There is a strong urge to urinate that can be difficult to control if your bladder is overactive. In addition to passing urine frequently during the day and night, you may also experience unintentional loss of urine (urgency incontinence). There are effective treatments available for overactive bladder, which can help you manage your symptoms and improve your well-being. Overactive bladder can cause embarrassment, anxiety, and sleep problems.
Causes
A person with overactive bladder experiences abnormal contractions of the bladder muscle, causing them to feel the need to urinate even when their bladders are not full. There are several possible reasons for overactive bladder, including:
-
The bladder muscle and pelvic floor muscles that support the bladder can weaken with age
-
In women, hormonal changes, such as menopause, can affect bladder function and nerve sensitivity
-
In neurological disorders such as stroke, Parkinson's disease, or multiple sclerosis, bladder nerves can be damaged
-
Infections of the urinary tract, which can cause inflammation and spasms of the bladder
-
Stones, tumors, or other abnormalities in the bladder can obstruct the flow of urine or stimulate the nerve endings in the bladder
-
Diuretics, antihistamines, and antidepressants can increase urine production or affect bladder muscle tone
-
Drinking too much fluid, especially caffeinated and alcoholic beverages, or eating spicy or acidic foods can increase bladder activity or irritate the bladder lining.
Symptoms
Overactive bladder is characterized by a strong and sudden urge to urinate that you can't delay. Other symptoms include:
-
More than eight times in 24 hours, frequent urination
-
Having to urinate more than twice during the night is known as nocturia
-
When you feel the urge to urinate, you leak urine involuntarily
-
A feeling of residual urine in the bladder or difficulty emptying the bladder completely
-
Due to fear of leakage or lack of access to bathrooms, reduced quality of life, such as avoiding social activities, traveling, or exercising
Diagnosis
Overactive bladder can be diagnosed by asking your doctor about your symptoms, medical history, and medications. Your doctor may also perform a physical examination, which may include:
-
Performing a pelvic exam for women or a rectal exam for men to check for infection, prolapse, or prostate enlargement
-
Checking for infection, blood, and glucose in the urine
-
Keep a bladder diary, which records how much and how often you urinate, as well as any episodes of leakage or urgency
Some tests may also be ordered by your doctor to evaluate your bladder function, such as:
-
A post-void residual test (PVR) measures how much urine remains in your bladder after urinating
-
Uroflowmetry measures the speed and volume of your urine flow
-
Cystometry measures your bladder's capacity and pressure
-
Through a thin, flexible tube with a light and camera, a cystoscopy examines the inside of your bladder and urethra
-
An ultrasound uses sound waves to create images of your bladder and kidneys
Treatment
Treatment options for overactive bladder depend on the severity of your symptoms and your personal preferences. Examples include:
-
Therapies based on behavioral principles, such as:
-
During bladder training, you gradually increase the time between urinations and resist the urge to urinate until you reach a scheduled time
-
To strengthen and improve bladder control, pelvic floor muscle exercises, also known as Kegel exercises, involve contracting and relaxing muscles that support the bladder and urethra.
-
Limiting fluid intake, especially before bedtime or going out, and avoiding beverages that can irritate the bladder, such as caffeine, alcohol, or carbonated drinks
-
Changes in lifestyle, such as quitting smoking, losing weight, managing stress, and treating constipation, can reduce overactive bladder risk factors or triggers
-
-
Medications include:
-
Anticholinergics, such as oxybutynin, tolterodine, or solifenacin, block nerve signals that cause the bladder to contract
-
A beta-3 agonist, such as mirabegron, relaxes bladder muscles and increases bladder capacity
-
Injecting botulinum toxin (Botox) into the bladder muscle temporarily paralyzes it, reducing bladder contractions and urination urges
-
-
A variety of devices, including:
-
During an activity, a urethral insert is inserted into the urethra and removed afterwards to prevent urine leakage
-
To reduce urine leakage, a pessary is inserted into the vagina and supports the bladder and urethra
-
To regulate bladder activity, a nerve stimulator is implanted under the skin and delivers electrical impulses to the nerves that control the bladder
-
-
The following types of surgery are available:
-
To increase the bladder capacity and reduce pressure, augmentation cystoplasty involves enlarging the bladder with tissue from the intestine or stomach
-
The procedure involves bypassing the bladder by creating a new way for urine to exit the body, either through the abdomen or the urethra
-
Prevention
There are some steps you can take to reduce your risk or delay the onset of overactive bladder, such as:
-
Performing regular pelvic floor exercises to maintain the strength and function of the muscles that support the bladder and urethra
-
Keep your urine diluted and prevent dehydration by drinking enough fluids, but not too much
-
A balanced diet, rich in fiber, can prevent constipation, which can put pressure on the bladder
-
Foods and drinks that irritate the bladder, such as caffeine, alcohol, carbonated beverages, spicy foods, or acidic foods, should be avoided or limited
-
If you experience any symptoms of urinary tract infection, such as burning, pain, frequent urination, or blood in the urine, seek medical attention immediately
-
Getting regular checkups and screening tests, especially if you have a family history of overactive bladder or other conditions that can affect bladder function, such as diabetes, stroke, or multiple sclerosis.
