenic OAB, dysfunction in afferent (sensory) or efferent (motor) neural pathways, often due to central or peripheral neurological disorders, leads to impaired coordination between the bladder and urethral sphincter, resulting in involuntary detrusor contractions.^[42] Conversely, non-neurogenic or idiopathic OAB involves myogenic factors, such as altered detrusor smooth muscle properties, or urothelial changes that enhance bladder sensitivity without overt neurological damage.^[43] A key mediator in detrusor contraction for both types is acetylcholine, released from parasympathetic nerves, which binds to muscarinic receptors (primarily M3 subtype) on bladder smooth muscle cells, triggering calcium influx and muscle contraction via G-protein-coupled signaling pathways.^[44] Emerging research as of 2025 highlights central nervous system (CNS) dysregulation as a significant contributor to OAB, particularly involving impaired function of the pontine micturition center (PMC), which coordinates storage and voiding reflexes through descending pathways to the spinal cord.^[45] Disruptions in suprapontine inhibitory inputs to the PMC can disinhibit micturition reflexes, promoting DO.^[46] Additionally, shared cholinergic pathway deficiencies link OAB to cognitive impairment, as reduced central cholinergic transmission affects both bladder control and cognitive processes like memory and attention.^[47] On the peripheral level, urothelial cells release adenosine triphosphate (ATP) in response to bladder distension, which sensitizes suburothelial afferent nerves via P2X3 receptors, amplifying urgency signals in OAB.^[48] Comorbidities such as metabolic syndrome or chronic inflammation further exacerbate these mechanisms by promoting local inflammatory responses that heighten afferent sensitivity and contribute to detrusor instability.^[49]

Diagnosis

Clinical Evaluation

The clinical evaluation of overactive bladder (OAB) begins with a comprehensive medical history to assess urinary symptoms, including urgency, frequency, nocturia, and urgency urinary incontinence, while identifying potential triggers, comorbidities, and medication effects that may exacerbate symptoms.^[50]^[51] Patients are typically asked to complete a bladder diary, a 3-day voiding record that tracks episodes of voiding frequency, urine volume, urgency, and incontinence to quantify symptom patterns and aid in diagnosis.^[50]^[52] Validated symptom questionnaires, such as the Patient Perception of Bladder Condition (PBC) scale—a single-item global measure of perceived bladder problems—and the International Consultation on Incontinence Questionnaire (ICIQ), particularly the ICIQ-OAB module, are used to evaluate symptom severity, bother, and impact on daily life.^[53]^[54] A targeted physical examination follows, focusing on the pelvic region to identify prolapse, atrophy, or signs of infection in women, and a neurological assessment to detect deficits such as impaired reflexes, sensory changes, or lumbosacral nerve root issues that could contribute to or mimic OAB symptoms.^[50]^[55] This exam helps differentiate OAB from other lower urinary tract disorders and guides further evaluation. To exclude confounding conditions, urinalysis is performed to rule out urinary tract infection (UTI) through detection of pyuria or nitrites, and microscopic hematuria, which may indicate alternative pathologies like stones or malignancy.^[51]^[56] In elderly patients where cognitive impairment is suspected due to overlapping symptoms or risk factors, cognitive screening, such as with the Mini-Mental State Examination (MMSE), may be considered, as suggested in recent reviews, to assess potential links between OAB and cognitive decline, informing tailored management.^[57] This initial non-invasive evaluation establishes the OAB diagnosis and may prompt specialized tests if needed.

