Overactive Bladder

What is Overactive Bladder?

An overactive bladder is a condition that results from sudden, involuntary contraction of the muscle in the wall of the urinary bladder. Overactive bladder causes a sudden and unstoppable need to urinate (urinary urgency), even though the bladder may only contain a small amount of urine.

Overactive bladder can also result in urge incontinence which is one cause of urinary incontinence (unintentional loss of urine).

Although it can happen at any age, overactive bladder is especially common in older adults. Overactive bladder affects an estimated one in 11 adults in the United States. Overactive bladder, however, should not be considered a normal part of aging.

Risk Factors

Overactive bladder is primarily a problem of the nerves and muscles of the bladder. Overactive bladder typically results from inappropriate contraction of the bladder muscle regardless of the amount of urine in the bladder.

The common abnormalities of the nervous system that cause of overactive bladder are:

  • Spinal cord injury
  • Strokes
  • Parkinson’s Disease
  • Dementia
  • Multiple Sclerosis
  • Diabetic Neuropathy

There are also some causes of overactive bladder and urge incontinence with a normal nervous system. For example, urinary tract infection, bladder stones, or bladder tumors can cause also cause overactivity of the bladder muscle, leading to overactive bladder.

Sometimes no apparent cause of overactive bladder can be determined (idiopathic overactive bladder).

Symptoms

The symptoms of an overactive bladder include frequent urination, urgency of urination, nocturia (urinating in the middle of the night), and urge incontinence. Overactive bladder may cause significant social, psychological, occupational, domestic, physical, and sexual problems. Again, these symptoms should not be considered a normal part of aging.

Diagnosis

Careful medical history and review of symptoms related to overactive bladder are very important. Getting up to urinate at least three times in the middle of the night, increased urinary frequency (urinating at least eight times daily), urinary urgency, and urinary incontinence are all important clues in evaluating someone suspected of having overactive bladder.

In addition to a general physical examination, a pelvic exam in women (to assess for dryness, atrophy, inflammation, infection) and a prostate examination in men (to assess for size, tenderness, texture, masses) are helpful in excluding other contributing conditions.

Urine Analysis (UA) to assess for infections and occasionally urine cytology (to look for cancer cells in the bladder) are sometimes advised in individuals undergoing evaluation of urinary incontinence and overactive bladder. Ultrasound measurement of the amount of urine left in the bladder after urination (called post-void residual) may also provide additional information about the cause of urinary incontinence (obstruction to urine flow, weak bladder muscle).

Treatment

The treatment for overactive bladder depends on the capabilities of the patient. Generally, treatment can be behavioral retraining, pharmacological (medications), and surgical.

Here are commonly recommended treatments.

Pelvic muscle rehabilitation to improve pelvic muscle tone and prevent leakage

  • Kegel Exercises: Regular, daily exercising of pelvic muscles can improve, and even prevent, urinary incontinence. This is particularly helpful for younger women. These exercises should be performed 30-80 times daily for at least eight weeks. These exercises are thought to strengthen the muscles of the pelvis and urethra which can support the opening to the bladder to prevent incontinence. Their success depends on practicing the proper technique and the recommended frequency.
  • Biofeedback: Used in conjunction with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles.
  • Vaginal weight training: Small weights are held within the vagina by tightening the vaginal muscles. These exercises should be performed for 15 minutes, twice daily, for four to six weeks.
  • Pelvic-floor electrical stimulation: Mild electrical pulses stimulate muscle contractions. This should be done in conjunction with Kegel exercises.

Behavioral therapies to help people regain control of their bladder

  • Bladder training teaches people to resist the urge to void and gradually expand the intervals between voiding.
  • Toileting assistance uses routine or scheduled toileting, habit-training schedules, and prompted voiding to empty the bladder regularly to prevent leaking.

Medications to decrease the overactivity of the bladder muscle

There are several medications recommended for the treatment of overactive bladder. Using these medications in conjunction with behavioral therapies has shown to increase the success rate for the treatment of overactive bladder.

The most common medications (anticholinergics) target to decrease the overactivity of the bladder muscle. These medications (anticholinergics) should be used under the direction of the physician prescribing them. They may have some common side effects, including dry mouth, constipation, blurry vision, and confusion (in the elderly).

Estrogen, either oral or vaginal, may be helpful in conjunction with other treatments for postmenopausal women with urinary incontinence.

Some of the other newer therapies for overactive bladder are still in trial stages and some are occasionally used in special cases. For example, botulinum toxin injection (Botox) into the bladder muscle may be helpful in some patients with urge incontinence who have not responded to other more traditional treatments. There are still other medications for overactive bladder in the research stage that may specifically act on the bladder muscles.

Surgery to decrease the overactivity of the bladder muscle

Surgery is usually not necessary in treating overactive bladder unless symptoms are debilitating and unresponsive to other treatments.

  • InterStim Therapy has proven a successful in the treatment for patients who are unresponsive to other treatments. InterStim therapy helps control urinary problems through an implanted device that sends mild electrical impulses via a thin wire to the sacral nerves that control the bladder, sphincter, and pelvic floor muscles. Some people refer to the InterStim system as a “pacemaker for the bladder”.
  • Reconstructive bladder surgery (cystoplasty) is used in severe cases. This surgery makes the bladder larger and decreases its ability to contract.
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