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Overactive Bladder

WHAT IS OVERACTIVE BLADDER?

Overactive bladder is a condition characterized by excessive or uncontrollable urinary urgency.

At Loma Linda University Health, our whole person care approach is used to treat all conditions, including overactive bladder.

WHAT ARE THE SYMPTOMS OF OVERACTIVE BLADDER?

The most common symptoms of overactive bladder are:

  • The sudden need to urinate
  • Inability to control urges to urinate
  • Frequent urination, both day and night

Overactive bladder can be caused or contributed to by:

  • Neurological signals that tell the brain telling the bladder is full
  • Overactive, involuntarily contracting muscles in the bladder
  • Neurological disorders, such as stroke and multiple sclerosis
  • Diabetes
  • Medications that cause an increase in urine production
  • Acute urinary tract infections
  • Tumors in the bladder
  • Bladder stones
  • Enlarged prostate causing an obstruction to the bladder
  • Excess liquid consumption (specifically, caffeine or alcohol)
  • Limited bladder capacity

Researches know that overactive bladder and urine leakage:

  • Should not be considered a normal part of the aging process
  • Should not be considered a normal part of being a woman
  • Should not be considered a normal part of being a man with an enlarged prostate
  • Symptoms can respond to treatment
  • Do not always have to be treated with surgery

HOW IS OVERACTIVE BLADDER DIAGNOSED?

An overactive bladder diagnosis begins with a physical exam and questions to help your doctor understand your medical history.

Some patients are asked to keep a bladder diary. If you already have one started, it is recommended that you bring it with you to your first appointment.

Possible diagnostic tests include:

  • Urine culture, to check for infections
  • A bladder ultrasound, to see if urine remains in the bladder after urination
  • Cystoscopy, which can rule out other causes of the symptoms
  • Urodynamic testing, to check the function of the lower urinary tract

HOW IS OVERACTIVE BLADDER TREATED?

A combination of treatment strategies may be the best approach to relieve overactive bladder symptoms. Overactive bladder treatment may involve combining several of the following options.

Behavioral Interventions

These are the first choice in helping manage an overactive bladder. They're often effective, and they carry no side effects. Behavioral interventions may include:

Scheduled toilet trips - For example, urinating every two to four hours may get you on track to urinate at the same time every day instead of waiting until you feel the urge to urinate. This is probably the quickest and easiest way to achieve the most immediate results.

Bladder training - Bladder training involves training yourself to delay voiding when you feel the need to urinate. With this method, you must be able to tighten your pelvic floor muscles. To do this, you may need to do exercises.

Exercises - Kegel exercises and other pelvic floor muscle exercises can strengthen the urinary sphincter muscle.

Weight management: If you are overweight, losing weight may ease the symptoms.

Medications

Medications are not recommended for those with stress incontinence. They are only recommended for urge incontinence that does not improve with bladder training. Medications sometimes prescribed include:

  • Fesoterodine (Toviaz)
  • Tolterodine (Detrol, Detrol LA)
  • Oxybutynin (Ditropan XL)

Devices

Intermittent catheterization - This involves periodically wearing a catheter to completely empty the bladder.

Absorbent pads and undergarments - Wearing absorbent pads or undergarments can protect your clothing and help you avoid embarrassment.

Devices for men - There are two types of overactive bladder devices for men: collecting systems and fixer-occluder devices.

Other Treatments

Biofeedback - Biofeedback uses measuring devices to help the patient become aware of his or her body's functioning. By using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.

Bladder injections - Botox™, used in small doses directly injected into bladder tissues, can be an effective treatment. The temporary effects generally last five months or more, and repeat injections will be necessary.

Nerve stimulation - Regulating the nerve impulses to your bladder can improve overactive bladder symptoms.

Surgery

Surgery to treat overactive bladder is reserved for people with severe symptoms who don't respond well to other treatments. The goal is to improve the bladder's ability to store urine and reduce pressure in the bladder. However, these procedures won't help relieve bladder pain. Surgeries include:

Surgery to increase bladder capacity - This procedure uses pieces of your bowel to replace a portion of your bladder. This surgery is used only in cases of severe urge incontinence that don’t respond to other, more conservative treatment measures.

Bladder removal - This procedure is used as a last resort and involves removing the bladder and surgically constructing a replacement bladder (neobladder) or an opening in the body (stoma) to attach a bag on the skin to collect urine.

WHAT ARE THE COMPLICATIONS OF OVERACTIVE BLADDER?

If left untreated, overactive bladder can negatively impact your life by:

  • Disrupting your sleep leaving you tired and depressed
  • Affecting your work, causing disruptions in your train-of-thought and making you look bad in front of your employer and peers
  • Affecting your social life for fear of not being able to find a bathroom when you need one, leaving you feeling lonely, isolated and resentful
  • Affecting your quality of life by keeping you from doing activities you enjoy

Your physical and mental health may deteriorate as a result of having an overactive bladder.

WHO IS AT RISK FOR OVERACTIVE BLADDER?

Those most at risk for overactive bladder include:

  • Women who have gone through menopause
  • Men who have had prostate problems
  • People who have had a stroke
  • People with diseases that affect the spinal cord or brain, such as multiple sclerosis
  • People who have had a stroke

NEXT STEPS

Seek medical intervention. If you are having symptoms of an overactive bladder, be proactive and seek medical advice. To request an evaluation at Loma Linda University Health, contact your provider or schedule the appointment through MyChart.