Overactive bladder describes a combination of symptoms that can include a frequent urge to urinate and waking up at night to urinate. Causes can include weak muscles, nerve damage, use of medications, alcohol or caffeine, infection, and being overweight. Lifestyle changes may help. Urology 216.444.5600. Nephrology 216.444.6771.
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A frequent urge to 'run to the bathroom' day or night is a problem that is disruptive to everyday life for those affected by the condition. You may even find the situation embarrassing or shy away from talking to your doctor about it. However, telling your primary care physician is the first step to treatment. The recommended treatment option will depend on the type and severity of your symptoms.
Your bladder is a muscular balloon-like sac that makes up your urinary tract system. The bladder holds urine until your brain sends a signal that it's time to go to the bathroom. The sphincter muscle in the urethra also plays an important role by opening up to release urine when your bladder contracts.
Overactive bladder develops when your brain tells your bladder muscles to contract for you to pass urine even when your bladder isn't full. When the bladder is full, the strong and uncontrollable urge to urinate immediately may lead to an involuntary loss of urine, also called urge incontinence.
Changes in the body or brain brought on by a disease, disorder, or dysfunction, can cause the bladder to become too active. Common changes or factors associated with OAB include:
Neurologic disorders or nerve damage may interfere with the signals between your brain and bladder. Nerve signals trigger your bladder to contract when it is full and squeeze out urine. Nerve damage can disrupt this function and cause your bladder to contract in preparation for urination even when it isn’t full (involuntary contraction).
The muscles around the urethra (a thin tube that takes urine from the kidney to the bladder) may also become too loose due to nerve damage. Medical conditions such as diabetes, herniated disc, multiple sclerosis, or stroke may lead to nerve damage and OAB.
A drop in estrogen during perimenopause and menopause can lead to overactive bladder and urinary incontinence in aging women. Estrogen is a hormone that plays a role in the functioning of the lower urinary tract. Menopausal women may leak urine especially when laughing, coughing, sneezing, or lifting. These actions put pressure on the bladder and cause urine to squeeze out involuntarily.
The risk of an overactive bladder increases with age. There's also a higher risk of medical conditions such as diabetes, enlarged prostate, or spinal problems which can contribute to bladder dysfunction. A decline in cognitive function due to aging may also interfere with brain signals being sent to your bladder.
Weak pelvic muscles can lead to an overactive bladder. A woman’s pelvic floor muscles help support the bladder. Pregnancy and childbirth tend to overstretch and weaken women's pelvic floor muscles. In addition, the bladder may sag as a result of the urethra becoming overstretched or too lax causing you to pass urine involuntarily. Doctors refer to this as urinary incontinence.
Overactive bladder, urge incontinence, and overflow incontinence is common in diabetics and, especially, in those with type 2 diabetes. Involuntary urine leakage may also occur if the sphincters have trouble contracting or relaxing due to nerve damage caused by diabetes.
Being overweight due to obesity or a growing uterus during pregnancy puts additional pressure on your bladder. Hormonal changes in pregnancy also lead to an overactive bladder, excessive urine, or a frequent urge to urinate.
Medications such as diuretics (water pills) may cause your bladder to fill up quickly and trigger a frequent urge to run to the restroom. Some people also leak urine on their way to the bathroom. Your doctor may describe these symptoms as drug-induced urinary incontinence or loss of bladder control (urge incontinence).
Other risk factors of a frequent urge to urinate include excess consumption of caffeine or alcohol, incomplete bladder emptying, and a urinary tract infection. But these factors are not typically associated with nerve damage or nerve signal dysfunction.
Ultimately, your doctor may diagnose you with an overactive bladder if you urinate eight or more times a day or two or more times at night. Other hallmark symptoms include:
Your doctor or urologists will need to do a physical exam and run tests to diagnose overactive bladder. Blood and urine tests may be done to check for infection. A neurological exam can help detect sensory or reflex problems associated with OAB.
The recommended treatment will depend on the underlying cause but can include:
Lifestyle changes are also helping in managing OAB symptoms. For example, limiting food and drinks that stimulate bladder activity or doing kegel exercises.
Surgery may be required as a last resort if other treatments failed. Surgery is aimed at increasing bladder size and urine storage capacity.
Both women and men can develop an overactive bladder although women have a higher risk. Regardless, OAB can be a nuisance or interfere with daily function and sleep if it's not controlled. With treatment and lifestyle changes, you can manage the symptoms and continue to enjoy a normal life.
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