Overactive bladder is a common condition characterized by bladder storage malfunctioning resulting in sudden urges to urinate.
These urges are often very difficult to stop and the condition of overactive bladder could lead to incontinence, or the involuntary loss of urine.
If you have this condition, chances are that you may limit your work and social life and even isolate yourself because you feel embarrassed by it.
However, there is some good news: a very short evaluation can determine if there is a specific cause for your symptoms.
It is possible to manage your overactive bladder with behavioral strategies such as scheduling your fluid intake and voiding, and bladder-holding techniques using your pelvic floor muscles.
If these don’t help with controlling your symptoms, there are other methods of treatment available.
Symptoms of Overactive Bladder
The condition of overactive bladder is indicated by the following signs and symptoms:
- A sudden, difficult to control urge to urinate
- Involuntary loss of urine following an urgent need to urinate- known as urge incontinence
- Frequent urination- eight or more times within a 24 hour period of time
- Awaken twice or more during the night to urinate
Though you may be able to get to a toilet when you need to urinate, overactive bladder can cause serious disruption in your day to day life.
When Should You Seek Medical Attention?
While it is true that overactive bladder is common among older individuals, it is not a normal part of getting older. If your symptoms are causing you distress, consider behavioral strategies and other management options.
There are some treatments that could help you. Discussing your signs and symptoms might not be easy, but it’s necessary to do it- especially if your symptoms are disrupting your life.
Causes of Overactive Bladder
When your body is functioning normally, your kidneys produce urine and it drains into your bladder. Then, when you urinate, the urine flows from your bladder through a tube called the urethra. The urethra is just above the vagina in women and at the tip of the penis in men.
As your bladder begins to fill up, nerve signals being sent to your brain trigger the urge to urinate. Then, after urination, those same nerve signals help the pelvic floor muscles and the muscles of the urethra to relax as the muscles of the bladder contract to push the urine out.
The condition of overactive bladder happens when the muscles of the bladder contract even when the amount of urine in the bladder is low.
This contraction results in the urgent need to urinate. There are several conditions that may contribute to the signs/symptoms of overactive bladder, including the following:
- Neurological Disorders, including Parkinson’s, MS, and strokes
- Conditions causing high urine production such as poor kidney functioning or diabetes and high fluid intake
- Medications that result in an increase in urine production or require lots of fluids to be consumed
- Acute UTI that can result in signs and symptoms similar to overactive bladder
- Abnormal growths in bladder such as stones or tumors
- Factors obstructing bladder flow such as constipation, scarring from previous treatments for incontinence, or an enlarged prostate
- Overconsumption of alcohol or caffeine
- A decline in cognitive functioning due to aging
- Difficulty walking
- Incomplete emptying of bladder, which can result in signs/symptoms of overactive bladder
In most cases, the specific cause of overactive bladder is not clear.
Risk Factors for Overactive Bladder
As you get older, your risk for developing overactive bladder increases. Additionally, you’re at an increased risk of other conditions such as diabetes and an enlarged prostate, which can contribute to issues with normal bladder functioning.
Many individuals who have conditions involving cognitive decline also develop overactive bladder, especially with Alzheimer’s or stroke.
Incontinence that is due to situations like this can be managed with scheduling fluid intake and voiding, wearing absorbent garments, and bowel programs.
Some individuals who have the condition of overactive bladder also have issue with controlling bowels, so make sure you inform your physician if this is an issue for you.
Complications From Overactive Bladder
Any time you have incontinence, it can have an effect on your overall quality of life. If your condition has resulted in major disruptions on your life, you may also have the following:
- Sleep disturbances
- Emotional distress
If you have any of the above, your physician will likely recommend treatment of these, but it is not clear if treating the associated condition will also help with the urinary symptoms.
Some women will experience a condition that is known as mixed incontinence where both stress incontinence and urge occur together.
Stress incontinence is when you lose urine after exerting physical stress or pressure on your bladder when participating in activities including jumping or running.
Treatment of this condition is not likely to have an effect on the symptoms of overactive bladder.
Older individuals may also have a combination of bladder storage/emptying issues. You may experience the urgency and incontinence, but it doesn’t always empty very well. A specialist may be required to help you with this combination.
