Overactive Bladder Symptoms and Risk Factors

The clinical presentation of Overactive Bladder is characterized by a specific constellation of symptoms that affect the storage phase of micturition. While the severity varies from patient to patient, the presence of these symptoms defines the syndrome and guides the therapeutic approach at Liv Hospital. The symptoms are often interrelated, creating a cycle of dysfunction that disrupts daily life.

• Urinary Urgency: This is the cornerstone symptom of OAB. It is defined as a sudden, compelling desire to pass urine that is difficult to defer. Unlike the gradual signal of a full bladder, OAB urgency is abrupt and intense. Patients often describe it as a panic-inducing sensation that requires immediate attention. It can occur regardless of how much urine is actually in the bladder. This sensory distortion is the primary driver of patient distress and often precedes leakage.
• Urinary Frequency: Frequency is defined as voiding more often than is considered normal, typically more than eight times in 24 hours. In OAB patients, frequency is usually a behavioral adaptation to urgency. To avoid the distressing sensation of the urge or the potential for incontinence, patients adopt a strategy of “defensive voiding,” emptying the bladder preemptively at low volumes. Over time, this can functionally reduce the bladder’s capacity, perpetuating the need for frequent trips to the restroom.
• Nocturia: This symptom involves waking one or more times during the night to void. In the context of OAB, the micturition reflex, which usually suppresses during sleep, is compromised. Patients are awakened not just by a full bladder, but by the sensation of urgency. Nocturia is particularly debilitating as it fragments sleep architecture, preventing deep restorative sleep. This leads to daytime fatigue, cognitive impairment, and mood disturbances. In the elderly population, nocturia is a significant risk factor for falls and fractures occurring during nighttime trips to the bathroom.
• Urge Urinary Incontinence: Involuntary loss of urine associated with a strong desire to void. It occurs when the detrusor muscle contracts with such force that the urethral sphincter cannot maintain closure. This leakage can range from a few drops to complete bladder emptying. It is often triggered by specific sensory cues, such as the sound of running water, the feel of cold objects, or the act of unlocking the front door. The unpredictability of urge incontinence is a significant source of social anxiety and embarrassment.