Specialized Tests

Overactive bladder (OAB) is classified as a symptom syndrome characterized by urinary urgency, usually accompanied by increased daytime frequency and/or nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology, according to the International Continence Society (ICS) standardization from 2002. In contrast, detrusor overactivity (DO) represents a urodynamic observation defined as involuntary detrusor contractions during the bladder filling phase, which may be spontaneous or provoked, and can lead to urgency or incontinence.^[41] Urodynamic studies serve as confirmatory tests for OAB when symptoms are refractory or complex, providing objective assessment of bladder function. Cystometry, a key component, measures intravesical and abdominal pressures to derive detrusor pressure during bladder filling, identifying DO through pressure tracings that reveal involuntary detrusor contractions during the bladder filling phase.^[58] Uroflowmetry complements this by evaluating voiding dynamics, recording maximum flow rate (typically 15-25 mL/s in healthy adults) and flow curve patterns to detect potential outflow obstruction contributing to OAB symptoms.^[52] These tests are recommended by the American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (AUA/SUFU) guidelines for cases where initial conservative management fails, though not routinely for uncomplicated OAB.^[42] Post-void residual (PVR) urine measurement quantifies incomplete bladder emptying, with volumes exceeding 100-200 mL suggesting potential retention that may exacerbate OAB. This is performed noninvasively via bladder ultrasound, which estimates residual volume using the formula (length × width × height × 0.52), or invasively through catheterization for precise measurement.^[59] Elevated PVR is particularly assessed in patients with mixed symptoms or neurological comorbidities to rule out underactive detrusor or obstruction.^[52] Imaging modalities are employed when structural abnormalities are suspected, such as in cases of hematuria or recurrent infections. Bladder ultrasound visualizes post-void residual and detects anomalies like diverticula or stones, offering a radiation-free initial evaluation.^[60] Cystoscopy provides direct endoscopic inspection of the bladder mucosa to identify pathologies including tumors, interstitial cystitis, or calculi that could mimic or complicate OAB, and is indicated if noninvasive tests are inconclusive.^[56] In research settings as of 2025, functional magnetic resonance imaging (fMRI) has emerged to explore central nervous system mechanisms in OAB, such as altered periaqueductal gray connectivity during bladder filling tasks, though it remains nonroutine for clinical diagnosis due to limited accessibility and validation.^[61]^[62]

Management

Behavioral and Lifestyle Interventions

Behavioral and lifestyle interventions represent the first-line approach to managing overactive bladder (OAB), emphasizing patient education and self-directed strategies to improve bladder control and reduce symptoms without medications or procedures. These non-invasive methods, supported by clinical guidelines, focus on modifying daily habits to enhance bladder capacity, minimize irritants, and strengthen supporting muscles, often yielding significant symptom relief in a majority of patients when adhered to consistently.^[63] Bladder training involves scheduled voiding to progressively extend the time between urination episodes, typically starting with intervals based on a bladder diary and increasing by 15-30 minutes weekly over 6-12 weeks, alongside urge suppression techniques such as distraction or pelvic floor contraction to inhibit involuntary contractions. This structured program increases bladder capacity and reduces urgency episodes, with evidence from randomized controlled trials indicating potential improvement in incontinence and frequency symptoms compared to no treatment, though certainty is low.^[63]^[64] Fluid management entails optimizing daily intake to 1.5-2 liters of water while restricting consumption in the evening to curb nocturia, and limiting bladder irritants like caffeine and alcohol, which can exacerbate detrusor overactivity. Clinical studies indicate that such adjustments decrease nighttime voids by up to 1-2 episodes per night and overall urgency, particularly when combined with timed intake to avoid dehydration or overload.^[63] Pelvic floor muscle training (PFMT), commonly known as Kegel exercises, targets strengthening the muscles that support the bladder through repeated contractions held for 5-10 seconds, performed 3-4 times daily, often enhanced by biofeedback for proper technique. Supervised programs lasting 8-12 weeks reduce urgency urinary incontinence episodes by 40-60% and improve overall OAB symptoms, as demonstrated in systematic reviews of multiple trials.^[63]^[65] Weight loss is particularly beneficial for overweight or obese individuals, with a 5-10% reduction in body weight—achieved through diet and exercise—leading to decreased abdominal pressure on the bladder and a 30-50% reduction in OAB symptoms like urgency and frequency. Seminal randomized trials and recent reviews confirm this effect, highlighting its role in long-term symptom management for this subgroup.^[63]^[66]^[67] Dietary adjustments involve avoiding common bladder irritants such as spicy foods, carbonated beverages, artificial sweeteners, citrus, and tomatoes, which can heighten detrusor sensitivity and urgency. Prospective studies show that eliminating these triggers results in a 20-40% decrease in symptom severity, promoting better tolerance during bladder training without nutritional deficits.^[63]

