Frequent sudden urges to urinate that are difficult to control could be caused by Overactive Bladder Syndrome (OAB), a common condition that occurs increasingly as we age. OAB is not a disease - it’s the name used to refer to a group of non-infectious conditions with different causes that cause a sudden urge to urinate.
Another common bladder problem, called Stress Urinary Incontinence (SUI), involves leakage of urine when sneezing, laughing or doing physical activities. It is a different condition than OAB and is treated differently, but a person can have both stress incontinence and overactive bladder. I’ll discuss both of these conditions in this article… so scroll down if “laughing so hard you peed your pants” is your main complaint!
OVERACTIVE BLADDER SYNDROME (OAB)
OAB is not just a normal part of getting older, part of “being a woman” or, for men, just part of having a prostate problem. If you need to urinate urgently 8 or more times during the day, or 2 or more times during the night, talk to your doctor to determine what may be the cause. Be aware that urinary tract infections and bladder cancer can cause symptoms similar to OAB, and these should be treated as soon as possible. There are effective treatments for OAB, both medicines and non-medical treatments, that can improve your quality of life.
Symptoms of OAB can have several different causes:
Excess caffeine or alcohol
Incomplete bladder emptying, leaving less room for storage of new urine
Nerve disorders, such as stroke or multiple sclerosis, that affect nerve signals to the bladder
Diabetes, which also can cause damage to nerves
Mobility disorders, that make it more difficult to get to the bathroom quickly enough
Medications that cause a rapid increase in urine production or require high fluid intake
Abnormalities in the bladder, such as tumors or bladder stones
The specific cause may be unknown
Diagnosis:
A bladder diary kept for a few days before your doctor’s appointment, with the number of times you need to urinate, any urine leakage, amount and timing of fluid intake and timing of any medications you take can be helpful
A scan may be done or a small tube called a catheter may be inserted to determine if any residual urine remains in the bladder after urinating.
A urine culture may be done to ensure your symptoms are not being caused by a treatable infection.
A scope may be performed to eliminate other causes.
TREATMENTS
Lifestyle changes (Behaviour therapy):
Limit intake of food and drinks that you find irritate the bladder
E.g. coffee, tea, artificial sweeteners, caffeine, alcohol, carbonated drinks, citrus fruit, tomatoes, chocolate, spicy foods
Keeping a bladder diary for a few days may help you determine contributing causes (foods, activities, etc)
Double voiding
After urinating, wait a few seconds, relax and try again. This may be helpful if you have trouble emptying your bladder completely.
Delayed voiding
This involves waiting a few minutes before urinating, and gradually increasing the time to train the bladder to delay emptying. Check with your healthcare provider before trying this strategy, as it may not be helpful with some types of OAB.
Scheduled voiding
This involves urinating on a schedule instead of waiting until you feel the urge.
Exercises to relax your bladder muscle
These are sometimes called “quick flicks” – quickly squeezing and releasing the pelvic floor muscles (the muscles you use to hold urine in) can send a message to your nervous system and back to your bladder to stop squeezing and relax. Keeping still, relaxing and concentrating on the “quick flicks” can help the relaxation of the bladder.
If you have urine leakage, specialized absorbent products are available that also control odor, allowing you to participate in activities that could cause problems for you.
If you are overweight, losing weight may reduce symptoms
Excessive fluid restriction may cause urine to become concentrated and irritating to the lining of the bladder, increasing the urge to urinate.
Strengthening the pelvic floor muscles by doing Kegel exercises may be helpful. Click here for a description of how to do this exercise.
Medical and surgical treatments:
There are several prescription drugs available to relax the bladder muscle, and prevent it from contracting when the bladder isn’t full. These may be considered when lifestyle changes do not control the problem adequately. Common side effects include dry mouth and eyes, constipation, drowsiness and blurred vision. They are available as tablets and capsules taken by mouth, or as a gel or patch to deliver medication through the skin.
If medications don’t help, injections to partially paralyze the bladder muscle or stimulation of the sacral nerve that controls the bladder may be tried. These treatments would be performed by a specialist.
STRESS URINARY INCONTINENCE (SUI)
Stress incontinence is loss of urine due to physical movement or activities - such as coughing, sneezing, running, or heavy lifting - that put pressure or stress on your bladder. It occurs when muscles and tissues that support the bladder and the muscles that regulate the release of urine (urinary sphincter) weaken.
Risk factors include:
Childbirth in women, particularly forceps delivery, and hysterectomy
Prostate surgery in men
Age – muscles generally weaken as you age, but SUI is not considered a normal part of aging. It can occur at any age.
Body weight – being significantly overweight can increase pressure on the abdominal organs, including the bladder
Illness or smoking can increase coughing, worsening stress incontinence
Treatment strategies:
Pelvic floor muscle (Kegel) exercises (click here for a description)
Fluid consumption – adjusting the amount and timing of fluid intake may help, but avoid dehydration. Avoiding alcohol and caffeine is of questionable benefit.
Healthy changes – quitting smoking, losing extra weight, or treating a chronic cough may improve symptoms
Bladder training or scheduled urinating may be helpful, especially before activity.
Medications:
There are no approved medications specifically for stress incontinence, but estrogen replacement (often given as a vaginal cream, suppository or ring when being used for urinary or vaginal problems) can help some post-menopausal women by improving the health of these estrogen-responsive tissues. The medication, desmopressin, given as a nasal spray, blocks the production of urine and is sometimes used to reduce the need to urinate at night.
Surgical treatments:
Sling procedure – a strip of tissue or tape is surgically placed under the urethra for support
Bladder neck suspension – designed to lift the bladder and support it. Can be performed laparoscopically, with instruments inserted through small incisions in the abdomen.
You can read more about these medications and procedures here.
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