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Despite what many people think, an overactive bladder is not a natural or inevitable part of aging. It is a diagnosable condition that, while more likely with age, can occur at any age.
Certain neurological and other conditions can cause the urge to urinate to occur, even when the bladder is not full.
Having an overactive bladder can result in urinary incontinence, or the inability to hold urine in. This can be embarrassing, and disrupt your normal day-to-day functioning.
If an overactive bladder is affecting your quality of life, it’s time to see your doctor. There are behavioral strategies that can help to control and regulate bladder function and voiding, as well.
How the bladder operates normally
Your kidneys produce urine, which drains into your bladder, where it is held until you urinate.
As your bladder fills, nerve signals sent to your brain will eventually trigger the urge to urinate. When you urinate, nerve signals also work to relax the pelvic floor muscles and the urinary sphincter muscles, while tightening the bladder, which helps push urine out.
Following my recent brain surgery, it was clear that there was a temporary disruption in these nerve signals. In my case, the urge to urinate was there, but the bladder was not pushing the urine out. When I tried to urinate, nothing happened, and a catheter was needed. Fortunately, this situation resolved itself with time.
With an overactive bladder, though, what you have is an involuntary contraction of the bladder, causing the often uncontrollable release of urine, even when the bladder is far from full. It’s like you just can’t hold it in.
What causes overactive bladder?
Conditions that may cause overactive bladder include:
- Neurological disorders like a stroke or multiple sclerosis
- Abnormalities of the bladder, such as tumors or bladder stones
- Decline in cognitive functioning – this can make it difficult for your bladder to “understand” the signals it gets from your brain
- Factors that obstruct bladder outflow, such as an enlarged prostate, constipation, or perhaps previous surgeries that were done to treat other forms of incontinence
Other things that can cause the symptoms of an overactive bladder are excessive caffeine and alcohol consumption, urinary tract infections, and medications that cause a rapid increase in urine production, or that need to be taken with a lot of fluid.
Symptoms of an overactive bladder
With an overactive bladder, you will experience a sudden urge to urinate that is difficult to control. Incontinence, or the loss of urine upon feeling this urge, is common.
An overactive bladder will cause you to urinate frequently, up to eight or more times in 24 hours. You may also wake two or more times during the night to urinate, a condition known as nocturia.
Treatments for an overactive bladder
Fortunately, there are medications and other interventions that can help control the activity of an overactive bladder. If the condition is disrupting your sleep or your normal daily life, it’s a good idea to talk to your doctor about these.
Behavioral interventions. This will likely be your doctor’s first choice to help you. They are simple to employ and carry no side effects as some medications do.
Pelvic floor muscle exercises – Your doctor can teach you how to do Kegel exercises, in which you voluntarily contract the muscles of your urinary sphincter and pelvic floor. Be aware that it could take six to eight weeks of regular practice of these exercises before you see any changes.
Bladder training – Once you can control your pelvic floor muscles, bladder training is a possibility. It involves training yourself to delay urinating, even when you feel the urge. Beginning with short delays of, say, 30 minutes, and gradually working your way up to urinating every three or four hours, this method re-trains your bladder.
A toileting schedule – Much like a sleep schedule, where you re-train your body to fall asleep and wake up at certain times, a toileting schedule can help re-train your body and get it on track to urinate, say, every two or four hours, rather than waiting for the urge to strike.
While these interventions are at work, you can make use of absorbent pads or undergarments so that you don’t need to limit your activities for fear of an embarrassing situation.
Medications. Medications that relax the bladder muscle can help reduce episodes of incontinence. Among these are Darifenacin (Enablex) and Oxybutynin (Ditropan XL). Your doctor can prescribe these, but you may want to read about the downsides of these anticholinergic medications and the problems they can cause with memory and cognitive abilities.
Nerve stimulation. In a surgical procedure, a thin wire is placed close to the sacral nerves that carry signals to your bladder. Or, your doctor may try a more advanced procedure where an electrode is implanted that can deliver signals through the wire to your bladder. If this is successful, a battery-powered pulse generator, similar to a pacemaker, can be used to regularly deliver the needed signals.
Bladder botox. Known for paralyzing muscles in the foreheads of women yearning to avoid frown lines and wrinkles, botox can also paralyze bladder muscles and decrease the muscular “spasms” that can arise from an overactive bladder. The effect generally lasts for 6 to 8 months (longer than a wrinkle-free forehead!) and can be done in your doctor’s office.
How not to irritate your bladder
Drink enough. If you have an overactive bladder, you might think you should limit your fluid intake. Don’t! If your urine becomes too concentrated, it can irritate the lining of your bladder and actually increase the urge to urinate. But you might avoid drinking fluids a couple of hours before bedtime so you don’t make frequent nighttime trips to the restroom.
Avoid irritating foods. Caffeine, alcohol, apples, carbonated drinks, chocolate, citrus juice and fruit, spicy foods, tea, tomatoes, and vinegar are some foods known to irritate the bladder. If any of these worsen your symptoms, do your best to avoid them.
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