Pharmacological Treatments

Pharmacological treatments for overactive bladder (OAB) primarily involve antimuscarinics and β3-adrenoceptor agonists, which target detrusor muscle overactivity to alleviate symptoms such as urgency and incontinence.^[68] These agents are typically considered after initial behavioral interventions prove insufficient.^[69] Antimuscarinics, the traditional first-line pharmacotherapy, work by competitively antagonizing muscarinic acetylcholine receptors, particularly the M3 subtype in the bladder detrusor muscle, thereby inhibiting parasympathetic-mediated contractions and increasing bladder capacity.^[70] Common examples include oxybutynin and tolterodine; oxybutynin is available in immediate-release (5 mg orally 2-3 times daily) and extended-release formulations (5-30 mg once daily), while tolterodine comes in immediate-release (2 mg twice daily) and extended-release (4 mg once daily) options.^[71] These drugs effectively reduce urgency and incontinence episodes, but common side effects include dry mouth (affecting 20-30% of users), constipation, and blurred vision due to off-target effects on other muscarinic receptors.^[1] Extended-release formulations mitigate these anticholinergic adverse events by providing steadier plasma levels and lower peak concentrations compared to immediate-release versions.^[72] β3-Adrenoceptor agonists represent a newer class that activates β3 receptors on the detrusor smooth muscle, stimulating adenylate cyclase to increase intracellular cyclic adenosine monophosphate (cAMP) levels, which promotes muscle relaxation and enhances bladder storage without the anticholinergic burden.^[73] Mirabegron, approved by the FDA in 2012, is dosed at 25-50 mg once daily and reduces micturition frequency and incontinence episodes comparably to antimuscarinics, with a lower incidence of dry mouth (3-10%) and no significant cognitive impairment risks.^[74] Vibegron, approved in 2020 for adults with OAB and in December 2024 for men with OAB symptoms receiving alpha-blocker therapy for benign prostatic hyperplasia, is administered as 75 mg once daily and similarly relaxes the detrusor via the cAMP pathway, offering an alternative for patients intolerant to antimuscarinics.^[75]^[76] These agents are particularly advantageous in older adults due to their peripheral action and reduced central nervous system penetration.^[77] For refractory OAB, combination therapy combining an antimuscarinic (e.g., solifenacin) with a β3-agonist (e.g., mirabegron) has shown superior efficacy in reducing urgency incontinence and increasing patient-reported treatment satisfaction compared to monotherapy, with manageable side effects when titrated appropriately.^[78] As of 2025, trospium chloride, a quaternary ammonium antimuscarinic, is favored for its CNS-sparing profile due to minimal blood-brain barrier penetration, resulting in lower cognitive side effects in elderly patients.^[79] However, long-term use of anticholinergics like oxybutynin in older adults carries warnings for increased dementia risk, with studies indicating a 20-30% higher incidence compared to β3-agonists.^[80] Dosing adjustments and monitoring are recommended, especially in those over 65, to balance efficacy and safety.^[81]

