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Overactive Bladder

Overactive bladder is a medical condition caused by involuntary contractions of muscles in the bladder. These spasms create an urgency to urinate, whether the bladder is full or not.

The urge occurs more frequently than is considered normal. If there’s urine in the bladder, it may leak at the same time the contraction occurs (known as urge incontinence). Nearly 1 in 5 Canadians of both genders over the age of 35 have overactive bladder.

Symptoms of Overactive Bladder

The symptoms of overactive bladder include:

  • Sudden, strong urge to urinate.
  • Urinating frequently, usually eight or more times in 24 hours.
  • Inability to control the urge to urinate until bathroom is reached.
  • Large amounts of urine leaked if incontinent.
  • Waking from sleep to urinate.
  • Many people mistakenly assume it is a natural part of aging and do not seek treatment that could alleviate their symptoms.

Overactive bladder can cause problems for patients in all aspects of their lives – professional, social and sexual. People with overactive bladder can struggle with depression, shame, isolation, and stress.

Causes of Overactive Bladder

The kidneys produce urine, which drains into your bladder. When you urinate, urine passes from your bladder through an opening at the bottom and flows out a tube called the urethra. In women, the urethral opening is located just above the vagina. In men, the urethral opening is at the tip of the penis.

As your bladder fills, nerve signals sent to your brain eventually trigger the need to urinate. When you urinate, nerve signals coordinate the relaxation of the pelvic floor muscles and the muscles of the urethra (urinary sphincter muscles). The muscles of the bladder tighten (contract), pushing the urine out.

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Contributing Conditions

Overactive bladder occurs because the muscles of the bladder start to contract involuntarily even when the volume of urine in your bladder is low. This involuntary contraction creates the urgent need to urinate. Several conditions may contribute to signs and symptoms of overactive bladder, including:

  • Neurological disorders, such as stroke and multiple sclerosis.
  • Diabetes.
  • Medications that cause a rapid increase in urine production or require that you take them with lots of fluids.
  • Acute urinary tract infections that can cause symptoms similar to an overactive bladder.
  • Abnormalities in the bladder, such as tumors or bladder stones.
  • Factors that obstruct bladder outflow — enlarged prostate, pregnancy, constipation or previous operations to treat other forms of incontinence.
  • Excess consumption of caffeine or alcohol.
  • Declining cognitive function due to aging, which may make it more difficult for your bladder to understand the signals it receives from your brain.
  • Difficulty walking, which can lead to bladder urgency if you’re unable to get to the bathroom quickly.
  • Incomplete bladder emptying, which may lead to symptoms of overactive bladder, as you have little urine storage space left.

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Risk Factors

As you age, you’re at increased risk of developing overactive bladder. You’re also at higher risk of diseases and disorders, such as enlarged prostate and diabetes, which can contribute to other problems with bladder function.

Many people with cognitive decline — for instance, after a stroke or with Alzheimer’s disease — develop an overactive bladder. Incontinence that results from situations like this can be managed with fluid schedules, timed and prompted voiding, absorbent garments, and bowel programs.

Some women also may have a disorder called mixed incontinence, when both urge and stress incontinence occur. Stress incontinence is the loss of urine when you exert physical stress or pressure on your bladder, such as during activities that include running or jumping. Treatment of the stress incontinence is not likely to help the overactive bladder symptoms.

Older people may have a common combination of bladder storage problems and bladder-emptying issues. The bladder may cause a lot of urgency and even incontinence, but it doesn’t empty well. A specialist may be able to help you with this combination of bladder problems.

Overactive Bladder Treatments

The symptoms of overactive bladder are treatable. The doctor may ask you to keep a voiding journal – a record of your urges, frequency, incontinence and fluid consumption. There are many types of response to overactive bladder:

Behavioral Techniques:

Bladder Training: Teaching yourself to increase the time you have before you urinate
Biofeedback: A technique for learning to control a body function that is not normally under conscious control

Medications:

Anticholinergics: These pills or patches help to reduce the spasms of muscles in the bladder. They are particularly effective when paired with bladder training.
Bladder Injections: Botox injections for the bladder can calm the nerves and bladder muscles to block the impulses that trigger overactive bladder urges.

Life Style Factors

These healthy lifestyle choices may reduce your risk of overactive bladder:

  • Maintain a healthy weight.
  • Get regular, daily physical activity and exercise.
  • Limit consumption of caffeine and alcohol.
  • Quit smoking.
  • Manage chronic conditions, such as diabetes, that might contribute to overactive bladder symptoms.

Learn where your pelvic floor muscles are and then strengthen them by doing Kegel exercises — tighten (contract) muscles, hold the contraction for two seconds and relax muscles for three seconds. Work up to holding the contraction for five seconds and then 10 seconds at a time. Do three sets of 10 repetitions each day.

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