Incontinence/Oab: Symptoms, Types, Causes and Treatment

Urinary incontinence (UI) and overactive bladder (OAB) are common, often under-discussed conditions that can significantly affect quality of life for millions of people worldwide. Although sometimes misunderstood as a normal part of aging, both OAB and incontinence are clinical syndromes with clear diagnostic criteria and a range of available treatments. This article provides a comprehensive, evidence-based overview of their symptoms, types, causes, and treatments—equipping you with information to recognize, understand, and navigate these conditions.

Symptoms of Incontinence/OAB

OAB and incontinence present with distinct but overlapping symptoms that can interfere with daily life, social interactions, and sleep. Recognizing these symptoms is the first step toward diagnosis and effective management.

Symptom	Description	Prevalence/Impact	Source(s)
Urgency	Sudden, compelling need to urinate	Core symptom of OAB	2 3 9 10 12 13
Frequency	Need to urinate more often than normal	Both daytime & nighttime	2 3 11
Nocturia	Waking at night to urinate	Most prevalent LUTS in surveys	1 2 3 11
Urge Incontinence	Involuntary leakage with urgency	OAB may have with/without this	2 3 7 9 10
Stress Incontinence	Leakage on exertion/cough/sneeze	Not OAB, but often co-occurs	4 6 8 11
Coital Incontinence	Leakage during sexual activity	Impacts sexual quality of life	6

Table 1: Key Symptoms

Understanding the Symptoms

Urgency and Frequency

• Urgency is the hallmark symptom of OAB: a sudden, strong desire to void that is difficult to postpone 2 3 9 10 12 13.
• Frequency refers to urinating more often than normal, both during the day and at night (nocturia), and is commonly reported by individuals with OAB and/or incontinence 2 3 11.
• Nocturia—waking up during the night to urinate—is particularly disruptive and is reported by nearly half of all men and women surveyed in large studies 1.

Urge and Stress Incontinence

• Urge incontinence means involuntary leakage accompanying urgency. OAB can occur with ("OAB-wet") or without urge incontinence ("OAB-dry") 2 3 7 9 10.
• Stress incontinence involves leakage with physical exertion or increases in abdominal pressure, such as coughing or sneezing; while not a symptom of OAB, it often coexists and can complicate diagnosis 4 6 8 11.
• Coital incontinence—urine leakage during sexual activity—can be associated with OAB, stress incontinence, or both, and negatively impacts sexual wellbeing 6.

Symptom Impact and Quality of Life

These symptoms can be persistent or fluctuate over time, and often lead to embarrassment, social withdrawal, poor sleep, and reduced quality of life 3 5 6 11. Both women and men are affected, with prevalence and severity increasing with age 1 7 11.

Types of Incontinence/OAB

Incontinence and OAB are umbrella terms that cover several subtypes, each with unique features and implications for treatment.

Type	Key Features	Gender/Age/Prevalence	Source(s)
OAB-dry	Urgency, frequency, no leakage	More common than OAB-wet	7 9 13
OAB-wet	OAB symptoms with urge incontinence	More common in older adults	7 9 13
Stress Incontinence	Leakage with physical stress/exertion	More common in women	4 6 11
Mixed Incontinence	Combination of stress + urge incontinence	Common in older women	4 8 11
Overflow Incontinence	Leakage due to bladder overfilling	Less common, more in men	4 11
Functional Incontinence	Inability to reach toilet in time	Often due to mobility/cognition	4 11
Coital Incontinence	Leakage during sexual intercourse	Affects quality of sex life	6

Table 2: Types of Incontinence/OAB

Exploring the Types

Overactive Bladder (OAB): OAB-dry and OAB-wet

• OAB-dry: Characterized by urgency and frequency without incontinence. It is significant because symptoms are bothersome even without leakage 7 9 13.
• OAB-wet: Involves urgency with urge incontinence—i.e., not getting to the toilet in time. This type is more prevalent in older adults and is associated with greater impact on quality of life 7.

Stress and Mixed Incontinence

• Stress incontinence is leakage with sudden increases in abdominal pressure and occurs most frequently in women, especially after childbirth or menopause 4 6 11.
• Mixed incontinence combines features of both stress and urge incontinence, and is commonly seen in older women or those with pelvic floor weakness 4 8 11.

Other Types

• Overflow incontinence results from the bladder being overly full, typically due to obstruction or underactive bladder—more common in men with prostate issues 4 11.
• Functional incontinence arises when individuals cannot physically reach the toilet in time due to mobility or cognitive impairments 4 11.
• Coital incontinence impacts sexual activity and is frequently associated with both OAB and stress incontinence 6.

Prevalence and Dynamic Nature

Population-based studies reveal that these types often overlap, with many individuals experiencing different types over time. For example, symptoms can progress from OAB-dry to OAB-wet with age or other risk factors 5 7 11.

Causes of Incontinence/OAB

Understanding the underlying causes of incontinence and OAB is crucial for targeted management. The etiology is often multifactorial, involving physiological, anatomical, and sometimes environmental components.

Cause Group	Mechanism/Description	Key Risk Factors/Examples	Source(s)
Myogenic	Detrusor muscle overactivity	Aging, obstruction, metabolic disease	9 10 12
Neurogenic	Nervous system dysfunction	MS, Parkinson's, stroke, diabetes	9 10 12 13
Urotheliogenic	Urothelium sensory/chemical disruption	Inflammation, infection	9 12
Anatomical	Pelvic floor/bladder neck incompetence	Childbirth, surgery, obesity	4 8 11
Environmental	Shared behaviors, partner with OAB	Cohabitation, lifestyle factors	7
Other	Medications, hormonal changes, cognitive issues	Anticholinergics, menopause, dementia	4 11

Table 3: Causes of Incontinence/OAB

What Drives Incontinence and OAB?