Interventional Procedures

Interventional procedures are considered for patients with overactive bladder (OAB) refractory to behavioral and pharmacological therapies. These options range from minimally invasive neuromodulation techniques to surgical interventions, aiming to modulate bladder function or restructure the urinary tract when conservative measures fail.^[52] Neuromodulation targets neural pathways controlling bladder activity. Percutaneous tibial nerve stimulation (PTNS) involves inserting a needle electrode near the posterior tibial nerve above the medial ankle, delivering electrical pulses for 30 minutes per session, typically over 12 weekly treatments followed by maintenance as needed. Clinical reviews indicate PTNS achieves symptom improvement in 37-100% of OAB patients, with a meta-analysis reporting overall subjective benefits in about 60% of cases, including reduced urgency and incontinence episodes.^[82]^[83] Sacral neuromodulation (SNM) uses an implanted device, such as the InterStim system, to deliver continuous electrical stimulation to the sacral nerves via a lead placed through the S3 foramen and a subcutaneous pulse generator. This third-line therapy is recommended by guidelines for refractory OAB with urgency urinary incontinence, showing sustained symptom reduction in long-term studies, with moderate to marked improvement maintained in up to 77% of patients at three years.^[52]^[84]^[85] Intravesical botulinum toxin A (Botox) injections provide targeted detrusor muscle relaxation. Administered cystoscopically as 100-200 units diluted in saline and injected into 20-30 sites in the bladder wall, effects last 6-9 months, requiring repeat injections. Randomized trials demonstrate significant reductions in urgency incontinence episodes, with both 100-unit and 200-unit doses proving effective and safe for idiopathic OAB unresponsive to anticholinergics, though higher doses may increase risks like urinary retention.^[86]^[87] Minimally invasive ablation techniques, such as transurethral or transvaginal radiofrequency (RF) thermotherapy, apply energy to disrupt overactive detrusor nerves without resection. Transurethral bipolar RF thermotherapy, performed under local anesthesia, heats bladder tissue to induce denervation, with early studies reporting symptom relief in refractory OAB without major complications. Similarly, transvaginal RF ablation via devices like Morpheus has shown preliminary safety and efficacy in reducing urgency and frequency in 2025 pilot evaluations.^[88]^[89] For severe refractory cases, invasive surgeries alter bladder anatomy. Augmentation cystoplasty enlarges the bladder by incorporating a segment of bowel (enterocystoplasty) to increase capacity and compliance, recommended for complicated OAB failing other interventions, with long-term data showing sustained symptom control in pediatric and adult cohorts despite risks like metabolic acidosis. Urinary diversion, involving bladder removal (cystectomy) and urinary tract rerouting (e.g., ileal conduit), serves as a last-resort option for intractable OAB, preserving quality of life when all else fails but carrying high morbidity.^[90]^[91]^[52] Emerging in 2025, transcranial direct current stimulation (tDCS) applies low-intensity electrical currents to the scalp to modulate central brain regions involved in bladder control. Pilot trials combining tDCS with mindfulness have demonstrated reductions in urgency urinary incontinence episodes by up to 1.76 per day and improved symptom scores, positioning it as a non-invasive adjunct for refractory OAB, though larger studies are ongoing.^[92]^[93]

Prognosis and Epidemiology

Long-term Outcomes

With appropriate treatment, overactive bladder (OAB) symptoms improve in 30-50% of patients, though complete resolution is uncommon due to the condition's multifactorial nature. Spontaneous remission occurs in approximately 37-39% of cases during a given year without intervention.^[52] Untreated or poorly managed OAB can lead to several long-term complications, including recurrent urinary tract infections (UTIs) due to incomplete bladder emptying and urinary stasis, which promotes bacterial growth.^[1] In older adults, urgency and nocturia associated with OAB increase the risk of falls and fractures, as hurried movements to reach the bathroom heighten instability.^[94] If recurrent UTIs ascend to the kidneys, they may progress to chronic kidney disease or pyelonephritis, causing permanent renal damage.^[95] Regarding treatment durability, beta-3 agonists such as vibegron and mirabegron sustain efficacy in reducing urgency and incontinence episodes for over one year, with continued improvements observed at 52 weeks.^[96] Intravesical botulinum toxin (Botox) injections provide relief for approximately 6-9 months, necessitating re-injections to maintain benefits, with the minimum interval of 12 weeks to avoid diminished response.^[97] A 2025 study highlights an elevated dementia risk associated with anticholinergic medications for OAB syndrome compared to no drug therapy, particularly in patients over 55 years, quantified by cumulative exposure.^[98] Outcomes are influenced by early intervention, which enhances quality of life through better symptom control, whereas comorbidities such as frailty or multiple chronic conditions exacerbate persistence and severity. This aligns with broader concerns about cognitive decline from prolonged anticholinergic use, as noted in underlying mechanisms.

