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Overactive bladderBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/overactive-bladder/DS00827
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 (incontinence).
If you have an overactive bladder, you may feel embarrassed, isolate yourself, or limit your work and social life. The good news is that a brief evaluation can determine whether there's a cause for your overactive bladder symptoms. Available treatments may greatly reduce or eliminate the symptoms and help you manage their effect on your daily life.
Signs and symptoms of overactive bladder may mean you:
- 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 and nighttime urination can disrupt your life.
When to see a doctor
Overactive bladder isn't a normal part of aging. Treatments are available that might help you. It can be difficult to discuss such a private matter with your doctor, but it's important that you do — especially if your symptoms disrupt your work schedule, social interactions and everyday activities.
Normal bladder function
Filling and emptying your bladder is a complex interplay of kidney function, nerve signals and muscle activity. A problem anywhere in this system can contribute to overactive bladder and urge incontinence.
The kidneys produce urine, which drains into your bladder. When you urinate (void), the urine passes from your bladder through an opening at the bottom (neck) and flows out a tube called the urethra (u-REE-thruh). In women, the urethral opening is located just above the vagina. In men, the urethral opening is at the tip of the penis.
As your bladder fills, nerve signals alert your brain and eventually you'll feel the need to urinate. When you urinate, nerve signals coordinate the relaxation of the pelvic floor muscles and the muscles of the urethra (urinary sphincter muscles). The muscles of the bladder tighten (contract), pushing the urine out.
Involuntary bladder contractions
Symptoms of an overactive bladder occur because the muscles of the bladder are starting to contract involuntarily. This contraction creates the urgent need to urinate.
Several conditions may contribute to signs and symptoms of overactive bladder, including:
- Neurological disorders, such as Parkinson's disease, strokes and multiple sclerosis
- High urine production as might occur with high fluid intake, poor kidney function or diabetes
- Medications that cause a rapid increase in urine production or require that you take them with lots of fluids
- Acute urinary tract infections that can cause symptoms similar to an overactive bladder
- Abnormalities in the bladder, such as tumors or bladder stones
- Factors that obstruct bladder outflow — enlarged prostate, constipation or previous operations to treat other forms of incontinence
- Excess consumption of caffeine or alcohol
Often, the specific cause of an overactive bladder isn't known.
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. Although common among older adults, an overactive bladder isn't considered a normal part of aging.
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.
Urge and any urge-related incontinence can affect your overall quality of life. People whose overactive bladder causes major disruption in their lives have an increased risk of:
- Emotional distress
- Sleep disturbances and interrupted sleep cycles
Some women may also have a disorder called mixed incontinence, when both urge and stress incontinence occur. Stress incontinence is the loss of urine when you exert physical stress or pressure on your bladder, such as during activities that include running or jumping.
Preparing for your appointment
For overactive bladder, you're likely to start by seeing your primary doctor. After your initial appointment, you may be referred to a specialist in urinary disorders in men and women (urologist), a specialist in urinary disorders in women (urogynecologist) or a specialist in physical therapy for diagnosis and treatment.
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Keep a bladder diary for a few days, recording when, how much and what kind of fluids you consume, when you urinate, whether you feel an urge to urinate and whether you experience incontinence. A bladder diary may help determine why you have to get up to urinate at night.
- Note any other symptoms you're experiencing, particularly those related to your bowel function.
- Let your doctor know if you have diabetes, a neurological disease, or have had pelvic surgery or radiation treatments.
- Make a list of all the medications you take, as well as vitamins or supplements, as many medications can affect bladder function.
- Write down questions to ask your doctor.
For overactive bladder, basic questions might include:
- What are the possible causes of my symptoms?
- Is my urine clear?
- Do I empty my bladder well?
- Is my pelvic floor muscle strength good enough for me to keep my bladder from contracting when I have an abnormal urge?
- Do you recommend any other tests? Why?
- What treatments are available and which do you recommend for me?
- What types of side effects can I expect from treatment?
- Are there any dietary restrictions that could help?
- How do my other health problems affect my bladder symptoms?
- If I need to see a specialist, what can I expect?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there brochures or other printed material that I can have? What websites do you recommend?
What to expect from your doctor
Your doctor may use an overactive bladder questionnaire to make an assessment of your symptoms, asking questions such as:
- How long have you had these symptoms?
- Do you unexpectedly leak urine? How often?
- What do your symptoms keep you from doing that you like to do?
- During daily activities, such as walking or bending over, do you leak urine?
Tests and diagnosis
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 also may 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. This test is important if your bladder can't empty completely when you urinate or experience urinary incontinence. Remaining urine (postvoid residual urine) may cause symptoms identical to an overactive bladder. To measure residual urine after you've 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 pressure. 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, of you're a woman, in your vagina. This procedure can identify whether you have involuntary muscle contractions or a stiff bladder that's not able to store urine under low pressure. You may be asked to void during the study (pressure-flow study), which can also measure the pressure used to empty your bladder and indicate whether or not you have a bladder blockage (obstruction).
Your doctor will review the results of any tests with you and suggest a treatment strategy.