Myogenic, Neurogenic, and Urotheliogenic Factors

• Myogenic: Changes in the detrusor muscle (bladder wall muscle) can lead to overactivity, making the bladder contract unpredictably 9 10 12.
• Neurogenic: Nervous system issues—whether in the peripheral nerves, spinal cord, or brain—can disrupt bladder control. Diseases like multiple sclerosis, Parkinson’s, stroke, and diabetes are notable causes 9 10 12 13.
• Urotheliogenic: The bladder lining (urothelium) can become overly sensitive due to inflammation, infection, or chemical irritation, contributing to urgency and frequency 9 12.

Anatomical and Functional Contributors

• Anatomical: Weakness or incompetence at the bladder neck or pelvic floor, often after childbirth, surgery, or with obesity, can cause or worsen incontinence and OAB 4 8 11.
• Bladder neck incompetence is especially notable in women with mixed incontinence or those with new OAB symptoms after surgery 8.

Environmental and Behavioral Factors

• Environmental: Living with a partner who has OAB increases the risk, possibly due to shared behaviors or environmental cues 7.
• Lifestyle: Obesity, physical inactivity, and certain dietary habits can increase risk 7 11.

Other Causes

• Medications: Some medications, like diuretics or anticholinergics, can worsen symptoms.
• Hormones: Menopause and hormonal changes affect bladder and pelvic floor function.
• Cognitive/Functional: Dementia or mobility issues may lead to functional incontinence 4 11.

Dynamic and Progressive Nature

Importantly, symptoms can appear, remit, or progress over time. Some individuals may see symptom improvement, while others experience worsening without intervention 5 11.

Treatment of Incontinence/OAB

Effective treatment is tailored to the type and cause of symptoms, and often requires a multifaceted approach. Therapeutic options range from behavioral interventions to medications and advanced therapies.

Treatment	Description/Approach	Efficacy/Notes	Source(s)
Behavioral Therapy	Bladder training, PFMT	First-line, effective	4 17 18
Physical Therapy	Pelvic floor muscle training (PFMT)	Reduces urgency, leakage	17
Medications	Antimuscarinics, β3-agonists (mirabegron)	Both effective, mirabegron fewer side effects	14 15 16
Combination Therapy	Antimuscarinic + β3-agonist	More effective for OAB-wet	15
Nerve Stimulation	TTNS, PTNS	Effective, non-invasive	18
Surgery	Sling, TVT for stress/mixed incontinence	For refractory cases	4 6 8

Table 4: Treatment Options

Behavioral and Physical Interventions

Pelvic Floor Muscle Training (PFMT) and Behavioral Therapy

• PFMT strengthens the muscles supporting the bladder and urethra, reducing leakage and urgency. It's effective for both men and women and is often combined with bladder training and urge suppression techniques 4 17.
• Behavioral therapy includes scheduled voiding, fluid management, and avoiding bladder irritants.

Nerve Stimulation

• Transcutaneous tibial nerve stimulation (TTNS) and percutaneous tibial nerve stimulation (PTNS) are non-invasive approaches stimulating nerves regulating bladder function. These are as effective as PFMT and PTNS, though slightly less than anticholinergic medications, and are particularly useful for individuals who cannot tolerate drug side effects 18.

Pharmacological Treatments

Antimuscarinic Medications

• These drugs (e.g., solifenacin, tolterodine, oxybutynin) are first-line pharmacologic therapies for OAB. They reduce urgency and frequency but can cause side effects like dry mouth and constipation, which often lead to discontinuation 14 16.

β3-Adrenoceptor Agonists

• Mirabegron is a newer agent that relaxes the bladder muscle to increase capacity. It has similar efficacy to antimuscarinics but a lower risk of dry mouth and constipation 14 16.
• Combination therapy (e.g., mirabegron + solifenacin) is more effective than either agent alone, especially for patients with persistent incontinence after monotherapy 15.

Surgical and Advanced Therapies

Surgical Interventions

• For severe or refractory stress or mixed incontinence, surgical options such as mid-urethral slings (e.g., TVT) can be effective 4 6 8.
• Correcting anatomical abnormalities like bladder neck incompetence can improve both incontinence and OAB symptoms 8.
• Surgery is generally reserved for cases where conservative and medical therapies have failed.

Personalized and Multimodal Care

• Treatment is individualized, considering age, gender, severity, comorbidities, and patient preference 4 11 17.
• Many people benefit from a combination of treatments, and ongoing follow-up is important due to the dynamic nature of symptoms 5 11.

Conclusion

Urinary incontinence and overactive bladder are widespread, complex conditions with significant impact on daily life, yet they are highly manageable. Key takeaways include:

• Symptoms: OAB and incontinence manifest as urgency, frequency, nocturia, and involuntary leakage, affecting quality of life and sleep 1 2 3 11.
• Types: Multiple subtypes exist, including OAB-dry, OAB-wet, stress, mixed, overflow, and functional incontinence, with overlapping features 4 7 8 11.
• Causes: Etiology is multifactorial—myogenic, neurogenic, urotheliogenic, anatomical, behavioral, and environmental factors all play roles 7 9 10 12 13.
• Treatment: A wide range of effective therapies exists—behavioral, physical, pharmacologic, nerve stimulation, and surgery—with many patients benefiting from combined approaches 4 14 15 16 17 18.

By understanding symptoms, types, causes, and modern treatments, individuals and clinicians can work together to improve bladder health and overall well-being. If you or someone you know is experiencing these symptoms, seeking evaluation and treatment can make a profound difference.