What is meant by overactive bladder?

The bladder, which can hold up to 300 or 400 mL of urine (more than a cup), gives you a signal when it is getting full, but can wait to be emptied until the time is convenient for you. That’s when the bladder works well. If you have an overactive bladder, however, it doesn’t work well. If you have an overactive bladder, you need to use the toilet frequently – you can’t wait until it is convenient. And if there is no toilet readily available, you may lose control of your bladder.

There are three key symptoms of an overactive bladder. You may have only the first two, or all three. The first symptom is frequency, needing to empty your bladder more frequently than usual. Going to the toilet more than eight times in 24 hours is usually regarded as unusual. The second key symptom of overactive bladder is urgency, the sudden feeling that you have to go right now.  The final symptom, and the most distressing, is called urgency incontinence. This means that your need to go is so urgent that you lose control before you can get to a toilet. Of all those who have an overactive bladder, 40% have urgency incontinence.

Who gets overactive bladder?

The brief answer – lots of people! One estimate is that at least 2.9 million Canadians have an overactive bladder or suffer from incontinence. An overactive bladder is more common in women, and in older adults, but can be found in younger folks and in men. Unfortunately, many people who have symptoms of an overactive bladder suffer silently and needlessly because they do not seek medical help.

Are there other types of incontinence?

Overactive bladder and incontinence are not the same thing. Many people with overactive bladder (approximately 60%) do not have accidents. And many people have incontinence but do not have an overactive bladder.

Apart from overactive bladder, another common cause of bladder leaking is called stress incontinence. This problem, found almost entirely in women, involves loss of urine with sneezing, coughing, laughing, or lifting.

Many men will have incontinence after prostate surgery. Diseases affecting the brain or spinal cord (strokes, multiple sclerosis, Alzheimer’s diseases) can all cause loss of bladder control. Urinary tract infections, common in young women, can cause temporary problems with bladder control. You can see there are many different causes and types of incontinence.

What can be done about an overactive bladder?

Lots can be done to help you if you have an overactive bladder.

The first step is to seek appropriate help. Many people with an overactive bladder assume that nothing can be done, so they learn to cope with their problem. You may be in the habit of only shopping at certain stores, because you know where their toilets are. Or you may avoid social activities, avoid going to the theatre, avoid doing some of the pleasurable things of life for fear of embarrassment. You may choose to only wear dark clothing to disguise leakage, or carry a spare set of clothing. These strategies really don’t address the problem, however. You deserve good treatment. Your doctor can help.

When you see your doctor, an accurate diagnosis will be needed. Your doctor will ask questions about your urinating habits, when problems occur, other symptoms, and so on. A urine sample will often be taken to check for diabetes or infection. Your doctor may ask you to keep a “bladder diary” for a couple of days, listing how often and when you urinate, how much urine you pass, how much urgency you feel, and when accidents occur.

If your problem is indeed an overactive bladder, the first treatment usually suggested is pelvic floor rehabilitation. This means training the muscles of the pelvic floor – the muscles that surround the opening of the bladder and control urine flow. Strengthening these muscles will reduce accidents, and help your bladder to hold more urine. There are exercises that you can do, called Kegel exercises, which strengthen the pelvic floor muscles. Your doctor can instruct you in these. Biofeedback is sometimes used as a training technique. In some women, vaginal weights are used for training, because the same muscles that surround the bladder opening also surround the opening of the vagina. Again, your doctor can help you with the choice of pelvic floor training exercises.

Along with the exercises, there are other specific steps that you can take. Reducing the amount of fluid that you take, especially caffeine-containing beverages such as coffee or tea, will help reduce the amount of urine that you produce, and reduce frequency and urgency. Keeping a bladder diary can let you identify a pattern to your problem, which may allow you to make some changes that make a difference.

Although Kegel exercises and other behavioural steps often help, most people with an overactive bladder will need medication as well. The medications that are used, called anticholinergic medications, work on the nerves that control the muscles of the bladder. By reducing spasms in the muscles, and relaxing the muscles, symptoms of urgency and frequency are significantly reduced. These medications are generally very safe. The most common side effect - dry mouth - is a nuisance that many people with overactive bladder are happy to put up with, because these medications can be very effective.

You do not need to suffer silently with an overactive bladder. Appropriate treatment can often help you go out and enjoy yourself again.