Getting Ready to See Your Physician
If you are experiencing the signs and symptoms of overactive bladder, you will need to get started by seeing your primary physician. After this initial appointment, he/she will most likely refer you to a urologist, or a urogynecologist in order to get a proper diagnosis and treatment.
Following are some tips to help you prepare for your appointment and what you should expect from your physician.
Things for You to Do
A few days before your appointment, record when, how much, and the type of fluids you are consuming.
You will also need to record whether or not you feel the need to urinate, when you urinate, and whether or not you experience incontinence. This could open your eyes to the reasons why you’re having to get up at night to urinate.
Make sure you inform your physician about how long you have experienced your signs and symptoms and how much of an impact they are having on your day to day life.
Take note of any other signs and symptoms you may be experiencing, especially anything related to bowel functioning.
Be sure to inform your physician if you have any other conditions- whether or not you believe they are affecting or related to your overactive bladder. You will also want to let him/her know if you have had any sort of pelvic surgery.
Make a list of all of the medications you are on- OTC, prescription, herbal, vitamins, supplements, etc. Some of these could actually have an effect on the functioning of your bladder.
Write down questions to bring up to your physician during the appointment. These days, they are always so rushed during appointments, you want to make the most of the time that you do have with him/her and having this list will make things go so much more smoothly.
Some of the most common questions include:
- What are all of the possible causes of my symptoms?
- Is my urine clear in color?
- Am I emptying my bladder well?
- Is the strength of my pelvic floor muscles enough to keep my bladder from contracting with abnormal urges?
- Are there any other tests you would recommend? Why or why not?
- What are the treatment options that are available?
- What treatment options do you believe that I would benefit from?
- What are the side effects I can expect from the recommended treatment?
- Are their dietary changes I could make that might help my condition?
- Are any of my other health conditions affecting the signs/symptoms of bladder functioning I have?
- Should I see a specialist for my condition?
- Is there a generic alternative available for the medication you are prescribing?
- Is there some information about my condition and treatment options that I can take with me and are there any websites you recommend?
What You Should Expect from Your Physician
Your physician may ask some questions to assess your signs and symptoms, including the following:
- How long have you experienced these symptoms?
- Do you leak urine unexpectedly? If so, how often?
- Do your symptoms interfere with your day to day activities?
- Do you leak urine during your day to day activities such as bending over or walking?
Testing and Diagnosing Overactive Bladder
If you have abnormal urges to urinate, your physician will test to make sure there is no infection and/or blood in your urine.
He/she will also want to test to find out whether or not you are emptying your bladder completely.
During your appointment, your physician will be looking for clues that indicate certain factors are contributing to your condition. Your work-up will most likely consist of the following:
- Medical history
- Physical exam- specifically genitals and abdomen
- Urine sample
- Neurological exam, focusing on abnormal reflexes and/or sensory problems
Special Testing for Overactive Bladder
Your physician may do a simple urodynamic test in order to assess the functioning of your bladder and its ability to empty completely and steadily. This testing will typically require a referral to a specialist. Testing will include:
Measuring the amount of urine that is left in the bladder: this test is critical if your bladder is not emptying completely when you are urinating. If there is urine remaining in the bladder, this could result in symptoms like those of overactive bladder.
In order to measure the urine left in your bladder after urinating, your physician may do an ultrasound of your bladder or pass a catheter into your bladder to drain/measure the urine that is remaining.
Measuring the flow rate of urine: your physician may request that you urinate into a uroflowmeter in order to measure the speed and volume of your urine. This device will then translate that information onto a graph.
Testing bladder pressures: this test, known as cystometry, measures the amount of pressure on your bladder and surrounding areas during the time that your bladder is filling. Your physician will insert a catheter into your bladder and slowly fill it with warm water.
Another catheter will be placed into the vagina if you are a woman or the rectum if you are a man. This procedure will reveal whether you are having involuntary muscle contractions or your bladder cannot function even under low pressure.
You may also be asked to urinate during this study to measure the pressure used to empty your bladder and to reveal whether or not there is an obstruction due to pelvic organ prolapse in women or an enlarged prostate in men. Both of those will lead to signs and symptoms of overactive bladder.
After testing, your physician will review the results with you and will offer treatment options based on the findings.
