Overactive Bladder: Symptoms, Causes, and Diagnosis - Urology

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Understanding Overactive Bladder (OAB) is crucial for managing symptoms and improving quality of life. OAB is characterized by a frequent and urgent need to urinate, often accompanied by incontinence. It can significantly impact daily activities and emotional well-being. Let's address your questions regarding your symptoms and concerns.

1. Recurrent Blood in Urine and Antibiotic Use: The recurrence of blood in your urine (hematuria) despite maintaining good hygiene practices raises several considerations. While urinary tract infections (UTIs) are a common cause of hematuria, other underlying issues such as bladder stones, interstitial cystitis (IC), or even malignancies should be ruled out. It is not advisable to take antibiotics continuously without a doctor's guidance, as this can lead to antibiotic resistance and other complications. Instead, you should consult a urologist for a thorough evaluation, which may include urine cultures, imaging studies, or cystoscopy to identify the root cause of your hematuria. If recurrent UTIs are confirmed, your doctor may recommend preventive measures, which could include post-coital antibiotics or other prophylactic strategies.

2. Frequent Urination and Possible OAB Diagnosis: The symptoms you describe, including the need to urinate more than eight times during waking hours and experiencing urgency, are consistent with OAB. The fact that you can hold your urine for two hours without discomfort suggests that your bladder is functioning normally at times, but the urgency and frequency indicate a possible overactivity of the bladder muscle. The inability to fully empty your bladder in one go (with volumes around 100-150 ml) could suggest a condition known as bladder overactivity, where the bladder contracts involuntarily, leading to frequent urges. It's essential to discuss these symptoms with your healthcare provider, who may recommend urodynamic testing to assess bladder function and confirm a diagnosis of OAB.

3. Definition of OAB and Diagnostic Criteria: OAB is typically defined by the presence of urinary urgency, with or without urgency incontinence, and usually involves urinating more than eight times in a 24-hour period. This measurement includes both daytime and nighttime urination. To diagnose OAB, your doctor may perform a bladder diary assessment, where you track your fluid intake, urination frequency, and any episodes of urgency or incontinence over a few days. Additional tests, such as urinalysis, urine culture, and possibly imaging studies, can help rule out other conditions.

In summary, your symptoms warrant a comprehensive evaluation by a urologist to determine the underlying cause of your hematuria and frequent urination. Treatment options for OAB may include lifestyle modifications, bladder training, pelvic floor exercises, and medications such as anticholinergics or beta-3 agonists. In some cases, more advanced therapies like neuromodulation or Botox injections may be considered. It’s essential to have an open dialogue with your healthcare provider to tailor a treatment plan that addresses your specific symptoms and improves your quality of life.