An overactive bladder is a condition in which the urge to pass urine comes suddenly and strongly and is hard to put off, usually together with frequent urination during the day and getting up at night. In some people the urge leads to leaking before they reach the toilet.
The condition affects about one in ten adults, becomes more common with age and occurs in both women and men. It disrupts sleep and limits daily life more than it seems from the outside, but it is treated step by step and most patients achieve a noticeable improvement.
What is an overactive bladder
Normally the bladder fills quietly, and the urge comes when there is a considerable amount of urine and can be put off. With an overactive bladder, the muscle in its wall (the detrusor) contracts involuntarily or signals an urge when there is still only a little urine. The diagnosis is made after infection, stones, a tumour and other causes of the same symptoms have been ruled out.
Most often no cause is found. In the neurogenic form the urges are caused by a disease of the nervous system – stroke, multiple sclerosis, Parkinson’s disease, spinal cord injury. In men, overactivity is often secondary, caused by an enlarged prostate that overloads the bladder.
Symptoms
- a sudden, urgent need to pass urine that you find hard to put off;
- passing urine more than eight times a day;
- getting up two or more times at night;
- leaking urine after an urge – urge incontinence;
- urges triggered by cold, the sound of running water or getting close to home.
Some accompanying signs need prompt investigation. Blood in the urine, even once and without pain, must be investigated without delay, because it may be the first sign of a bladder tumour. Urges with a temperature and pain in the lower back point to a kidney infection. If you cannot pass urine and your bladder is swollen and painful, go to an emergency department or call 112 (the European emergency number).
Causes and risk factors
Besides neurological diseases and an enlarged prostate, the risk increases with age, menopause, excess weight, constipation, diabetes, smoking and drinking too much coffee, tea, fizzy drinks and alcohol. Diuretics also make the urges stronger. Cystitis, bladder stones, interstitial cystitis and uncontrolled diabetes cause similar symptoms, so they are ruled out at the very first consultation.
Diagnosis
The most valuable test is a three-day bladder diary – fluids, each time you pass urine with the approximate amount, urges and leaks. It shows whether the bladder really holds only a little, or whether you are simply drinking a lot.
The consultation with Dr Penev includes a conversation about your medicines and other health conditions, a physical examination, a urine test and an ultrasound scan with measurement of the residual urine; if difficulty emptying is suspected, uroflowmetry is added. Cystoscopy is arranged if there is blood in the urine, pain or no response to treatment, and urodynamic testing if the picture is unclear or before invasive methods. The full consultation for urinary problems takes place in Plovdiv and Karlovo by appointment.
Treatment
First step – habits and training. Spreading fluids through the day and limiting them in the evening, less caffeine and alcohol, treating constipation and weight control. Bladder training teaches you to put off the urge – first by a minute or two, then gradually longer, until the intervals reach three to four hours. Pelvic floor exercises complete the programme.
Second step – medication. Antimuscarinic medicines reduce involuntary contractions, but they can cause a dry mouth and constipation and are used with care in older people. Beta-3 agonists relax the bladder with fewer such effects. In women in menopause, local oestrogen therapy helps, and in men with an enlarged prostate the treatment is combined. In suitable patients Dr Penev may also recommend magnetic stimulation of the pelvic floor as an additional method.
Third step – for persistent symptoms. Botulinum toxin injections into the bladder wall, tibial nerve stimulation or sacral neuromodulation are considered when the first two steps do not help; Dr Penev decides on the right method for each patient and arranges the treatment, if necessary at the Department of Urology at Kaspela University Hospital (UMBAL Kaspela), Plovdiv.
When to see a urologist
When the urges disturb your sleep, work or social life; when you use pads or cut down on fluids for fear of leaking; when the symptoms appear after a neurological illness; and always with blood in the urine, pain or a temperature. You can find more about night-time urination in the article on nocturia.
Prevention
Do not go to the toilet “just in case” – it teaches the bladder to signal at small volumes. Keep to a healthy weight, limit caffeine and alcohol, treat constipation and control your blood sugar if you have diabetes.
An overactive bladder is not something you simply have to put up with. Book an appointment with Dr Penev – with a bladder diary and a few simple tests the cause is clarified, and the treatment is chosen to suit your way of life.
Frequently asked questions
Is an overactive bladder a psychological problem?
No, although anxiety can make the urges stronger. The underlying cause is involuntary contractions or increased sensitivity of the bladder, which can be identified and treated. Stress has an effect, but it is not the cause.
How long does it take for the medication to work?
The first effect is usually felt after one to two weeks, and the full effect after about one to two months of taking it regularly. If there is no improvement by then, or the side effects are unacceptable, Dr Penev changes the medicine or the approach.
Can it be treated without medication?
Yes. In a large proportion of patients, bladder training, adjusting fluids and caffeine, and pelvic floor exercises reduce the symptoms considerably. Medication is added when this is not enough.
Is it dangerous to hold back the urge during bladder training?
No, as long as the training is gradual – the intervals are extended by a few minutes a week. The aim is for the bladder to get used to holding more urine, not to put up with pain.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.