Definition

What is overactive bladder?

Overactive bladder is a problem with bladder-storage function that causes a sudden urge to urinate. The urge may be difficult to stop, and overactive bladder may lead to the involuntary loss of urine.

Many muscles are also involved in urination. This creates many areas for a potential problem. Bladder and kidney health, obstructions, and muscle problems can all lead to overactive bladder.

How common is overactive bladder?

Overactive bladder affects millions of people worldwide. According to the National Association for Continence (NAFC), one in five adults over the age of 40 are affected by overactive bladder or recurrent symptoms of urgency and frequency. Eighty-five percent of these people are women. In addition, one in four women experiences urine leakage at one time or another.

However, it can be managed by reducing your risk factors. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of overactive bladder?

With an overactive bladder, you may:

  • Feel a sudden urge to urinate that’s difficult to control
  • Experience urge incontinence — the involuntary loss of urine immediately following an urgent need to urinate
  • Urinate frequently, usually eight or more times in 24 hours
  • Awaken two or more times in the night to urinate (nocturia)
  • Although you may be able to get to the toilet in time when you sense an urge to urinate, unexpected frequent urination and nighttime urination can disrupt your life.

When should I see my doctor?

Although it’s common among older adults, overactive bladder isn’t a normal part of aging. If your symptoms distress you, consider behavior strategies and management options. Treatments are available that might help you.

If you have any signs or symptoms listed above or have any questions, please consulting with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes overactive bladder?

The cause is not fully understood. The bladder muscle seems to become overactive and squeeze when you don’t want it to.

Normally, the bladder muscle is relaxed as the bladder gradually fills up. As the bladder is gradually stretched, we get a feeling of wanting to pass urine when the bladder is about half full. Most people can hold on quite easily for some time after this initial feeling until a convenient time to go to the toilet.

However, in people with an overactive syndrome, the bladder may feel fuller than it actually is. The bladder contracts too early when it is not very full and not when you want it to. This can make you suddenly need the toilet.

In most cases, the reason why an overactive bladder develops is not known. This is called overactive bladder syndrome. Symptoms may become worse at times of stress. Symptoms may also be made worse by caffeine in tea, coffee, cola, and by alcohol, etc.

In some cases, symptoms of an overactive bladder develop as a complication of a nerve- or brain-related disease such as:

  • Following a stroke.
  • With Parkinson’s disease.
  • With multiple sclerosis.
  • After spinal cord injury.

Also, similar symptoms may occur if you have a urine infection or a stone in your bladder.

Strictly speaking, these conditions are not classed as overactive bladder syndrome as they have a known cause.

Risk factors

What increases my risk for overactive bladder?

As you age, you’re at increased risk of developing overactive bladder. You’re also at higher risk of diseases and disorders, such as enlarged prostate and diabetes, which can contribute to other problems with bladder function.

Many people with cognitive decline — for instance, after a stroke or with Alzheimer’s disease — develop an overactive bladder. Incontinence that results from situations like this can be managed with fluid schedules, timed and prompted voiding, absorbent garments, and bowel programs.

Some people with an overactive bladder also have bowel control problems; tell your doctor if this is a problem for you.

Diagnosis & Treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

 

How is overactive bladder diagnosed?

If you have an abnormal urge to urinate, your doctor will check to make sure that you don’t have an infection or blood in your urine. Your doctor may also want to make sure that you’re emptying your bladder completely when you urinate.

Your doctor will look for clues that might also indicate contributing factors. The work-up will likely include a:

  • Medical history
  • Physical exam, focusing on your abdomen and genitals
  • Urine sample to test for infection, traces of blood or other abnormalities
  • Focused neurological exam that may identify sensory problems or abnormal reflexes

Your doctor may order a simple urodynamic test to assess the function of your bladder and its ability to empty steadily and completely. These tests usually require a referral to a specialist. Tests include:

  • Measuring urine left in the bladder. To measure residual urine after you have voided, your doctor may request an ultrasound scan of your bladder or pass a thin tube (catheter) through the urethra and into your bladder to drain and measure the remaining urine.
  • Measuring urine flow rate. To measure the volume and speed of your voiding, you may be asked to urinate into a uroflowmeter. This device translates the data into a graph of changes in your flow rate.
  • Testing bladder pressures. Cystometry measures pressure in your bladder and in the surrounding region during bladder filling. During this test, your doctor uses a thin tube (catheter) to fill your bladder slowly with warm water. Another catheter with a pressure-measuring sensor is placed in your rectum or, if you’re a woman, in your vagina. This test is generally used for people who have neurologic diseases that affect the spinal cord.