Prevalence and Risk Factors

Overactive bladder (OAB) affects a significant portion of the global adult population, with a pooled prevalence of 20% (95% CI 0.18–0.21) based on a 2025 systematic review and meta-analysis of studies worldwide; prevalence has increased from 18.1% (95% CI 0.13–0.23) in 2000–2005 to 23.9% (95% CI 0.19–0.29) in 2021–2024.^[99] Among adults aged 40 years and older, prevalence rates typically range from 10% to 20%, with a landmark epidemiological survey reporting 16.6% in this demographic.^[100] The condition is more common in women (21.9% prevalence) than in men (16.1%, 95% CI 0.15–0.18), a pattern observed across multiple international studies.^[99] Prevalence increases markedly with age, peaking at around 30% in individuals over 65 years, particularly among postmenopausal women where estrogen decline contributes to heightened susceptibility.^[101] In the United States, OAB impacts approximately 33 million adults, translating to about 16.5% of the population based on national evaluation programs.^[9] Annual incidence rates show a 2–3% increase after age 60, reflecting progressive age-related changes in bladder function.^[102] Several modifiable risk factors elevate OAB likelihood at the population level. Sleep disturbances follow a U-shaped curve, with both short (≤6 hours) and long (≥9 hours) durations raising risk, while 6–7 hours nightly appears optimal for minimization.^[103] Extremes of fluid intake—either excessive volumes leading to heightened frequency or insufficient intake causing concentrated urine irritation—also contribute to symptom onset and worsening.^[104] Geographic variations highlight higher reported prevalence in Asia (e.g., 20.8%) compared to some Western countries (e.g., 11.8–16.8% in Europe and North America), potentially due to differences in study design, aging populations, and awareness levels, with underdiagnosis persisting in Asia due to cultural stigma.^[3]

