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Thirty-three million people in the United States have been diagnosed with overactive bladder. But is it a real disease? And is medication really necessary for controlling it?

In 2001 the National Overactive BLadder Evaluation (NOBLE) Program called 5,204 adults in the USA and asked them an embarrassing, uncomfortable question: Do you go to the bathroom too much? 

In response, 16.9 percent of women and 16.9 percent of men said yes. To the delight of the drug company that sponsored the survey, a new disease was born. It came to be known as overactive bladder.

Both Men and Women Can Have Overactive Bladder

The NOBLE survey found almost exactly equal numbers of men and women reported overactive bladder symptoms, but the severity of those symptoms differed by age. Only 0.3 percent of men under the age of 45 reported too-frequent urination, while 2.0 percent of women did. The percentage of women who complained of irritable bladder or overactive bladder increased sharply after age 44, while the percentage of men reporting these symptoms increased sharply after age 64.

Men and women also reported different rates of urge incontinence, leaking if you don't get to go. Across all age groups, urge incontinence was more common in women than in men. Of all the symptoms of overactive bladder, it was the most likely to interfere with sleep and to lower perceived quality of life.

Before the NOBLE study, overactive bladder was treated as a "women's problem." This study showed that the problem was common in both women and men, and however sexist and discriminatory the point of view was at the time, encouraged drug companies to do research to develop medications to treat it. By 2015, annual sales of medications for overactive bladder in the United States alone totaled $3 billion, despite the fact that many experts believe that the condition is best managed without drug treatment.

What Are the Symptoms of Overactive Bladder?

How do you know you have overactive bladder? The original survey would have classified you as having overactive bladder if just once in your life you had felt a sudden urge to urinate, but most doctors will look for affirmative answers to these questions:

  • Do you need to urinate more than eight times a day?
  • Do you have to get up to urinate more than three times a night? Do you wake up because you need to urinate, or do you wake up and then later need to urinate?
  • Do you ever leak urine when you have a strong urge to go to the toilet?
  • Do you use protective pads or diapers to prevent visible leaks? How many pads do you use each day?
  • Does this problem keep you from doing things you like to do?

Even if the answer to these questions is yes, the doctor will usually ask the patient to keep a three-day diary of urination, how much, when, how often there are "accidents," and how much fluid is consumed. The doctor will do an exam to see if the bladder can be felt (if it feels full, there may be an obstruction that is causing the problem with leakage). Women will be examined for signs of estrogen deficiency (lack of redness in the labia of the vagina, thinness of the membrane over the vagina), and men will be given the digital (finger) exam for enlargement of the prostate.

Continue reading after recommendations

  • Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, Hunt TL, Wein AJ. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003 May. 20(6):327-36. PMID: 12811491.
  • Willis-Gray MG, Dieter AA, Geller EJ. Evaluation and management of overactive bladder: strategies for optimizing care. Res Rep Urol. 2016. 8:113-22.
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