Overactive bladder (OAB) is marked by urgency, with or without urinary incontinence, often accompanied by frequent urination and nocturia. Causes include detrusor overactivity, bladder hypersensitivity, or low compliance, significantly impacting quality of life. Diagnosis requires ruling out conditions like bladder outlet obstruction, diabetes, or urinary tract infections (UTI). Refractory OAB, which doesn’t respond to treatment, may be linked to neurogenic bladder, bladder outlet obstruction, or chronic inflammation. It is sometimes misdiagnosed as UTI due to low-grade bacterial colonization.

Chronic bladder inflammation, common in OAB and interstitial cystitis , increases bladder sensitivity. Elevated inflammatory markers like TNF-α and urinary nerve growth factor are linked to this heightened sensitivity. Urinary microbiota imbalances, including reduced Lactobacillus, are associated with refractory OAB and urgency urinary incontinence, even when routine urine cultures are negative. Emerging treatments, such as platelet-rich plasma injections and urinary microbiota transplants, offer new ways to manage refractory OAB and recurrent UTI.

Reference: Ke QS, Lee CL, Kuo HC. Recurrent urinary tract infection in women and overactive bladder – Is there a relationship? Tzu Chi Med J. 2020;33(1):13-21. doi: 10.4103/tcmj.tcmj_38_20.