Treating Overactive Bladder
Since there is no one-size-fits-all treatment for this condition, your physician is most likely to recommend a combination of strategies to help with symptom relief.
The very first choice in managing overactive bladder is behavioral interventions. These are often very effective and have no side effects. Behavioral interventions include the following:
Exercising the pelvic floor muscles: Kegel exercises can be used to strengthen the muscles of your pelvic floor and your urinary sphincter. With stronger muscles, you can stop the involuntary contractions of your bladder.
Your physician or a physical therapist can teach you how to properly perform Kegel exercises. It may take 6 to 8 weeks before you are able to see a difference in your symptoms.
Maintain a healthy weight: if you are overweight or obese, losing weight could help to relieve your symptoms. In addition, losing weight can help correct stress urinary incontinence.
Consume less fluids: You may need to cap the amount of fluids you are consuming after a certain amount or even only consume them during appropriate times- cutting off after a certain time of day so that you’re not up several times during the night.
Double Voiding: in order to completely empty your bladder, you may need to wait a few minutes after urinating to try to empty your bladder again.
Schedule your Toilet Trips: Creating a toilet schedule, every two to four hours or so, will help to get you to urinate at the same times each day instead of waiting until you feel the urge.
Catheterization: Periodically using a catheter to empty your bladder will help your bladder to perform like it is supposed to.
Wearing absorbent pads/undergarments: wearing these will help to protect your clothes and to avoid being embarrassed by accidents, meaning you won’t be forced to limit your activities.
Training your bladder: this method of treatment involved training yourself to delay urinating when you feel the urge.
You should begin with short delays- no more than 30 minutes- and slowly work up to where you are urinating every three to four hours. Of course, keep in mind that this is only possible if you can contract the muscles of your pelvic floor.
Medications for Treating Overactive Bladder
Medications that relax your bladder are helpful for relieving the symptoms of an overactive bladder and reducing urinary incontinence.
Some of the common side effects of these medications include dry eyes and mouth- however drinking water to quench your thirst can actually aggravate your symptoms.
Another potential side effect is constipation- which can also aggravate the symptoms of overactive bladder.
Using the extended-release forms such as gels or patches can result in fewer side effects. If a medication is working to relieve your symptoms, it’s best to treat the side effects rather than stop taking the medications.
Bladder medications are not likely to keep you from having to get up during the night to urinate because this is typically not at all related to an issue with the bladder, but the way your heart and kidneys are managing bodily fluids.
As you get older, you are likely to make just as much if not more urine at night than during the day.
Bladder Injections for Treating Overactive Bladder
Botox can be used in small doses to partially paralyze the muscles of the bladder. Research reveals that this is often effective for treating severe cases of incontinence. However, it has not been approved by the FDA for those individuals who do not have a neurological disorder. The effects of this are temporary, lasting 6 to 9 months.
This medication brings along a risk of causing more issues with emptying the bladder in older individuals as well as those who have other health issues. If you are considering this treatment, you must be willing to catheterize yourself if retention occurs.
Nerve Stimulation for Treating Overactive Bladder
In one procedure, a thin wire will be placed close to your sacral nerve near your tailbone. These are the nerves that carry the signals to your bladder.
This is a surgical procedure and is typically done with a temporary wire is placed on a trial basis or a permanent electrode is implanted as an advanced procedure.
Your physician will then connect a device to the wire that sends electrical impulses to your bladder. This is very similar to what a pacemaker will do to the heart.
Surgery for Treating Overactive Bladder
This treatment option is used only in severe cases of overactive bladder where other treatments have been ineffective. The primary goal is to improve the storage ability of the bladder as well as reduce pressure.
However, this will not relieve the pain associated with overactive bladder. Surgical interventions include:
Surgery to increase capacity of the bladder: in this procedure, pieces from your bowel will be used to replace a portion of our bladder.
This is only used in severe cases of urge incontinence where other treatment measures have not worked. If you do have this surgery, you will most likely need to use a catheter sometimes to empty your bladder for the rest of your life.
Removal of Bladder: this treatment is a last resort and involves surgically removing the bladder and constructing a replacement or creating an opening in the body to attach a urine collection bag.
Overactive bladder is a common condition- especially as an individual ages. However, it is very treatable and often will respond well to self-care treatments.