For millions of people across the United States, having a urological disease is a daily reality that can be unpleasant, disruptive, and even sometimes embarrassing. Some of these diseases, such as prostate or bladder cancer, require extensive treatment and can be life-threatening. But there are numerous other diseases that may be less serious and yet still can have a significant negative impact on one’s day-to-day life. One example of just such a disease is having an overactive bladder.   

What is an overactive bladder?

The simplest definition of an overactive bladder is a recurring feeling of the need to urinate beyond one’s normal needs. This often includes rather sudden urges that can be difficult to control. In more than 40% of cases, this urge to urinate is accompanied by an actual loss of control, which is referred to as urge incontinence. 

While an overactive bladder is not a serious or life-threatening condition, it nevertheless can negatively affect a person’s daily life. In cases where the person has urge incontinence, the sudden loss of control can happen in public places, leading to embarrassment or confusion. But even without loss of bladder control, the ongoing urge to urinate can cause the kind of anxiety that leads to a person rearranging their lives just to avoid an incident. 

In addition to ongoing urinary urgency, a feeling that can send someone running to the bathroom at a moment’s notice, symptoms of an overactive bladder also include actually urinating more frequently than normal. Another symptom that is often the concern is nocturia, an urge to urinate in the middle of the night that usually involves being awoken from sleep. 

What causes an overactive bladder? 

In a properly functioning urinary system, the process of passing urine begins in the kidneys; as a function of their capacities as filters, the kidneys remove toxins and any other waste materials and pass them through the ureters in the form of urine. The urine then collects in the bladder before it is ready to be expelled via the urethra. 

Normally, nerves in the bladder send signals to the brain when it is full in order to trigger the urge to urinate. That urge is then coordinated with the muscles of the bladder, the muscles of the pelvic floor, and the urethra to push out the urine at a time of the person’s choosing. In an overactive bladder, the muscles involved in urination contract involuntarily, triggering the urge to urinate even if the bladder isn’t full. 

The root cause of this condition is not fully known, but it is possible that several factors may work in combination. However, doctors have identified a few different possible causes that may play a role in causing an overactive bladder: 

  • Nerve damage: Trauma can cause damage to the nerves in the urinary tract or elsewhere in the muscles that are part of passing urine. This damage can cause signals to be sent at the wrong time, which can then lead to unwanted urges or urge incontinence. There are also some conditions or diseases that can cause nerve damage: 
    • Pelvic surgery
    • Parkinson’s disease
    • Multiple sclerosis 
    • Herniated disc 
    • Radiation treatment 
    • Stroke
  • Weak pelvic muscles: When the muscles of the pelvic floor are stretched or weakened, often due to pregnancy, childbirth, or prostate cancer treatments, the bladder can subsequently “sag” and pull away from its normal position. In these circumstances, bladder leakage is possible and the urge to go can become abnormal. 
  • Infection: Infections, especially a urinary tract infection (UTI), can irritate or inflame the muscles of the bladder. This irritation can cause the muscles to contract involuntarily.
  • Obesity: People who carry substantial extra weight around the midsection are prone to a variety of medical problems, including putting the kind of excess pressure on the pelvic muscles that can lead to an overactive bladder.  
  • Medications: Since medications are often processed in the kidneys and excreted in the urine, some of their components can cause inflammation or other problems in the urinary tract. 
  • Alcohol and caffeine: Both alcohol and caffeine have a diuretic effect on the bladder, which means they can stimulate the bladder and potentially cause urge incontinence or leakage.  
  • Estrogen deficiency: When women are in menopause, the accompanying estrogen deficiency causes a variety of changes, including potentially an overactive bladder.   

Risk Factors

Research has shown that people are at a greater risk for an overactive bladder as they get older. While the reasons for this aren’t fully understood, research suggests a combination of factors that probably includes lower bladder capacity and deterioration of neurological functions. Indeed, age is one of the biggest factors, and it is estimated that 40% of men and 30% of women over the age of 75 are affected by an overactive bladder. The other main risk factor associated with an overactive bladder is body mass index; in other words, being overweight also puts people at greater risk. 

What are the treatment options for an overactive bladder? 

Overactive bladder is actually a fairly common condition, but the good news is that doctors have numerous treatment methods at their disposal to improve the lives of those who are struggling with it. There are actually several categories of treatment options available: 

Lifestyle Modification: Doctors usually turn to these methods first since they are often effective and have essentially no side effects. By modifying behavior or lifestyle habits, many patients see a great improvement in symptoms: 

  • Maintain a healthy weight: Since obesity is one of the main factors, losing weight and maintaining a healthy weight is one of the easiest ways to treat an overactive bladder. 
  • Pelvic floor muscle exercises: A doctor or physical therapist can help provide guidance in doing exercises, referred to as Kegel exercises, that can strengthen the muscles of the pelvic floor or urinary sphincter. 
  • Toilet schedule: Rather than waiting for the urge to urinate, which can be unreliable with an overactive bladder, scheduling trips to the toilet every 2-4 hours can help maintain regularity. 
  • Bladder training: This method involves purposely delaying urination when the urge happens in order to train one’s bladder to regain control of the urges. 
  • Absorbent pads: In cases where urge incontinence is prevalent, absorbent pads may be necessary as a backup in case other methods aren’t effective.   

Medication: Doctors can prescribe medications that can relax the bladder and reduce the frequency of urges. While these medications can be effective, there are also some potential side effects, including dry eyes or dry mouth. Some common examples of medication include: 

  • Oxybutynin (Oxytrol, Gelnique, Ditropan)
  • Tolterodine (Detrol)
  • Trospium (Sanctura)
  • Darifenacin (Enablex)
  • Solifenacin (Vesicare)

Procedures: In cases where lifestyle changes and medications are effective, or if a patient isn’t able to take medication, there are some different procedures available that can make a difference. 

  • Bladder injection: Research has indicated that bladder injections of Botox, a neurotoxic protein often used for cosmetic purposes, can suppress involuntary contractions of the bladder. This can be potentially effective for up to 9 months. 
  • Nerve stimulation: By sending electrical impulses through an electrode attached to the sacral nerves (the nerves in the spinal cord responsible for controlling the bladder), the contractions of the bladder can be regulated. 
  • Surgery: Reserved for patients with the most severe symptoms, doctors can perform surgery to either increase the capacity of the bladder or actually remove the bladder; in the situation where the bladder is removed, a stoma is made in the abdominal wall and an artificial pouch is used to collect urine.  

When should I see a doctor?  

Having an overactive bladder can be a significant challenge to overcome depending on the severity of the symptoms. While there is no “rule” on when to see a doctor about this problem, anyone whose daily life is affected by the loss of urinary control or the anxiety of an ongoing urge to urinate should seek out a urologist. If you would like to speak to a board-certified urologist about your overactive bladder, contact the Mississippi Urology Clinic to make an appointment.