Overactive Bladder

The bladder is a muscular, hollow organ that stores urine. When a person urinates, the bladder empties and the muscles of the pelvic floor relax. In people with overactive bladder, this process happens more often and at inconvenient times. There are many causes of an overactive bladder, such as urinary tract infection or diabetes, medications that weaken the muscles in the pelvic floor or block signals from nerves that tell your brain that you need to pee, or conditions like Parkinson’s disease. The symptoms can range from urinary leaks to going so often you have little time for anything else in your life.

One common symptom of an overactive bladder is urinary incontinence. This can be any unintentional loss of urine that causes a person discomfort, embarrassment or inconvenience. The two main types of incontinence are stress incontinence and urge incontinence. Stress incontinence is leaking urine when coughing, sneezing, laughing, running, or lifting something heavy. Urge incontinence is an overwhelming feeling to go to the bathroom that cannot be stopped once it starts. The person loses control over their bladder and leaks a little bit of urine before reaching a toilet or other appropriate place to go.

Another symptom of an overactive bladder is urgency—the sudden need to urinate with little or no warning. Urgency can last for a few seconds, a few minutes, or hours. Because of the speed, some people can’t make it to a bathroom in time and risk embarrassing accidents (e.g., wetting their pants).

The treatment of choice is bladder training with biofeedback and desmopressin (DDAVP), which has been shown to improve overactive bladder symptoms by about 75% and is relatively safe with no side effects. A standard biofeedback training course consists of 20–40 individual sessions and usually takes about two months. The techniques are supervised by trained therapists. They teach people to recognize the early warning signs of bladder fullness so they can try to delay urination or find a bathroom in time. They also teach how to relax their pelvic floor muscles after urinating so they don’t leak urine when coughing, sneezing, laughing, etc. A person may have occasional accidents at the beginning of treatment but less and less as training progresses. One study showed that when people with urge incontinence used biofeedback at home for six months, they had better control over their bladder and were less likely to have leakage than those who used medication.

One effective treatment is a medicine called desmopressin, a synthetic version of the hormone vasopressin. Desmopressin is available as a nasal spray or as a pill. It reduces the amount of unchanneled water that leaks from the kidney into the bladder. In people with overactive bladder, this extra water fills up the bladder and makes them feel like they have to go to the bathroom even when their bladder isn’t complete. The medicine also helps reduce urgency because people wait until they have a stronger feeling of going, which decreases urine loss and frequency of urination during the day. Desmopressin can be used in addition to biofeedback training. The treatment is safe with no side effects.

Medications that cause the muscles of pelvic floor muscles to relax are also used to treat overactive bladder. These medications include oxybutynin, oxybutynin, solifenacin, and tolterodine. These drugs are called anticholinergics because they have properties similar to another chemical in the body called acetylcholine, which causes muscles in the organs and glands of the body to contract. Anticholinergic medications work by blocking action at a receptor site on the nerves near your bladder. The blocking of the nerve receptors makes the muscles in the bladder, and pelvic floor relax, which decreases the urgency. Oxybutynin, oxybutynin, and tolterodine are available in tablet form, while solifenacin is available in capsules taken by mouth.

Botox is approved by the FDA for the treatment of overactive bladder with incontinence in people who have overactive bladder symptoms in addition to urinary incontinence. It is injected into the bladder wall under ultrasound guidance to block nerve impulses from the brain to the bladder muscles. The most common side effects are urinary tract infection and urinary retention (not urination). Botox is becoming an increasingly popular treatment for overactive bladder with incontinence. Research has shown that it improves symptoms such as urge incontinence and frequency of urination in patients with overactive bladder.

Several other treatments are available, such as electrical stimulation, abdominal exercises, and the drug oxybutynin chloride. Many people do not choose one of these treatments because they require a doctor’s approval and, in some cases, surgery. There may be risks and benefits to each treatment, and the medications need to be taken for a long time to treat overactive bladder in most patients. Overactive bladder with incontinence is not life-threatening, but it can affect the quality of life if left untreated. If the symptoms are bothersome, it is essential to speak to your doctor about the treatments available.

Bladder training with or without biofeedback is the first treatment option. This type of training has been shown to improve symptoms by about 75%. Some people may also benefit from taking anticholinergics medications that relax the muscles in the bladder and pelvic floor. These drugs include oxybutynin (Oxytrol), solifenacin (Vesicare), tolterodine (Detrol), and darifenacin (Enablex). These drugs can help reduce the urgency and frequency of urination during the day.