Overactive Bladder

Topic Overview

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 bathroom. This can lead to urine leakage, called incontinence.

Overactive bladder is very common in older adults. Both men and women can have it, but it's more common in women.

Overactive bladder is a kind of urge incontinence. But not everyone with overactive bladder leaks urine.

Even without incontinence, overactive bladder can make it hard to do the things you enjoy. The need to drop everything and race to the bathroom 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 bathroom 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 overactive bladder?

Overactive bladder is caused by an overactive muscle in the bladder that pushes urine out. There are many things that can make this muscle overactive. It can be caused by a bladder infection, stress, or another medical problem. Some brain problems, such as Parkinson's disease or a stroke, can also lead to overactive bladder. 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 bathroom.
• Taking many trips to the bathroom 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 overactive bladder diagnosed?

Your doctor will do a physical exam. He or she will ask 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 (What is a PDF document?) for 3 or 4 days before you see your doctor.

Your doctor probably will also do a few tests, such as:

• A pelvic exam if you are a woman.
• A rectal exam if you are a man.
• A urine test.
• A blood test.

You may have more tests if your doctor thinks your symptoms could be caused by other problems, such as diabetes or prostate disease.

How is it treated?

Things to try at home

The first step in treatment will be to try some things at home, such as urinating at scheduled times. This is called bladder retraining.

You can also do special exercises called Kegels to make your pelvic muscles stronger. These muscles control the flow of urine. Doing these exercises can improve some bladder problems. It may help to work with a physical therapist who has special training in pelvic muscle exercises.

There are other changes you can make that can help:

• Cut back on caffeine drinks, such as coffee, tea, and sodas.
• 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.

Medicine

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 oxybutynin, solifenacin, and tolterodine. They may cause side effects like dry mouth and constipation.
• Drugs that help the bladder store more urine, such as mirabegron. Side effects may include increased blood pressure, inflammation of the nose and pharynx, and urinary tract infections (UTIs).

Other treatments

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

• Botox (botulinum toxin) injections. You may need to get a shot every 3 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. Small electrodes send pulses to the nerves in the lower back.
  • Sacral nerve stimulation (SNS) affects bladder storage and emptying.
  • Peripheral tibial nerve stimulation (PTNS) affects bladder control and pelvic floor muscle strength.
• Surgery to make the bladder bigger (augmentation cystoplasty) or to make another way to store and pass urine (urinary diversion).

Complementary treatments

Acupuncture may help with overactive bladder. It has been shown to work as well as medicine for some women.^{footnote 1}