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[33]
A New Perspective on the Etiology of Overactive Bladder Syndrome ...
Mar 31, 2025 · This study offers a new perspective on the psychological aspects of OAB, suggesting that OAB symptoms may result from heightened bodily sensations and ...
[34]
Overactive Mind, Overactive Bladder - Psychology Today
Aug 25, 2025 · Research indicates a positive correlation between the severity of anxiety symptoms and overactive bladder (OAB)/incontinence symptoms. In fact, ...
[35]
Bidirectional relationships between depression, anxiety and urinary ...
Jan 15, 2025 · A study found evidence that, compared with healthy controls, women with OAB have higher stress reactivity, suggesting that psychological stress ...Research Paper · 2. Participants And Methods · 2.3. Statistical Analysis
[36]
Pathophysiology of Overactive Bladder and Pharmacologic ...
Detrusor overactivity (DO), often confused with OAB, is strictly a urodynamic finding characterized by involuntary detrusor contractions during the filling ...
[37]
Overactive Bladder - ICS
Jun 1, 2018 · In some patients, it is accompanied by uncontrolled contractions of the detrusor muscle during bladder filling, called detrusor overactivity (DO) ...
[38]
Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic ...
Sep 1, 2019 · The purpose of this guideline is to provide a clinical framework for the diagnosis and treatment of non-neurogenic overactive bladder (OAB).
[39]
Pathophysiological Mechanisms Involved in Overactive Bladder ...
Feb 28, 2023 · Evidence is mounting that poor bladder perfusion and local inflammatory responses are central mechanisms involved in the development of OAB/DO.
[40]
Muscarinic receptors in the bladder: from basic research to ... - NIH
Feb 6, 2006 · Muscarinic receptor antagonists (antimuscarinics) serve as the cornerstone in the pharmacological management of overactive bladder (OAB) by relieving the ...
[41]
Neuroanatomy, Pontine Micturition Center - StatPearls - NCBI - NIH
These supra-pontine lessons result in inhibitory control over the PMC, in turn, decreased bladder capacity and detrusor muscle overactivity. Preclinical ...
[42]
The Brain and the Bladder: Forebrain Control of Urinary ... - Frontiers
Jul 2, 2020 · This region, previously referred to as the “pontine micturition center,” is now known as Barrington's nucleus (Barrington, 1925, 1927; ...
[43]
Urinary dysfunction in patients with vascular cognitive impairment
Currently, there is no disease-modifying pharmacological treatment for cognitive impairment, and anti-acetylcholine drugs, which are commonly used to treat OAB, ...
[44]
Altered urothelial ATP signaling in a major subset of human ...
Basal ATP release from the urothelium of OAB patients with pyuria was inhibited by the P2 receptor antagonist suramin and abolished by the hemichannel blocker ...
[45]
The association between overactive bladder and systemic immunity ...
May 31, 2024 · Current research indicate that inflammation is linked to the development of overactive bladder (OAB). The aim of this study was to examine ...
[46]
EAU Guidelines on Non-neurogenic Female LUTS - DISEASE ...
Request that patients complete at least a three-day bladder diary at initial evaluation for overactive bladder (OAB). Strong. Do not routinely carry out ...<|control11|><|separator|>
[47]
The AUA/SUFU Guideline on the Diagnosis and Treatment of ...
Jul 1, 2024 · The purpose of this guideline is to provide evidence-based guidance to clinicians of all specialties on the evaluation, management, and treatment of idiopathic ...
[48]
The AUA/SUFU Guideline on the Diagnosis and Treatment of ...
Apr 23, 2024 · Chronic constipation has been associated with greater prevalence and severity of OAB. In a cross-sectional internet-based survey of randomly ...
[49]
The validation of the patient perception of bladder condition (PPBC)
The PPBC, a global patient-reported measure of bladder condition, demonstrated good construct validity and responsiveness to change.
[50]
ICIQ-OAB
The ICIQ-OAB is a questionnaire for evaluating overactive bladder and related impact on quality of life (QoL) and outcome of treatment in men and women.
[51]
Overactive Bladder Clinical Presentation - Medscape Reference
Mar 28, 2025 · A neurologic examination is important. This involves assessment of the lumbosacral nerve roots and should include evaluation of the deep ...
[52]
Overactive Bladder Workup - Medscape Reference
Mar 28, 2025 · Urinalysis is used to exclude microhematuria, pyuria, urinary tract infection, and glucosuria. In those individuals with microhematuria, further ...
[53]
Minimally invasive therapies for older patients with urgency urinary ...
Brief in-office screening options include the Mini Mental State Exam (MMSE, 10 min) and the Mini Cog (3 min) [14], [15]. The Montreal Cognitive Assessment (MoCA ...
[54]
Urodynamic Testing and Interpretation - StatPearls - NCBI Bookshelf
The 2 phases of standard invasive urodynamic testing include cystometry during the filling phase and a pressure-flow study during the voiding phase. Cystometry ...
[55]
Bladder Post Void Residual Volume - StatPearls - NCBI Bookshelf
