Overactive bladder

Definition
Overactive bladder is a problem with bladder function that causes a sudden urge to urinate. The urge may be difficult to suppress, and overactive bladder can even lead to the involuntary loss of urine (incontinence).

Does it feel like you're always hurrying to the bathroom, afraid that you won't make it on time? Do you have trouble sitting through meetings or social functions without taking a restroom break? If so, you may have an overactive bladder.

If you have overactive bladder, you may feel embarrassed, isolate yourself, or limit your work and social life. The good news is that after a brief evaluation to determine the cause, you can receive treatments that may greatly alleviate symptoms of overactive bladder and help you manage their impact on your daily life.

Symptoms
Signs and symptoms of overactive bladder may mean you:

• Feel a strong, sudden urge to urinate
• Experience urge incontinence, the involuntary loss of urine immediately following an urgent need to urinate
• Urinate frequently, usually eight or more times in 24 hours
• Awaken two or more times in the night to urinate (nocturia)

Although you may be able to get to the toilet in time when you sense an urge to urinate, frequent and nighttime urination, as well as the need to suddenly "drop everything," can definitely disrupt your life.

Causes
Filling and emptying your bladder is a complex interplay of kidney function, nerve signals and muscle activity. A problem anywhere throughout this system can contribute to overactive bladder and urge incontinence.

Normal bladder function
Your kidneys produce urine, which travels down a pair of long tubes from your kidneys to your bladder. Urine drains from your bladder through an opening at the bottom (neck) and flows out a short tube called the urethra (u-REE-thrah). In women, the urethral opening is located just above the vagina.  

Your bladder expands like a balloon to accommodate the flow of urine. When it's reached about half its capacity, nerve signals alert your brain, and you sense that your bladder is "full." By the time it's three-quarters full, you feel the need to urinate (void). When you urinate, nerve signals coordinate the relaxation of the pelvic floor muscles and the muscles surrounding the neck of the bladder and upper portion of the urethra (urinary sphincter muscles). The muscles of the bladder contract forcing urine out.

Involuntary bladder contractions
The symptoms of overactive bladder occur in most cases because the muscles of the bladder involuntarily contract. This contraction creates the urgent need to urinate. The urinary sphincter may remain constricted and prevent the bladder from leaking. If the sphincter's strength is overwhelmed by the contraction, then a person experiences urge incontinence.

Causal or contributing factors
In many cases doctors can't exactly identify the causes of overactive bladder.  Several factors may cause or contribute to symptoms similar to those of overactive bladder, and your doctor will try to rule them out during an evaluation because they require other specialized treatments. These factors include:

• High urine production as might occur with high fluid intake, poor kidney function, or diabetes
• Acute urinary tract infections that can cause symptoms very similar to an overactive bladder
• Inflammation of tissues near the urinary tract
• Abnormalities in the bladder, such as tumors or bladder stones
• Factors that obstruct bladder outflow — enlarged prostate, constipation or previous operations to treat other forms of incontinence
• Excess consumption of caffeine or alcohol
• Medications that cause a rapid increase in urine production or require that you take them with lots of fluids

Risk factors
As you grow older, you're at increased risk of developing overactive bladder, and you're also more susceptible to diseases and disorders that can contribute to problems with bladder function, such as enlarged prostate and diabetes. Although common among older adults, overactive bladder and urge incontinence shouldn't be considered a normal part of aging.

Complications
As might be expected, urge incontinence can affect your overall quality of life, but frequent urination and nocturia can also be detrimental to your well-being. People with significant disruption from an overactive bladder are more susceptible to:

• Depression
• Emotional distress

Some people may also have a disorder called mixed incontinence, when both urge incontinence and stress incontinence occur. Stress incontinence is the loss of urine when you exert physical stressors or pressure on your bladder, as when you cough or laugh.

When to see a doctor
Fewer than half of women and less than one-quarter of men who experience incontinence ever talk to their doctor about the problem, according to a study in the Journal of Urology.

Although it can sometimes be difficult to discuss such a normally private matter with your doctor, it's important that you do, especially if you experience urge incontinence or if other symptoms of overactive bladder disrupt your work schedule, social interactions and everyday activities.

Don't avoid an evaluation and simply deal with the condition by wearing absorbent undergarments or pads. Treatments are available that might help you. Additionally, it's important to talk to your doctor because an overactive bladder and urge incontinence may occur as a result of a serious underlying problem, such as a cancerous tumor.

Preparing for your appointment
You're likely to start by first seeing your family doctor or a general practitioner. However, he or she may refer you to a urologist or a urogynecologist for diagnosis and treatment. When you make your appointment, ask your doctor if you should keep a bladder diary for a few days. You record when, how much and what kind of fluids you consume; when you urinate; whether you feel an urge to urinate; and whether you experience incontinence. Your diary may reveal patterns that help your doctor understand your symptoms and identify contributing factors.
Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do
Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

• Make a list of all the medications you take, as well as any vitamins or supplements.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. 

What to expect from your doctor
Your doctor may use an overactive bladder screening questionnaire to make a preliminary assessment of your symptoms. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• Do you ever unexpectedly leak urine?
• Do you ever leak urine when you cough, laugh or sneeze?
• Do you ever leak urine on your way to the bathroom?
• Do you need to use pads or extra cloth in your underwear to ca