Your doctor will review the results of any tests with you and suggest a treatment strategy.

How is overactive bladder treated?

Your doctor is likely to recommend a combination of treatment strategies to relieve your symptoms.

Behavioral interventions

Behavioral interventions are the first choice in helping manage an overactive bladder. They’re often effective, and they carry no side effects. Behavioral interventions may include:

  • Pelvic floor muscle exercises: Kegel exercises strengthen your pelvic floor muscles and urinary sphincter.
  • Healthy weight: If you’re overweight, losing weight may ease your symptoms. Weight loss may help if you also have stress urinary incontinence.
  • Fluid consumption: Your doctor may recommend that you cap the fluids you consume at a certain amount and may suggest appropriate times during which to consume them.
  • Double voiding: To help empty your bladder more completely, you wait a few minutes after urinating and then try again to empty your bladder again.

Medications

Medications that relax the bladder can be helpful for relieving symptoms of overactive bladder and reducing episodes of urge incontinence. These drugs include:

  • Tolterodine (Detrol)
  • (Ditropan XL)
  • Oxybutynin as a skin patch (Oxytrol)
  • Oxybutynin gel (Gelnique)
  • Trospium (Sanctura)
  • Solifenacin (Vesicare)
  • Darifenacin (Enablex)
  • Mirabegron (Myrbetriq)
  • Fesoterodine (Toviaz)

Bladder injections

  • OnabotulinumtoxinA, also called Botox, is a protein from the bacteria that cause botulism illness. Used in small doses directly injected into bladder tissues, this protein partially paralyzes muscles.
  • Clinical research shows that it may be useful for severe urge incontinence. But it’s not approved by the Food and Drug Administration for this purpose in people without neurological disease. The effects are temporary, lasting only about six to nine months.
  • This medication also carries a risk of worsening bladder emptying in older adults and people already weakened by other health problems. If you’re considering Botox treatments, you should be willing and able to catheterize yourself if urinary retention occurs.

Nerve stimulation

Regulating the nerve impulses to your bladder can improve overactive bladder symptoms.

One procedure uses a thin wire placed close to the sacral nerves — which carry signals to your bladder — where they pass near your tailbone.

This surgical procedure is often done with a trial of a temporary wire or as an advanced procedure in which the permanent electrode is implanted and a longer trial is performed prior to a surgical placement of the battery-powered pulse generator. Your doctor then uses a device connected to the wire to deliver electrical impulses to your bladder, similar to what a pacemaker does for the heart.

If this successfully reduces your symptoms, the wire is eventually connected to a small battery device that’s placed under your skin.

Surgery

Surgery to treat overactive bladder is reserved for people with severe symptoms who don’t respond to other treatments. The goal is to improve the bladder’s storing ability and reduce pressure in the bladder. However, these procedures won’t help relieve bladder pain. Interventions include:

  • Surgery to increase bladder capacity. This procedure uses pieces of your bowel to replace a portion of your bladder. This surgery is used only in cases of severe urge incontinence that doesn’t respond to any other, more conservative treatment measures. If you have this surgery, you may need to use a catheter intermittently for the rest of your life to empty your bladder.
  • Bladder removal. This procedure is used as a last resort and involves removing the bladder and surgically constructing a replacement or an opening in the body (stoma) to attach a bag on the skin to collect urine.

Lifestyle changes & Home remedies

What are some lifestyle changes or home remedies that can help me manage overactive bladder?

These lifestyle changes may help reduce your symptoms:

  • Maintain a healthy weight: If you’re overweight, losing weight may ease your symptoms. Heavier people are also at greater risk of stress urinary incontinence, which may improve with weight loss.
  • Follow a fluid schedule: Ask your doctor how much fluid you need daily. People who are safely able to reduce their fluid intake by about 25 percent may experience a decrease in overactive bladder symptoms.
  • Avoid caffeine and alcohol: If caffeinated and alcoholic beverages worsen your symptoms, it might be wise to avoid them.

If you have any questions, please consult with your doctor to better understand the best solution for you.

 

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: March 7, 2017 | Last Modified: March 7, 2017

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