Overactive Bladder

Condition Basics

What is overactive bladder?

With overactive bladder, you have many strong, sudden urges to urinate during the day and night. You can get these urges even when you have only a little bit of urine in your bladder. You may not be able to hold your urine until you get to the toilet. This can lead to urine leakage, called incontinence.

Even without incontinence, overactive bladder can make it hard to do the things you enjoy. The need to drop everything and race to the toilet can disrupt your life. And if you leak, even if it's only a little bit, it can be embarrassing.

Overactive bladder can cause other problems too. Hurrying to the toilet can lead to falls and broken bones. Overactive bladder can also cause sleeping problems, depression, and urinary tract infections.

Many people are too shy to talk about their bladder problems. But overactive bladder can get better with treatment. Don't be afraid to talk with your doctor about how to control your overactive bladder.

What causes it?

Overactive bladder may be caused by bladder problems, spinal cord injury, or pelvic surgery. But in many cases, doctors don't know what causes it.

Some medicines can cause overactive bladder. Talk with your doctor about the medicines you're taking to find out if they could affect your bladder. But don't stop taking your medicine without talking to your doctor first.

What are the symptoms?

The main symptoms of overactive bladder are:

• An urgent need to urinate.
• The need to urinate often.
• Waking up to urinate 2 or more times a night.
• The need to urinate even if you have just gone to the toilet.
• Taking many trips to the toilet only to urinate just a little bit each time.
• Leaking urine when you have the urge to urinate.

You may have some or all of these symptoms.

How is it diagnosed?

Your doctor will ask you about your past health. You'll have a physical exam and be asked about any symptoms. Depending on your symptoms, you may have a pelvic exam. Or if your symptoms could be caused by prostate problems, you may have a rectal exam.

You'll be asked what kinds of fluids you drink and how much. Your doctor will also want to know how often you urinate, how much, and if you leak. It may help to write down these things in a bladder diary for 3 or 4 days before you see your doctor.

You'll also be asked about any medicines you take.

Your doctor will check a sample of your urine. Depending on the results, or if your doctor thinks that your problem may have more than one cause, you may have more tests.

How is overactive bladder treated?

Things to try at home

The first step in treatment will be to try some things at home.

• Pelvic floor exercises (Kegels). They help strengthen some of the muscles that control the flow of urine. It may help to work with a physical therapist who has special training in pelvic muscle exercises.
• Bladder training. This helps you slowly increase how long you can wait before you have to urinate.
• Cut back on caffeine, carbonated drinks, and alcohol.
• If it bothers you to get up at night to urinate, cut down on fluids before bed. But don't cut down on fluids at other times of the day. You need them to stay healthy.
• At night, if you have trouble getting to the toilet in time, clear a path from your bed to the bathroom. Or you could put a portable toilet by your bed.
• Get to and stay at a healthy weight.
• Prevent constipation by eating a healthy, high-fiber diet.

Medicine

Some medicines can cause this problem. Your doctor will check to see if any medicines you take might be causing your symptoms.

Sometimes medicines can help. This includes topical estrogen if thinning of vaginal tissue (atrophy) is a problem. Or medicine can help if an enlarged prostate is the problem.

If your symptoms really bother you or affect your quality of life, your doctor may suggest that you try medicine along with bladder training and exercises. These medicines include:

• Drugs that calm the bladder muscles, such as darifenacin, fesoterodine, and oxybutynin. They may cause side effects like dry mouth and constipation.
• Drugs that help the bladder store more urine, such as mirabegron and vibegron. Side effects may include increased blood pressure, headaches, and a runny nose.

Other treatments

For severe overactive bladder or severe urge incontinence that hasn't been controlled by exercises or medicine, treatments include:

• Botulinum toxin injections. You may need to get bladder injections every 3 to 12 months. Side effects may include having pain when you urinate, not being able to urinate easily, and getting a urinary tract infection (UTI).
• Electrical stimulation.
  • Sacral nerve stimulation (SNS) involves placing an electrical stimulator under your skin. It sends pulses to the sacral nerve in your lower back. This nerve plays a role in bladder storage and emptying.
  • Percutaneous tibial nerve stimulation (PTNS) involves regularly scheduled sessions where mild electrical stimulation is given through a needle placed behind the ankle. This is done to help reduce symptoms.
• Surgery to treat an enlarged prostate, to make the bladder bigger (augmentation cystoplasty), or to make another way to store and pass urine (urinary diversion).