Overactive bladder

Overview

Overactive bladder, also called OAB, causes a frequent and sudden urge to urinate that may be difficult to control. You may feel like you need to pass urine many times during the day and night, and may also experience unintentional loss of urine (urgency incontinence).

If you have an overactive bladder, you may feel embarrassed, isolate yourself, or limit your work and social life. The good news is that a brief evaluation can determine whether there's a specific cause for your overactive bladder symptoms.

You may be able to manage symptoms of an overactive bladder with simple behavioral strategies, such as dietary changes, timed voiding and bladder-holding techniques using your pelvic floor muscles. If these initial efforts don't help enough with your overactive bladder symptoms, additional treatments are available.

Symptoms

If you have an overactive bladder, you may:

• Feel a sudden urge to urinate that's difficult to control
• Experience unintentional loss of urine immediately after an urgent need to urinate (urgency incontinence)
• Urinate frequently, usually eight or more times in 24 hours
• Wake up more than two times in the night to urinate (nocturia)

Even if you are able to get to the toilet in time when you sense an urge to urinate, unexpected frequent urination and nighttime urination can disrupt your life.

When to see a doctor

Although it's not uncommon among older adults, overactive bladder isn't a typical part of aging. It might not be easy to discuss your symptoms, but if they are distressing you or disrupting your life, talk to your doctor. Treatments are available that might help you.

Causes

How a healthy bladder works

The kidneys produce urine, which drains into your bladder. When you urinate, urine passes from your bladder through a tube called the urethra (u-REE-thruh). A muscle in the urethra called the sphincter opens to release urine out of the body.

In women, the urethral opening is located just above the vaginal opening. 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, these 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.

Involuntary bladder contractions

Overactive bladder happens when the muscles of the bladder start to contract on their own even when the volume of urine in your bladder is low. These are called involuntary contractions, and they create an 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
• Urinary tract infections that can cause symptoms similar to those of an overactive bladder
• Hormonal changes during menopause in women
• Conditions affecting the bladder, such as tumors or bladder stones
• Factors that get in the way of urine leaving the bladder, such as enlarged prostate, constipation or previous surgery to treat incontinence

Overactive bladder symptoms may also be associated with:

• Medications that cause your body to make a lot of urine or require that you take them with lots of fluids
• Drinking too much 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

The specific cause of an overactive bladder may be unknown.

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, those who have had a stroke or have 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 people with an overactive bladder also have bowel control problems; tell your doctor if this is a problem for you.

Complications

Any type of incontinence can affect your overall quality of life. If your overactive bladder symptoms cause disruption to your life, you might also have:

• Emotional distress or depression
• Anxiety
• Sleep disturbances and interrupted sleep cycles
• Issues with sexuality

In some cases, treatment of these associated conditions may help with your urinary symptoms.

Women who have an overactive bladder may also have a disorder called mixed incontinence, when both urgency and stress incontinence occur. Stress incontinence is the unintentional loss of urine prompted by physical movement or activity that puts pressure on your bladder, such as coughing, sneezing, laughing or exercising. Treatment of stress incontinence is not likely to help overactive bladder symptoms. Similarly, treatment of overactive bladder is not likely to improve stress incontinence symptoms.

Some 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.

Prevention

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

• Maintain a healthy weight.
• Get regular, daily physical activity and exercise.
• Limit caffeine and alcohol.
• Quit smoking.
• Manage chronic conditions, such as diabetes, that might contribute to overactive bladder symptoms.
• Do exercises to make the pelvic floor muscles stronger. These exercises are called Kegel exercises.