Overactive Bladder

Overactive bladder describes a combination of symptoms that can include a frequent urge to urinate and waking up at night to urinate. Causes can include weak muscles, nerve damage, use of medications, alcohol or caffeine, infection, and being overweight. Lifestyle changes may help

OVERVIEW

What is overactive bladder?

Overactive bladder is a combination of symptoms that can cause you to need to urinate more frequently, have more urgency, experience incontinence (leakage) and a need to urinate at night. One or all of these symptoms can cause considerable stress and a negative impact on your quality of life.

SYMPTOMS AND CAUSES

What are the specific symptoms of overactive bladder?

Overactive bladder represents a collection of symptoms that can include:

Urinary urgency: This is a failure to be able to postpone the need to urinate. When you feel you need to urinate, you have a limited amount of time to get to a bathroom.

Frequency of urination: People who experience this symptom need to urinate very often. Typically it’s an increase in the number of times you urinate compared to what you previously experienced.

Urge incontinence: In this case, there can be a leakage of urine when you get the urge to urinate.

Nocturia: This symptom is characterized by the need to get up and urinate at least two times each night.

What causes overactive bladder?

An overactive bladder can be caused by several things, or even a combination of causes. Some possible causes can include:

Weak pelvic muscles: Pregnancy and childbirth can cause your pelvic muscles (the muscles and tissues that support the organs in your lower abdomen) to stretch and weaken. This can cause the bladder to sag out of its normal position. All of these factors can cause leakage.

Nerve damage: Sometimes signals are sent to the brain and bladder to empty at the wrong time. Trauma and diseases can cause this to happen. These can include:

Pelvic or back surgery.

Herniated disc.

Radiation.

Parkinson’s disease.

Multiple sclerosis.

Stroke.

Medications, alcohol and caffeine: All of these products can dull the nerves, which affects the signal to the brain. This could result in bladder overflow. Diuretics and caffeine can cause your bladder to fill rapidly and possibly leak.

Infection: An infection, like a urinary tract infection (UTI), can irritate the bladder nerves and cause the bladder to squeeze without warning.

Excess weight: Being overweight places extra pressure on your bladder. This can lead to urge incontinence.

Estrogen deficiency after menopause: This hormonal change could contribute to a loss of urine due to urgency. Ask your doctor if vaginal-only estrogen therapy is right for you. This is different from “systemic” hormone therapy, which is absorbed throughout the body.

Often, there may be no specific explanation for why this is occurring.

MANAGEMENT AND TREATMENT

How is overactive bladder treated?

It is actually very common to have an overactive bladder. This condition is very treatable, but it does require assistance from you and your doctor. Treatment for an overactive bladder can range from changing certain behaviors to medications to nerve stimulation (neuromodulation).

What behavioral changes can I make to help with overactive bladder?

There are many techniques and changes to your typical behavior that you can try to help with an overactive bladder. These can include:

Keeping a log: During a typical day, write down your fluid intake, the number of times you urinate, the number of accidents and when they occur. Make a note about what happened when the accident happened, like when you:

Cough.

Sneeze.

Laugh.

Were unable to reach the bathroom in time.

Monitoring your diet: Eliminate or decrease foods or beverages that may worsen your bladder symptoms. These could include:

Tea.

Coffee.

Alcohol.

Chocolate.

Caffeinated soft drinks (even decaffeinated coffee and tea contain some caffeine).

Citrus juices and fruits.

Tomatoes and tomato-based products.

Spicy and acidic foods and drinks.

Foods and drinks that contain artificial sweeteners.

Maintaining bowel regularity: Constipation can place added pressure on the bladder and have a negative effect on your bladder function. By keeping healthy bowel habits, you may be able to avoid constipation and help to lessen bladder symptoms. The following are some suggestions for maintaining bowel regularity:

Increase your fiber intake by eating foods like beans, pasta, oatmeal, bran cereal, whole wheat bread, and fresh fruit and vegetables.

Every morning, take 2 tablespoons of this mixture: 1 cup apple sauce, 1 cup unprocessed wheat bran, and ¾ cup prune juice.

Exercise regularly to maintain regular bowel movements.

Maintaining a healthy weight: Being overweight can add pressure on your bladder, which may contribute to bladder control problems. If you are overweight, weight loss can reduce the pressure on your bladder.

Stop smoking: Cigarette smoking is irritating to the bladder muscle. Repeated coughing spasms due to smoker’s cough can cause urine leakage.

Drinking plenty of non-irritating fluids: People with bladder symptoms often drink fewer liquids, so they don’t have to urinate as often. Drinking fewer fluids causes you to produce more concentrated (dark yellow, strong-smelling) urine. Highly concentrated urine is irritating to the bladder and may actually cause more frequent urination. Try not to dehydrate yourself. It is alright to drink to satisfy your thirst. Limit your intake starting two or three hours before going to bed. You should also decrease or eliminate beverages that may worsen bladder symptoms. These include:

Tea.

Coffee.

Alcohol.

Caffeinated soft drinks.

