What is an overactive bladder?
Overactive bladder represents a collection of symptoms that include:
- urinary urgency -- failure to be able to postpone the need to urinate
- frequency of urination -- the need to urinate at least eight times per day
- urge incontinence -- leakage of urine when one gets the urge to urinate
- nocturia -- the need to get up and urinate at least two times per night
What causes an overactive bladder?
Urine leakage and bladder control problems can have many possible causes. These include:
- Weak pelvic muscles -- muscles that have become stretched and weak due to pregnancy and childbirth, which in turn have let the bladder sag out of position and have stretched the opening of the urethra causing urine leakage.
- Nerve damage -- sending signals to the brain and bladder to empty at the wrong time. Diseases that can cause nerve damage include diabetes, Parkinson's, multiple sclerosis, and stroke. Trauma that can cause nerve damage includes pelvic or back surgery, herniated disc, and radiation.
- Medications, alcohol, caffeine -- these products can dull the nerves, affecting the signal to the brain, resulting in bladder overflow. Diuretics and caffeine can cause rapid bladder filling and may cause bladder leakage.
- Infection -- a urinary tract infection can irritate bladder nerves and cause the bladder to squeeze without warning.
- Excess weight -- being overweight puts pressure on the bladder and contributes to urge incontinence.
- Estrogen deficiency after menopause -- may contribute to 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.
How is overactive bladder treated?
Bladder over activity is a very common condition. It is very treatable, but requires assistance from both the doctor and the patient. Treatment can range from behavioral modification techniques to drugs to neuromodulation.
Behavioral modification techniques to help your overactive bladder
Keep a log
During a typical day, write down your fluid intake, the number of times that you urinate, the number of accidents and when they occur (after coughing, sneezing, laughing, because you were not able to reach the bathroom in time, etc.).
Monitor your diet
Eliminate or decrease foods or beverages that may worsen bladder symptoms. These include:
- 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 containing artificial sweeteners
Maintain bowel regularity
Constipation can place added pressure on the bladder and have a negative effect on 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 fiber intake by eating foods such as beans, pasta, oatmeal, bran cereal, whole wheat bread, and fresh fruits 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 to maintain regular bowel movements.
If you continue to have bowel problems, see your doctor.
Maintain 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 pressure on your bladder.
Cigarette smoking is irritating to the bladder muscle. Repeated coughing spasms due to smoker's cough can cause urine leakage.
Drink plenty of non-irritating fluids
People with bladder symptoms often drink fewer liquids so they don't have to urinate as often. You should regularly drink about 3 to 4 glasses of liquids per day. Try to spread them out as evenly as possible throughout the day. 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. Limit your intake starting 2 or 3 hours before going to bed.
Decrease or eliminate beverages that may worsen bladder symptoms. These include tea, coffee, alcohol, caffeinated soft drinks, citrus juices, and drinks that contain artificial sweeteners.
Begin 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 can hold urine better. Bladder retraining involves working with a healthcare professional to learn 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 train your bladder to urinate on schedule. For example, you will need to urinate every 2 hours while awake with no voiding in between the interval. 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 2 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 1 hour and 15 minutes between visits.
When you can maintain your new schedule without accident for 1 to 2 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 2 to 4 hours between bathroom visits.
Stick to the schedule as much as possible.
Control the urge
The key to bladder retraining is developing the ability to control urinary urges. 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.
- 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.
Be patient. An entire bladder retraining program usually takes at least 6 to 8 weeks to produce results.
Talk to your doctor about the best way to manage the symptoms of overactive bladder. He or she may recommend a combination of overactive bladder medication and bladder retraining to help you achieve the best outcome.
Drugs can work very well to return normal function to the bladder. The type selected is based on the specific bladder control problem. Treatment usually begins at a low dose followed by a gradual dose increase. The intent is to use the lowest effective dose, which in turn will reduce the risk of experiencing side effects. Ask your doctor about the risks and benefits of using the following commonly prescribed drugs:
These medications control muscle spasms in the bladder:
- Oxybutynin (Ditropan®), oxybutynin XL (Ditropan XL®), oxybutynin TDDS (Oxytrol®)
- Propantheline (Pro-Banthine®)
- Dicyclomine (Antispas®, Bentyl®, Di-Spaz®, Dibent®, Or-Tyl®, Spasmoject®)
- Tolterodine (Detrol®)
- Solifenacin (Vesicare®)
- Fesoterodine (Toviaz®)
- Darifenacin (Enablex®)
- Trospium (Sanctura XR®)
- Oxybutinin Gel (Gelnique®)
Beta-3 adrenergic medication
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.
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. Sacral nerve stimulation will not cure bladder control problems, but it can reduce the number of voids and/or the number of wetting episodes, and has very good overall efficacy.
Percutaneous tibial nerve stimulation: an outpatient nerve stimulation 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: 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. There is a dose-related side effect of urinary retention (inability to urinate) that may affect a small number of patients.
Overactive bladder therapy is challenging to manage, but can be very satisfactory with a dramatic improvement in one’s quality of life. Your physician will guide you to the best steps to begin with and give you options for helping you with more advanced options if necessary.
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