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What is overactive bladder?

Overactive bladder is a chronic bladder condition that causes the frequent, sudden and urgent need to urinate.

People with overactive bladder usually need to urinate eight or more times a day, experience intense urges to urinate, and may have to get up twice or more during the night to urinate. They may also experience urge incontinence (leaking urine when feeling an urgent need to urinate).

If these symptoms sound familiar, you aren’t alone. Overactive bladder is very common, says Frances Stewart, advanced practice nurse and nurse continence advisor at Women’s College Hospital. It affects 12 to 18 per cent of Canadians, including both men and women. It’s more common with aging, but it affects people of all ages.

Usually, when the bladder is full, it sends a signal to the brain, and the brain then registers the need to urinate. When you urinate, the muscles of the bladder need to contract to push the urine out. In people with overactive bladder, these muscles contract involuntarily before the bladder is completely full. That’s what prompts the frequent, urgent trips to the bathroom.

While it’s not clear what causes overactive bladder, risk factors may include frequent urinary tract infections and older age. Some medications may contribute to symptoms, and people with conditions such as multiple sclerosis, Parkinson’s disease, Alzheimer’s disease and dementia have higher risks of developing overactive bladder.

Impact

Overactive bladder can have a significant impact on people’s lives mentally, socially and physically.

People who have the condition often experience distress and anxiety. They may worry about experiencing leaks, or about not being able to find a bathroom quickly when they need one. Overactive bladder may cause people to limit their activities, and can affect their work productivity. Anxiety about urgency and leaks may affect sexual activity. People with overactive bladder may have poor sleep because of frequent nighttime trips to the bathroom, and they are at greater risk for falls and fractures as a result of rushing to the bathroom.

For many people, embarrassment is another side-effect of overactive bladder.

“It’s a very prevalent condition, but nobody talks about it,” Stewart says. “It’s a very hidden condition.”

Embarrassment around bladder conditions is something that Stewart would like to put an end to. It can not only bring about negative feelings in people with overactive bladder, but can also make them reluctant to discuss their condition with a healthcare provider.

“We need to bring it out of the closet,” she says. “You are not alone, and there is help. Speak to your family doctor, speak to a nurse practitioner.”

Bladder-friendly changes

Behaviour changes that can help manage overactive bladder include choosing bladder-friendly beverages, and avoiding things that can irritate the bladder.

  • choose water or apple juice as bladder-friendly choices
  • avoid caffeine, which is a diuretic
  • limit alcohol intake
  • avoid citrus juices, which are acidic and can irritate the bladder
  • avoid spicy foods, which can also be irritating
  • avoid constipation
  • drink when you’re thirsty: people with overactive bladder may be tempted to limit fluid intake to try to avoid trips to the bathroom, but it’s essential to stay hydrated

In addition to bladder-friendly choices, other factors that can help manage overactive bladder include lifestyle modifications, medication, or sometimes both. In rare cases, surgery may be used, but it’s important to note that it’s a completely different type of surgery than is performed for stress incontinence.

Conservative management

Conservative management is something patients can do on their own through lifestyle changes. Modifying behaviour and habits can help control overactive bladder. Conservative management includes:

  • doing Kegel exercises, which strengthen the muscles of the pelvic floor
  • tracking your bladder habits in a detailed bladder diary, which should include what you drank and when you drank it, when you went to the bathroom and whether it was a lot or a little urine, and other symptoms that you have, such as urgency or leakage
  • retraining your bladder

Bladder retraining can help increase bladder capacity and control bathroom trips. It involves using your bladder diary to recognize patterns, and setting a timed schedule for bathroom trips to change those patterns to a more manageable routine. At first, that might sound unrealistic to someone with frequent bladder urgency, but it provides beneficial results for many patients.

“Bladders are habitual,” Stewart says. “Sometimes it’s just a matter of breaking bad habits, like going to the bathroom every hour.”

People with overactive bladder may reach a point at which their bladder is controlling them, rather than the other way around, she says. Regaining control can be a matter of “mind over bladder.”

“Treatment can be successful, but it takes work. It takes time and effort,” Stewart says. “It took a long time to get this way, so it will take some time to change.”

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