Overactive Bladder

Overactive bladder is a type of bladder-control problem that affects more than 33 million Americans of all ages. 

 

Overactive bladder occurs when the detrusor muscle of the bladder contracts more often than necessary, even when the bladder is not full. This constant contraction causes sudden, overwhelming urges to urinate. Though overactive bladder is a common medical condition, many patients may feel ashamed or embarrassed to discuss it. However, it is important to communicate with your doctor about your overactive bladder so it can be properly treated. It is not a normal part of aging. Overactive bladder can be treated with medication, behavior modification and changes in diet. In rare cases in which these treatments do not work or cannot be used, minimally-invasive surgical procedures are available.

General Information

The common symptoms of overactive bladder are frequency (the need to urinate often), urgency (the sudden, uncontrollable need to urinate), nocturia (the need to urinate often at night) and urge incontinence, or wetting accidents. You may feel as if you can’t wait to reach a toilet and you may lose urine on the way. At times, you may leak urine without any warning at all. Patients with overactive bladder feel the need to urinate extremely often. They often have sudden, uncontrollable needs to urinate, even at night.

What causes Overactive Bladder?

Overactive bladder happens when the signals between the bladder and the brain are disrupted in some way. 

  • Medication side effects
  • Urinary tract infection or bladder irritation
  • Pregnancy or recent childbirth
  • Neurological disease, like Parkinson's or multiple sclerosis
  • Inflammation of the prostate in men
  • Nerve damage caused by surgery, injury or disease (like diabetes)

Diagnosis

To get a diagnosis of overactive bladder, your doctor starts with a complete health history to learn about other urinary conditions you’ve had in the past and when the problem started. Questions your doctor may ask about your overactive bladder include:

  • How often do you urinate?
  • How often do you leak urine, and how severely?
  • Do you feel any pain or discomfort while urinating?
  • For how long has the urge or urinary incontinence been occurring?
  • What medications are you taking?
  • Have you had any recent surgery or illnesses?

Keeping a voiding diary at home can help you answer these questions and help with an overactive bladder diagnosis. Each day, write down how much you drink, when you urinate, how much you urinate each time, and whether you ever feel an urgent need to go.

Your doctor will then examine your abdomen, genitals and rectum. You might also be given a neurological exam to look for problems in your nervous system that could affect your ability to urinate.

There are also a number of tests that may be performed to diagnose overactive bladder, including:

  • Urinalysis or urine sample
  • Bladder stress test to find out if you are leaking urine
  • Cystoscopy to look for cysts and growths in the bladder
  • Urodynamic testing
  • Voiding cystourethrogram to identify structural problems in the bladder and urethra

These tests can help diagnose whether your condition has something to do with an infection or other illness, a blockage or poorly functioning bladder muscles. Knowing the cause of your overactive bladder can help your doctor decide on the right treatment for you.

Treatment

There are many options for the treatment of overactive bladder:

  • Behavior modification consists of techniques that help strengthen and train pelvic muscles. Behavior modification techniques include bladder training and biofeedback. Bladder training, which can help control wetting accidents as well as frequency and urgency, consists of instruction about normal and abnormal urination and scheduling of urination.
     
  • Medication is prescribed either in conjunction with behavior modification or after behavior modification has been tried unsuccessfully. The drugs most commonly prescribed by doctors to treat overactive bladder are Detrol-LA and Ditropan-XL. These drugs, also known as anticholinergic drugs or antispasmodics, prevent involuntary contractions of the bladder muscle by relaxing and stabilizing the muscle. Another medication called Tofranil, most often used for depression, can also help by calming the bladder.
     
  • Doctors often recommend that overactive bladder patients limit their intake of caffeine and alcohol, which can irritate the bladder.
     
  • Some people do not benefit from or cannot tolerate behavior modification or medications. For these people, sacral nerve stimulation is an available treatment option. This is a procedure in which a neurostimulator device is inserted under the skin, near a nerve that affects bladder function, and sends electrical pulses to the sacral nerve. The sacral nerve affects bladder control muscles, and stimulation of this nerve can help improve overactive bladder. After the device is implanted, it can run for five to 10 years.

Patient Resources

Understanding Treatments for Bladder Control, presented by Scott Shie, MD