Citrus juices.

Drinks that contain artificial sweeteners.

Beginning bladder retraining: When you have overactive bladder, over time your bladder muscles become conditioned to react in a certain way. By retraining these muscles, you may hold urine better. Bladder retraining involves learning how to resist or inhibit the feeling of urgency, postpone voiding, and urinate according to a timetable (rather than in response to a feeling of urgency).

To begin bladder training you should start with your current voiding interval. For example, if you urinate every hour on average, this would be your current voiding interval.

Once the beginning voiding interval has been established, you try to wait a few minutes when you have to urinate and over time slowly increase the interval between urinations. If you develop urgency in between the voiding intervals, immediately sit down in a comfortable position, take slow deep breaths in and out of your mouth, and try to imagine yourself in a favorite vacation spot or use some other relaxation technique until the urge passes. Then proceed to the bathroom.

Empty the bladder around the clock at first. Don't wait until the last minute. For example, start every two hours, and if you have remained dry, then increase the time between urinations. If you are wet, then decrease that time to every hour, and gradually increase the time between bathroom visits. If you normally go every hour, try to increase it to one hour and 15 minutes between visits.

When you can maintain your new schedule without accident for one to two weeks, try increasing the time between bathroom visits by an additional 15 minutes until you reach an interval you feel comfortable with. The goal is to reach an interval of two to four hours between bathroom visits.

Stick to the schedule as much as possible.

Controlling the urge: The key to bladder retraining is developing the ability to control urinary urges. There are several tips and strategies you can follow, but remember to be patient. An entire bladder retraining program usually takes at least six to eight weeks to produce results. When you experience a sudden urge, the following strategies may help:

Stop what you are doing and stay put. Sit down when possible, or stand quietly. Remain very still. When you are still, it is easier to control your urge.

Squeeze your pelvic floor muscles quickly several times. Do not relax fully in between these squeezes.

Relax the rest of your body. Take a few deep breaths to help you relax and let go of your tension.

Concentrate on suppressing the urge feeling.

Wait until the urge subsides.

Walk to the bathroom at a normal pace. Do not rush. Continue squeezing your pelvic

floor muscles quickly while you walk.

Talk to your doctor about the best way to manage the symptoms of an overactive bladder. He or she may recommend a combination of medications and bladder retraining to help you achieve the best outcome.

What medications can I use for overactive bladder?

Your doctor may suggest trying behavioral techniques before having you use a medication to treat overactive bladder. However, medications can work very well to return normal function to the bladder. Ask your doctor about the risks and benefits of using the following commonly prescribed medications:

Anticholinergic medications

These medications control muscle spasms in the bladder:

Oxybutynin (Ditropan®), oxybutynin XL (Ditropan XL®), oxybutynin TDDS (Oxytrol®).

Tolterodine (Detrol®).

Solifenacin (Vesicare®).

Fesoterodine (Toviaz®).

Darifenacin (Enablex®).

Trospium (Sanctura XR®).

Oxybutinin Gel (Gelnique®).

Beta-3 adrenergic medication

Mirabegron (Myrbetriq).

How can nerve stimulation help overactive bladder?

There are several treatments that involve stimulating your nerves to help improve overactive bladder. Your nerves help communicate the message that your bladder needs to be emptied to your brain. By treating the nerves, your healthcare provider can improve your bladder control. Nerve stimulation is a reversible treatment that is considered when conservative treatments have not worked or have not been tolerated. Conservative treatments include behavioral therapies (diet modifications, biofeedback, bladder retraining, pelvic muscle exercises) and medications.

There are several types of nerve stimulation treatments. These can include:

Sacral nerve stimulation: Sacral nerve stimulation is a therapy that electrically stimulates the nerves that control the bladder. A small device (a neurotransmitter) is implanted under the skin in the upper buttock area in an outpatient setting. The device sends mild electrical impulses through a lead (a wire) close to the sacral nerve (a nerve located in the lower back). The impulses, in turn, help provide bladder control. Sacral nerve stimulation can reduce the number of voids and/or the number of wetting episodes, and has very good overall efficacy.

Percutaneous tibial nerve stimulation: This type of nerve stimulation is an outpatient procedure in which small nerve impulses are delivered to a nerve branch near the ankle that stimulates bladder control. Patients usually have to have 12 weekly sessions and then maintenance therapy once a month after that.

Botox injections into the bladder muscle: This treatment involves an injection of Botox A (onabotulinum toxin A) into the bladder wall using a small telescope (cystoscope). This therapy is very effective, even for patients who have not had good results with other therapies. A very small percentage of people may have temporary urinary retention (difficulty voiding) after Botox. This treatment wears off over time and generally needs to be repeated every six months.

OUTLOOK / PROGNOSIS

Can overactive bladder be controlled?

Overactive bladder therapy can be challenging to manage. However, many people are very satisfied with the treatment they receive and they often see a dramatic improvement in their quality of life. Your doctor will guide you to the best steps to begin with and give you options for any additional treatments you may need over time.