Do you find yourself running to the bathroom all the time or having this strong urge to run to the bathroom but you can’t make it and sometimes having accidents or are you waking up all night to go to the bathroom? well you might have overactive bladder. So what are the symptoms of overactive bladder, well there are four major symptoms, one is frequency or having to go to the bathroom more often than usual and the definition that we use is more than eight times a day is considered abnormal, of course if you’re drinking a lot more water you’re gonna go to the bathroom a lot more but if it’s affecting your quality of life then that’s something that is concerning, another thing is urgency which is essentially the sudden desire or urge to run to the bathroom that you cannot hold off or you can’t delay at all, sometimes this can be associated with bladder leakage or having an accident, this is called urgency urinary incontinence and lastly waking up at night to urinate more than one time is considered abnormal and this is called nocturia, so those are all the symptoms that taken together make up overactive bladder and the most important thing about these symptoms is how they affect your quality of life. Overactive bladder essentially is a problem that affects quality of life but it’s not that simple, it can affect more than just how bothered you are, it can affect how productive you are at work, if you’re always running to the bathroom you certainly can’t get work done, it can affect your social relationships and cause isolation because you don’t feel like you can go to the bathroom, sometimes people have to even map out where the bathrooms are wherever they go because they’re afraid of having an accident or they can’t go to the movies or go on long trips because they really have to go to the bathroom so frequently that it makes it impossible and financially this can be very problematic, you can end up spending lots and lots of money on absorbent pads and diapers and underwear and bedding and all that can really add up so taken together this can be a really big problem and when they’ve looked at studies about how many people have overactive bladder they found that about 16% of the population has these symptoms, that’s not a small number of people, also it can affect your relationships in the bedroom so if you’re having accidents during sex it’s going to potentially inhibit your desire to have sex.
So what causes overactive bladder, well age is a common cause, many times people will develop symptoms of overactive bladder related to age, that doesn’t mean it’s normal to have these symptoms, it just means that that is a cause of these symptoms, also being overweight can contribute to urinary incontinence or leakage, in fact when they look at women who are obese they have a threefold times more likelihood of having urinary incontinence episodes compared to women who are not obese, also having a history of vaginal deliveries or multiple pregnancies can contribute as well, other medical problems can also cause overactive bladder, the most common ones are things like diabetes, depression, having a history of a surgery, either a hysterectomy or radiation to the area and other neurologic conditions like having multiple sclerosis parkinson’s disease, spinal cord injuries or stroke, all can contribute to symptoms of overactive bladder, also if you’ve had surgery like a mid urethral sling or a public vaginal sling for stress urinary incontinence, those are surgeries for leakage that occur with coughing, sneezing, lifting exercise, those surgeries can also cause what we call obstruction or blockage of the p-tube which can lead to worsening overactive bladder symptoms.
Other things to consider are maybe if you’re having recurrent urinary tract infections that can cause symptoms of overactive bladder as well as certain medications like water pills, very often if you’re taking diuretics or water pills for high blood pressure or swelling that can make your overactive bladder symptoms much worse than when you come to see a urologist for your symptoms of overactive bladder, first we’re going to ask you several questions about your symptoms, when do they happen, how many pads a day are you using, what’s bothering you the most about it, how often are you going to the bathroom during the day and at night, also what’s your history, do you have any medical problems or surgeries in the past that might be contributing to this, then we’ll do a physical examination and during that exam we’ll look for any abnormalities that might be contributing to symptoms of overactive bladder like cysts underneath the urethra or around the urethra or p tube and men will do a prostate exam to see if there’s any enlarged prostate which can very often cause symptoms of overactive bladder, we’ll also check your urine to make sure there’s no blood or urinary tract infections because that could signal other problems, we’ll also do a bladder scan or a post void residual and what that is is a little ultrasound that we do on the bladder to see how well you’re emptying your bladder, are you emptying well or is your leakage happening because you have a lot of urine left over after you urinate and you’re not completely emptying.
So what are treatments for overactive bladder, as i mentioned earlier being overweight can contribute to symptoms of overactive bladder and studies have shown that losing as little as eight percent of your body weight so if you’re 200 pounds, that’s about 16 pounds of weight that you can actually significantly improve your urinary symptoms, so that’s a great place to start, another thing to do is to avoid bladder irritants, the simple things that you can avoid are alcohol, caffeine for some people spicy foods, acidic foods, artificial sweeteners and carbonated beverages but what i tell people is don’t dramatically change your life, eliminate one thing see how it goes for a few days, if it doesn’t make a difference, you can put it back in and try to eliminate something else, don’t drive yourself crazy over this, other things you can do are make sure you’re drinking enough but not too much, so you don’t want to over drink because that means you’re going to go to the bathroom more often and if you under drink actually, that can create your urine to be more concentrated which can then irritate the bladder lining, what i advice is drink whatever you want with breakfast, lunch and dinner and then sip on a bottle of water throughout the day but don’t take big gulps and try to make some major amount of fluid in fact if you do that and you’re eating fruits and vegetables and smoothies and soups you’re going to have plenty of fluid, you’re not going to be dehydrated, of course if you feel thirsty you should always drink another.
Big thing is avoiding constipation, constipation is a big problem and the reason for that is because the rectum sits right behind the bladder, so when it gets full because you haven’t had a bowel movement, it actually pushes on the bladder making it have less room to expand so that you have more urgency and frequency and worse symptoms, lastly if you smoke you want to quit smoking, smoking not only worsens symptoms of overactive bladder but also a risk factor for bladder cancer, so it’s really important to quit smoking, you can also see a pelvic floor physical therapist and they can help you do exercises that can help retrain your bladder, so what i tell people is when you get the urge to urinate, it’s like a bell curve and when you hit that urge really strongly, you typically run to the bathroom before the urge goes away but if you wait and you distract yourself with quick kegel exercises, you’ll notice that the urge will slowly go away and after it goes away you can calmly walk to the bathroom, of course before you start any kegel exercises make sure you see a urologist to get an exam to make sure you don’t have other issues like a high toned pelvic floor that might be causing problems as well, if these don’t work then there are medications that are available to you that can help reduce either the contractions or squeeze of the bladder or can help the bladder relax, and if those don’t work there are still other treatments available, there are things like a bladder pacemaker, there’s also a bladder botox where we do injections in the bladder wall with botox that lasts about six to nine months, so it is a repeated procedure that’s done every six to nine months, but both that and the bladder pacemaker is about 80% effective in reducing symptoms of overactive bladder.
Lastly there’s percutaneous tibial nerve stimulation and that’s kind of like acupuncture where we put a little needle in the ankle that stimulates the posterior tibial nerve and that nerve goes all the way up to the roots that then stimulate the bladder and so actually stimulating that nerve for 30 minutes once a week for 12 weeks and then once a month after that can actually help people improve their symptoms about 60 to 70 percent, there’s also a new device on the market that’s an implantable device that can go in the ankle that will then automatically stimulate you at home so you don’t have to come to the office so frequently and that’s also in early studies, very promising showing up to 70% improvement in overactive bladder symptoms after a quick straightforward procedure in the office, so i want you to be rest assured that we have lots of tools in our toolbox to help improve your overactive bladder, so if you’re suffering please see a urologist and we can help improve your overactive bladder as always.