What is Overactive Bladder? 7 Top Things You Should Know

Overactive bladder is a syndrome that is diagnosed by its symptoms. Patients with overactive bladder usually experience urinary frequency. How frequent is too frequent? Most guidelines say eight or more trips to the bathroom to urinate per day. Urinary frequency can result from drinking excess fluids, but in patients with overactive bladder, the frequency has more to do with how much the bladder can comfortably hold. While most people can easily hold between 10 and 20 ounces, those with overactive bladder often feel like they have a full bladder with as little as 2-3 ounces. This results in more frequent trips to the bathroom, even if you decrease your fluid intake.

Another feature common in overactive bladder is urinary urgency. Urgency is described as an uncomfortable need to urinate, a feeling that urinating is difficult to postpone. Urinary urgency can lead to urinary frequency. It can make you feel like you are chained to the bathroom. We often describe the “warning time” for urination; that is the time from when you have a first desire to urinate until you feel like you can’t control your urination. That warning time can be minutes or hours in a normal bladder but patients with overactive bladder sometimes have only seconds. One goal of treatment for overactive bladder is to increase your warning time. That helps you regain control over your life.

Related to warning time and urinary urgency is urgency incontinence. This is the most common type of bladder leakage in patients with overactive bladder and can result in frequent incontinence. Many patients describe this as losing control of their bladder or just urinating when they don’t want to, so the term “leakage” can be confusing. Some people may not even notice this as a strong urge because they have become accustomed to it. But incontinence that occurs when you are not doing something strenuous, such as sleeping, watching TV, washing dishes or walking to the bathroom, is usually urgency incontinence.

What causes overactive bladder?

It is not clear why any person develops an overactive bladder. There are numerous factors suspected of worsening symptoms but none of these, on their own, fully explains overactive bladder. Some of these factors can include obesity, smoking, advanced age and consuming irritating foods or beverages. Particularly with irritating foods and beverages such as caffeine or acids, reduction can improve bladder symptoms. But plenty of people have continued symptoms of overactive bladder even without eating or drinking anything irritating.

When should you see a urologist for overactive bladder?

Most people with symptoms of overactive bladder do not require extensive or invasive evaluation. However, you should be aware that certain symptoms increase the possibility of a more serious condition and should have a more extensive evaluation by a urologist. For instance, sudden onset of symptoms, especially if accompanied by pain (which is not a symptom of overactive bladder), often indicates another problem such as an infection or a urinary tract stone. Blood that you see mixed into your urine is also not a symptom of overactive bladder and should be investigated by a urologist. When visiting with your urologist, you will go over your symptoms and what treatment options might be best. 

What treatment options are available for overactive bladder?

While, unfortunately, there is no cure for overactive bladder, numerous treatment options are available. Treatment for overactive bladder can range from simple behavior changes to medications or even minor procedures. Urologist often begin with suggestions of simple behavioral therapies, which can be very effective in controlling symptoms, especially when mild.

Behavioral therapies, or sometimes called first-line therapies, should be the first treatment option someone tries to treat the syndrome of overactive bladder. This group of therapies is more conservative, meaning that they are unlikely to cause significant side effects and are not invasive in any way. They can also be undertaken largely on your own and can give you a lot of control over your own therapy. Because they do not require taking a medication or having a procedure done, they can sometimes be mistaken as being less effective. In fact, several studies suggest that, if taken seriously by a dedicated patient, these therapies can be at least as effective as taking a medication for bladder symptoms. But success depends heavily on how much work someone is willing to put into these therapies. Behavioral therapies include, diet changes, creating a bathroom schedule and exercising your pelvic floor.

How does diet affect overactive bladder?

One of the first things to consider for a person with an overactive bladder is their diet. Diet includes not just what we eat and drink, but how much we drink and when we drink. Taking a closer look at each of those factors can provide you with insight as to how your diet could be affecting your bladder symptoms.

• What we eat and drink means looking at common bladder irritants and whether they have an impact on your bladder symptoms. Some foods or beverages that can irritate the bladder include acidic foods and beverages, carbonated drinks and caffeinated beverages. Patients are encouraged to try keeping a food and beverage diary for a few days to see how certain food or drinks impacts their symptoms.
• For some patients, it isn’t what they are drinking but how much they are drinking. It is important that patients never restrict themselves from fluids. But, for most people, if you simply drink whenever you are thirsty, you are likely to achieve adequate hydration and will not worsen overactive bladder.
• Lastly, when you are drinking is important as well, especially for those who may be waking up at night to urinate. If you have overactive bladder, it is helpful to begin reducing or even eliminating fluids in the hours before you get into bed.

Whether is it is tracking your diet with a food and beverage diary, checking your total fluid input and output with a voiding diary or reducing your intake of liquids close to bedtime, simply taking a look at some of your dietary habits can make a significant difference in the OAB symptoms of many people. It certainly can be worth the time and effort it takes to put these diet changes into practice.

Can I train my bladder to urinate less often?

There actually are ways that you can “train” your bladder which help to reduce how frequently you urinate and gain control over urine leakage. Bladder training can help to control urinary frequency and urgency. Training often begins with a bladder diary which will give you information about how often you urinate or even leak urine. Figure out what the average interval of time is between your bathroom visits without having to rush to the bathroom. Once you determine this time, begin making regular visits to the bathroom at that interval, except for when you are sleeping. After 1-2 weeks, once you become comfortable with your first interval, begin to increase the time of the intervals by 15-30 minutes. Continue increasing the interval every 1-2 weeks until you reach your goal. For most patients with overactive bladder, your goal probably should not be beyond 3-4 hours.

Can pelvic floor exercises help overactive bladder?

Pelvic floor, or Kegel, exercises are often recommended for treating urine leakage which occurs with strenuous activity, such as coughing, laughing or exercising, called stress incontinence. However, these exercises can also be very useful for overactive bladder. Control of the pelvic floor muscles helps with overactive bladder first by helping to prevent any urinary leakage. A sudden, uncomfortable urge to urinate can be accompanied by accidental loss of urine. Strength of the pelvic floor muscles can help to prevent urine leakage. In addition, a contraction of the pelvic floor muscles activates a reflex which helps to suppress an uncomfortable desire to urinate. This means that pelvic floor contractions not only help to keep urine in, but they can also assist in decreasing a strong urge to urinate before it ever progresses to incontinence.

It can take several weeks of regular exercises for this to be effective so be patient with yourself and be persistent with a routine. Some patients, despite their efforts, are unable to properly identify their pelvic floor muscles. They tend to contract their stomach or thigh or gluteal muscles. If you are unable to comfortably do Kegel exercises, it can be helpful to meet with a specialized health provider called a pelvic floor physical therapist.

To treat pelvic health conditions, including overactive bladder, Ochsner offers a wide range of treatment options ranging from lifestyle changes and medication to innovative procedures and robotic surgery. We offer a multidisciplinary approach to pelvic health care that is unique to our region. What’s more, we do it in a caring, compassionate setting.