Definition
Overactive bladder is the inability to control the release of urine from your bladder.
Overactive bladder (OAB) is a common condition that affects millions of Americans. About 33 million Americans have overactive bladder. Thirty percent of all men and 40 percent of all women in the United States live with OAB symptoms.
Alternative Names
Causes
Urine leakage has many possible causes.
• Weak muscles. Most bladder control problems are caused by weak pelvic muscles. These muscles may become stretched and weak during pregnancy and childbirth. Weak muscles let the bladder sag out of position, which may stretch the opening to the urethra.
• Nerve damage. Damaged nerves may send signals to the bladder at the wrong time. As a result, a bladder spasm may push out urine without warning. Sometimes damaged nerves send no signals at all, and the brain can’t tell when the bladder is full. Nerves can be damaged by diseases or trauma.
Diseases and conditions that can damage the nerves include:
• diabetes
• Parkinson’s
• multiple sclerosis
• stroke
Trauma that can damage the nerves includes:
• pelvic or back surgery
• herniated disc
• radiation
Medicines, alcohol, and caffeine. Leaking can happen when medicines affect any of the muscles or nerves. You may take medicine to calm your nerves so that you can sleep or relax. This medicine may dull the nerves in the bladder and keep them from signaling the brain when the bladder is full. Without the message and urge, the bladder overflows. Drinking alcohol can also cause these nerves to fail. Water pills-diuretics-take fluid from swollen areas of your body and send it to the bladder. This rapid filling may cause the bladder to leak. Caffeine drinks such as coffee and cola also cause the bladder to fill quickly. Make sure your drinks are decaf.
Infection. A urinary tract infection can irritate bladder nerves and cause the bladder to squeeze without warning. This type of incontinence goes away once the infection has been cured.
Excess weight. Being overweight can put pressure on the bladder and contribute to stress incontinence.
Symptoms
Types of urinary incontinence include:
• Stress incontinence. This is loss of urine when you exert pressure — stress — on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. Stress incontinence occurs when the sphincter muscle of the bladder is weakened. In women, physical changes resulting from pregnancy, childbirth and menopause can cause stress incontinence. In men, removal of the prostate gland can lead to stress incontinence.
• Urge incontinence. This is a sudden, intense urge to urinate, followed by an involuntary loss of urine. Your bladder muscle contracts and may give you a warning of only a few seconds to a minute to reach a toilet. With urge incontinence, you may need to urinate often, including throughout the night. Urge incontinence may be caused by urinary tract infections, bladder irritants, bowel problems, Parkinson’s disease, Alzheimer’s disease, stroke, injury or nervous system damage associated with multiple sclerosis. If there’s no known cause, urge incontinence is also called overactive bladder.
• Overflow incontinence. If you frequently or constantly dribble urine, you may have overflow incontinence, which is an inability to empty your bladder. Sometimes you may feel as if you never completely empty your bladder. When you try to urinate, you may produce only a weak stream of urine. This type of incontinence may occur in people with a damaged bladder, blocked urethra or nerve damage from diabetes, multiple sclerosis or spinal cord injury. In men, overflow incontinence can also be associated with prostate gland problems.
• Mixed incontinence. If you experience symptoms of more than one type of urinary incontinence, such as stress incontinence and urge incontinence, you have mixed incontinence.
• Functional incontinence. Many older adults, especially people in nursing homes, experience incontinence simply because a physical or mental impairment keeps them from making it to the toilet in time. For example, a person with severe arthritis may not be able to unbutton his or her pants quickly enough. This is called functional incontinence.
• Total incontinence. This term is sometimes used to describe continuous leaking of urine, day and night, or the periodic uncontrollable leaking of large volumes of urine.
Exams and Tests
Physical Exam
The doctor will give you a physical exam to look for any health issues that may be causing your bladder control problem. Checking your reflexes can show possible nerve damage. You will give a urine sample so the doctor can check for a urinary tract infection. For women, the exam may include a pelvic exam. Tests may also include taking an ultrasound picture of your bladder. Or the doctor may examine the inside of your bladder using a cystoscope, a long, thin tube that slides up into the bladder through the urethra.
Bladder Function Tests
Your exam may include one or more tests that involve filling the bladder with warm fluid to measure the pressure at which leakage may occur. One simple test is called a stress test. You simply relax and then cough strongly to see if urine escapes.
Any medical test can be uncomfortable. Bladder testing may sound embarrassing, but the health professionals who perform the tests will try to make you feel comfortable and give you as much privacy as possible.
Treatments
Your doctor will likely offer several treatment choices. Some treatments are as simple as changing some daily habits. Other treatments require taking medicine or using a device. If nothing else seems to work, surgery may help a woman with stress incontinence regain her bladder control.
Pelvic Muscle Strengthening
Many women prefer to try the simplest treatment choices first. Kegel exercises strengthen the pelvic muscles and don’t require any equipment.
Changing Habits
• Timed voiding. By keeping track of the times you leak urine, you may notice certain times of day when you are most likely to have an accident.
• Diet changes. You may notice that certain foods and drinks cause you to urinate more often. You may find that avoiding caffeinated drinks like coffee, tea, or cola helps your bladder control.
• Weight loss. Extra body weight puts extra pressure on your bladder. By losing weight, you may be able to relieve some of that pressure and regain your bladder control.
Medicines
No medications are approved to treat stress urinary incontinence. But if you have an overactive bladder, your doctor may prescribe a medicine that can calm muscles and nerves. Medicines for overactive bladder come as pills, liquid, or a patch.
Pessaries
A pessary is a plastic ring, similar to a contraceptive diaphragm, that is worn in the vagina. It will help support the walls of the vagina, lifting the bladder and nearby urethra, leading to less stress leakage.
Nerve Stimulation
A device can be placed under your skin to deliver mild electrical pulses to the nerves that control bladder function.
Surgery
Doctors may suggest surgery to improve bladder control if other treatments have failed.
Catheterization
If your bladder does not empty well as a result of nerve damage, you might leak urine. This condition is called overflow incontinence. You might use a catheter to empty your bladder.
Possible Complications
Complications of chronic urinary incontinence include:
• Skin problems
• Urinary tract infections
• Changes in your activities
When to Contact a Medical Professional
You may feel uncomfortable discussing incontinence with your doctor. But if incontinence is frequent or is affecting your quality of life, seeking medical advice is important
Preventions
Urinary incontinence is not always preventable. However, you may be able to decrease your risk of incontinence with these steps:
• Maintain a healthy weight. If you’re overweight, reaching a healthy weight may help.
• Don’t smoke. Get help with quitting if you do smoke.
• Practice Kegel exercises. Doctors often advise pregnant women to do Kegel exercises during pregnancy as a preventive measure.
• Avoid bladder irritants. Avoiding or limiting certain foods and drinks may help prevent or limit urinary incontinence. For example, if you know that drinking more than two cups of coffee makes you have to urinate uncontrollably, cutting back to one cup of coffee or forgoing caffeine-containing drinks may be all that you need to do.
• Eat more fiber. Including more fiber in your diet or taking fiber supplements can help prevent constipation, a risk factor for urinary incontinence.
• Exercise. Physical activity reduces your risk of developing incontinence.