Overview. Overactive bladder is a form of urinary incontinence in which sudden, involuntary contractions of the muscle surrounding the bladder produce an urgent need to urinate – often so sudden that the person with the condition is unable to make it to the bathroom in time (a condition known as urge incontinence). Although more common among older adults, it is not a normal part of aging. As many as one in 11 adults in the United States have suffered from an overactive bladder, but the majority fail to seek treatment, either because they are unaware that effective therapies are available or because they are embarrassed to bring the condition to the attention of their physician.
When there are problems with frequent urination (often defined as eight or more times in 24 hours), urinary urgency, and urge incontinence, it is important to bring these matters to the doctor’s attention. For one, living with an overactive bladder can severely affect quality of life – an overactive bladder may cause disruptions at work, curtail social activities, reduce sexual intimacy, and interfere with sleep. In addition, the condition could indicate a more serious underlying problem such as a cancerous tumor.
Causes. The involuntary contraction that produces the sudden need to urinate can be caused by a variety of factors. These include neurological disorders (including Parkinson’s disease, multiple sclerosis, stroke, and spinal cord injury); nerve damage resulting from surgery or trauma to the abdomen or pelvis; bladder stones; and medication side effects. In some cases, symptoms similar to overactive bladder can actually stem from other conditions, including acute urinary tract infections; bladder obstructions from an enlarged prostate; or high urine production resulting from diabetes, poor kidney function, excess fluid intake, and certain medications.
Diagnosis. Beyond a medical history, physical exam and urinalysis, the diagnostic process may include urodynamic testing to measure the anatomic and functional status of the bladder and urethra; postvoid residual urine volume testing to determine whether the bladder is properly emptying; endoscopic tests such as cystoscopy to look for the presence of cysts, stones, or tumors in the bladder; and imaging tests to evaluate anatomic abnormalities that might be contributing to the condition.
Treatment. A variety of treatment strategies are used for overactive bladder. Pelvic muscle exercises can be helpful in reducing or preventing leakage. These may include daily Kegel exercises combined with approaches such as biofeedback, vaginal weight training (small weights are held in the vagina by tightening the vaginal muscles), and pelvic-floor electrical stimulation (mild pulses to stimulate muscle contractions). Behavioral interventions are also used to improve bladder control. Bladder training involves practicing a delay in urination when there is an urge to void – gradually building from small to larger time intervals. Scheduled urination can also help to ensure that the bladder is emptied before the urge strikes. Medications designed to relax the bladder may improve symptoms.
Other strategies, often used in combination with these, include changes in fluid and dietary consumption – eliminating or limiting caffeine and/or alcohol, changing the timing of fluid consumption, and increasing fiber intake, for example. Disposable absorbent garments can also be used to maintain dryness.
For those with a severe case of overactive bladder who don’t respond to any of these strategies, surgery may be recommended. Two surgical approaches are sacral nerve stimulation, in which the nerve impulses between the spinal cord and the bladder tissue are modulated; and surgical augmentation of the bladder to increase its capacity.