Post-void residual volume (PVR) is the amount of urine retained in the bladder after a voluntary void and functions as a diagnostic tool.Introduction · Procedures · Potential Diagnosis · Normal and Critical Findings
[56]
Overactive Bladder (OAB): Causes, Symptoms & Treatment
Causes include abdominal trauma, infection, nerve damage, medications and certain fluids. Treatment includes changing certain behaviors, medications and nerve ...
[57]
A sensation driven functional MRI study on brain activation during ...
Jul 2, 2025 · Here we design a sensation-driven functional magnetic resonance imaging (fMRI) during repetitive bladder filling and examine brain activation ...
[58]
New Imaging Techniques on the Horizon to Study Overactive and ...
Mar 5, 2025 · Bladder imaging techniques including near-infrared spectroscopy (NIRS), ultrasound, and functional magnetic resonance imaging (fMRI) will be reviewed.
[59]
None
Summary of each segment:
[60]
https://my.clevelandclinic.org/health/diseases/14248-overactive-bladder
[61]
https://www.nature.com/articles/s41598-025-05447-6
[62]
Weight Loss to Treat Urinary Incontinence in Overweight and Obese ...
Jan 29, 2009 · A 6-month behavioral intervention targeting weight loss reduced the frequency of self-reported urinary-incontinence episodes among overweight and obese women.
[63]
Efficacy of Body Weight Reduction in Improving Overactive Bladder ...
Dec 27, 2024 · Elevated BMI has been linked to urinary incontinence (UI), including Stress Urinary Incontinence (SUI), urge urinary incontinence (UUI), and ...3. Data Sources · 4. Results · 5. DisscussionMissing: overload | Show results with:overload<|separator|>
[64]
Effectiveness of antimuscarinics and a beta-3 adrenoceptor agonist ...
Jul 9, 2020 · Both antimuscarinics and beta-3 adrenoceptor agonists are generally used as first-line pharmacotherapy for overactive bladder (OAB).
[65]
Advances in pharmacotherapy for the treatment of overactive bladder
Nov 25, 2019 · The most recent AUA/SUFU guidelines now suggest consideration for the use of a combination anti-muscarinic agent with a β3-adrenoceptor agonist ...
[66]
Antimuscarinic drugs for overactive bladder and their potential ...
These drugs are thought to act primarily through antagonism at muscarinic M3 receptors located at neuromuscular junctions in the human bladder detrusor muscle.
[67]
Pharmacologic management of overactive bladder - PMC
Oxybutynin and tolterodine have been commonly associated with adverse effects such as dry mouth, constipation, headache, dyspepsia, and dry eyes. Cognitive ...Pharmacologic Options · Trospium · SolifenacinMissing: mechanism | Show results with:mechanism
[68]
Current pharmacotherapy of overactive bladder - PMC
Various antimuscarinic agents and the beta-3 agonists mirabegron and vibegron are currently available for the treatment of OAB.
[69]
[PDF] 213006Orig1s000 NON-CLINICAL REVIEW(S) - accessdata.fda.gov
Oct 29, 2020 · The intended mechanism of action of vibegron is to activate β-3 AR and increase bladder capacity by relaxing the detrusor smooth muscle of the ...
[70]
Mirabegron: A Beta-3 Agonist for Overactive Bladder - PMC - NIH
Dec 1, 2015 · Mirabegron has been efficacious in reducing mean number of micturitions and incontinence episodes per 24 hours, as well as improved other secondary outcomes ...
[71]
Vibegron | C26H28N4O3 | CID 44472635 - PubChem - NIH
Vibegron is the second beta-3 adrenergic agonist approved for the treatment of overactive bladder following [mirabegron], which was approved in 2012.
[72]
Clinical Utility of β3-Adrenoreceptor Agonists for the Treatment of ...
Apr 26, 2022 · β 3 -ARAs represent a valuable addition to pharmacological treatment of OAB syndrome. They provide better efficacy than placebo and similar efficacy to ACh.
[73]
Efficacy and Safety of Combination Pharmacotherapy for Patients ...
Conclusions: Mirabegron plus solifenacin provides effective, well-tolerated treatment for patients with OAB. Limited data for dual antimuscarinic therapy ...
[74]
A comprehensive non-clinical evaluation of the CNS penetration ...
Trospium chloride has no effect on memory testing and is assay undetectable in the central nervous system of older patients with overactive bladder. Int J ...
[75]
The Impact of Real-world Use of Overactive Bladder Medications on ...
Jul 11, 2025 · Studies have shown that overactive bladder (OAB) anticholinergics in older patients are associated with an increased dementia risk; we studied ...
[76]
Overactive bladder medications and risk of emergency hospital ...
Oct 27, 2025 · Risk of dementia associated with anticholinergic drugs for overactive bladder in adults aged ≥55 years: nested case-control study. BMJ Med ...
[77]
Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in ... - PubMed
Nov 25, 2013 · PTNS was found to be effective in 37-100% of patients with OAB, in 41-100% of patients with NOUR and in up to 100% of patients with CPP/PBS.
[78]
Effectiveness of percutaneous tibial nerve stimulation in the ...
PTNS can indeed modulate the voiding and storage function of the bladder leading to an overall subjective improvement of symptoms in about 60% of the patients.
[79]
Sacral Neuromodulation - StatPearls - NCBI Bookshelf - NIH