Treatments and drugs
Your doctor is likely to recommend a combination of treatment strategies to relieve your symptoms.
Behavioral interventions are the first choice in helping manage an overactive bladder. If you experience urge incontinence, these interventions alone aren't likely to result in complete dryness, but they may significantly reduce the number of incontinence episodes. The interventions your doctor recommends may include:
- Pelvic floor muscle exercises. Kegel exercises strengthen your pelvic floor muscles and urinary sphincter. These strengthened muscles can help you stop the bladder's involuntary contractions. Your doctor or a physical therapist can help you learn how to do Kegel exercises correctly. It may take as long as six to eight weeks before you notice a difference in your symptoms.
- 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 the amount and timing of your fluid consumption.
- Double voiding. People who have problems completely emptying their bladders may be helped by double voiding. After urinating, you wait a few minutes and then try again to empty your bladder completely.
- Scheduled toilet trips. Your doctor may recommend a schedule for toileting so you urinate at the same times every day — for example, every two to four hours — rather than waiting until you feel the urge to urinate.
- Intermittent catheterization. You can learn how to empty your bladder by using a catheter periodically to empty it completely. This simply helps the bladder do what it can't do itself. Your doctor can tell you if this is right for you.
- Absorbent pads. You can wear absorbent pads or undergarments to protect your clothing and avoid embarrassing incidents if you do experience incontinence. In addition, the use of pads means that you won't have to limit your activities due to your symptoms. Absorbent garments come in a variety of sizes and absorbency levels.
- Bladder training. Occasionally, your doctor may recommend a strategy to train yourself to delay voiding when you feel an urge to urinate. You'll begin with small delays, such as 30 minutes, and gradually work your way up to urinating every three to four hours. Bladder training is possible only if you're able to tighten (contract) your pelvic floor muscles successfully.
Medications that relax the bladder can be effective for relieving symptoms of overactive bladder and reducing episodes of urge incontinence. These drugs include:
- Tolterodine (Detrol)
- Oxybutynin (Ditropan XL)
- Oxybutynin as a skin patch (Oxytrol)
- Oxybutynin gel (Gelnique)
- Trospium (Sanctura)
- Solifenacin (Vesicare)
- Darifenacin (Enablex)
- Mirebegron (Myrbetriq)
Common side effects of most of these drugs include dry eyes and dry mouth, but drinking water to quench thirst can aggravate symptoms of overactive bladder. Constipation — another potential side effect — can decrease bladder capacity, also aggravating symptoms. Extended-release forms of these medications, including the skin patch or gel, may cause fewer side effects.
Treating the side effects of a medication that's working is more important than stopping the medication. For example, your doctor may recommend that you suck on a piece of sugar-free candy or chew sugar-free gum to relieve dry mouth, and use eyedrops to keep your eyes moist. Over-the-counter preparations, such as Biotene products, can be helpful for long-term dry mouth. To avoid constipation, your doctor might recommend a fiber-rich diet or use of stool softeners.
OnabotulinumtoxinA (on-uh-boch-yoo-LYE-num-tox-in-ay), 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.
Sacral nerve stimulation
Regulating the nerve impulses to your bladder can improve overactive bladder symptoms. In this procedure, a thin wire is placed close to the sacral nerves — which carry signals to your bladder — where they pass near your tailbone. 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 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 and home remedies
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.
- Following 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 these.
No complementary or alternative therapies have been proved to successfully treat overactive bladder. Research suggests that therapies such as reflexology and hypnotherapy aren't effective in treating this condition.
Complementary treatments that might be helpful include:
- Biofeedback. During biofeedback, you're connected to electrical sensors that help you measure and receive information about your body. The biofeedback sensors teach you how to make subtle changes in your body, such as strengthening your pelvic muscles so that when you have feelings of urgency you're better able to suppress them.
- Acupuncture. Acupuncture practitioners treat you using extremely thin, disposable needles. One small study suggested that acupuncture might help ease the symptoms of overactive bladder.
Complementary treatments may not be covered by insurance, so check your plan carefully.
Coping and support
Living with overactive bladder can be difficult. Consumer education and advocacy support groups such as the National Association for Continence (NAFC) can provide you with online resources and information, connecting you with people who experience overactive bladder and urge incontinence. Support groups offer the opportunity to voice concerns, learn new coping strategies, and stay motivated to maintain self-care strategies.
Educating your family and friends about overactive bladder and your experiences with it may help you establish your own support network and reduce feelings of embarrassment. Once you start talking about it, you may be surprised to learn how common this condition really is.
These healthy lifestyle choices may reduce your risk of overactive bladder:
- Get regular, daily physical activity and exercise.
- Limit consumption of caffeine and alcohol.
- Quit smoking.
- Manage chronic conditions, such as diabetes, that might contribute to overactive bladder symptoms.
- Learn where your pelvic floor muscles are and then strengthen them by doing Kegel exercises — tighten (contract) muscles, hold the contraction for two seconds and relax muscles for three seconds. Work up to holding the contraction for five seconds and then 10 seconds at a time. Do three sets of 10 repetitions each day.
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