Apr 18, 2024 · Sacral neuromodulation is a well-established, safe, effective, and minimally invasive advanced therapy for managing various lower urinary tract and bowel ...Introduction · Anatomy and Physiology · Indications · Technique or Treatment
[80]
Percutaneous tibial nerve stimulation for the long-term treatment of ...
A Bayesian model estimated that 77% (95% CI 64-90) of patients maintained moderate or marked improvement in overactive bladder symptoms at 3 years. Compared to ...Missing: review | Show results with:review
[81]
Efficacy of botulinum toxin type A 100 units versus 200 units for ... - NIH
Conclusion: A single-injection procedure of 100 U or 200 U BoNTA is an effective and safe treatment for patients with IOAB who failed anticholinergic regimens.
[82]
Overactive Bladder - Efficacy | BOTOX® (onabotulinumtoxinA)
BOTOX for injection is indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency in adults who have ...
[83]
:: International Neurourology Journal
Dec 31, 2024 · Transurethral bipolar radiofrequency (RF) thermotherapy is a minimally invasive method that does not require anesthesia and has been prominent ...
[84]
Transvaginal Detrusor Nerve Radiofrequency Ablation ... - UroToday
Apr 6, 2025 · In this study, we intended to establish the safety and efficacy of transvaginal radiofrequency energy delivered via a vaginal Morpheus (Inmode) ...
[85]
Augmentation cystoplasty: Contemporary indications, techniques ...
Augmentation cystoplasty (AC) has traditionally been used in the treatment of the low capacity, poorly compliant or refractory overactive bladder (OAB).
[86]
Augmentation Cystoplasty: Background, Indications, Contraindications
Oct 1, 2024 · ... cystoplasty may be considered for patients with severe, refractory, complicated overactive bladder. Neurogenic bladder in the pediatric ...
[87]
Mindfulness, Transcranial Stimulation Promising for Urgency Urinary ...
Jun 13, 2025 · In the MI+tDCS group, daily urgency decreased significantly by 1.76 episodes. The reduction in ICIQ-FLUTS score was clinically meaningful at one ...
[88]
Comparison of the effects of transcranial direct current stimulation ...
Feb 10, 2025 · This study aims to assess the potential benefits of transcranial direct current stimulation (tDCS) and compare them with the effects of posterior tibial nerve ...
[89]
Full article: Economic impact of using fesoterodine for the treatment ...
This study also reported 10.3% of patients with any urine leakage/month had spontaneous remission over 2 years, which was used as an alternative value.
[90]
Falls in the Elderly Secondary to Urinary Symptoms - PMC - NIH
Both BPH and OAB are associated with nocturia, which is often the prevailing factor leading to nighttime falls and fractures. Published reports have suggested ...Missing: kidney | Show results with:kidney
[91]
https://emedicine.medscape.com/article/443916-overview
[92]
Once-Daily Vibegron 75 mg for Overactive Bladder: Long-Term ...
May 1, 2021 · Vibegron demonstrated favorable long-term safety, tolerability and efficacy in patients with overactive bladder, consistent with results of the 12-week study.
[93]
[PDF] Botox for injection - accessdata.fda.gov
Repeat BOTOX treatment may be administered when the effect of a previous injection has diminished, but generally no sooner than 12 weeks after the previous ...
[94]
Optimizing Nonsurgical Treatments of Overactive Bladder in the ...
Factors influencing treatment discontinuation include age, comorbidities, cost, drug interactions, adverse effects, and inadequate efficacy. ... In addition, it ...
[95]
Global Prevalence of Overactive Bladder: A Systematic Review and ...
The random-effects meta-analysis revealed that the global prevalence of OAB is 20% (95% CI 0.18–0.21) (Fig. 1). Among women, the prevalence is 21.9% (95% CI ...
[96]
How widespread are the symptoms of an overactive bladder and ...
Jan 12, 2002 · The overall prevalence of overactive bladder symptoms in individuals aged 40 years was 16.6%. Frequency (85%) was the most commonly reported symptom.<|control11|><|separator|>
[97]
Subtypes of Overactive Bladder in Old Age - Oxford Academic
Two hundred and sixty-seven of them (33%) presented an overactive bladder. The prevalence of overactive bladder was constant up to the age of 65. A marked ...<|control11|><|separator|>
[98]
The natural history of the overactive bladder syndrome in females: A ...
Jun 9, 2011 · At baseline, the prevalence of OAB was 19.4% (n = 75/386) and increased to 27.2% (105/386) 6.5 years later resulting in an average annual ...Missing: post | Show results with:post
[99]
the U-shaped relationship between sleep duration and overactive ...
This study reveals a U-shaped relationship between sleep duration and the risk of overactive bladder (OAB), with both short (≤ 6 h) and long (≥ 9 h) sleep ...
[100]
Is it Safe to Reduce Water Intake in the Overactive Bladder ...
However, increased fluid intake exacerbates overactive bladder ... We found that an increased fluid intake is associated with a reduced risk of urolithiasis and ...Missing: excessive | Show results with:excessive
[101]
Prevalence and trends in overactive bladder among men in ... - Nature
Jul 15, 2024 · It can have significant impact on physical and psychological health, and quality of life. Additionally, OAB caused a substantial economic burden ...