Overactive Bladder – Constant Urgency to Urinate
Synonyms: urge incontinence, unstable bladder, irritable bladder, detrusor hyperactivity
Overactive bladder (OAB) is defined as urinary urgency, that is a frequent, sudden desire to urinate in the absence of an organic or metabolic disorder. Usually, the only symptom is urinating more than 8 times per 24 hours, sometimes also at night; some people experience urge incontinence but no pain.
The mechanism of OAB involves hypersensitivity of the nerves involved in bladder emptying 5. In a related disorder–interstitial cystitis–there is a damage of the bladder lining.
In some cases, OAB may be caused by nonrelaxing pelvic floor dysfunction 56 or it can be psychosomatic, but often the cause is uncertain 1. In one Japanese study, about 30% of individuals with OAB also had irritable bowel syndrome 10, and in other studies, OAB was associated with constipation 9 or fibromyalgia 6,8. Overactive bladder can develop in both men and women; the risk increases with age.
- Smoking (nicotine), caffeine (coffee, tea, cola, energy drinks, cocoa, chocolate), acidic foods (tomato products, oranges, grapefruits, lemons, limes, cranberries, pickled foods, vinegar), carbonated and alcoholic beverages, spicy foods, sauces, condiments, raw onions, sweeteners, either natural (sugar) or artificial (aspartame, sucralose), food additives, such as nitrites and nitrates in processed and canned foods, monosodium glutamate (MSG), vitamin C supplements 15.
A doctor can usually make a diagnosis of overactive bladder by the exclusion of organic and metabolic disorders.
- Avoid irritant foods and beverages. Do not try to drink less water because this will make your urine more concentrated and irritating for the bladder.
- Lose excessive weight.
- Treat constipation: be physically active, drink enough fluid and eat enough dietary fiber.
- Quit smoking.
- Have scheduled drinking and toilet visits.
- Try to solve emotional and other personal problems.
- Bladder training (bladder drill): gradually increase the time between each urination, for example, for 15 minutes every day.
- Try Kegel exercises — repeated contractions of the muscles in the pelvic floor with which you control the urine flow 3.
- Discuss with your doctor about anti-spasm medications (anticholinergics), such as tolterodine, or transdermal oxybutynin patch, available OTC, mirabegron (a beta-3 agonist), terazosin or doxazosin (an alpha-blocker) or desmopressin (an antidiuretic) 11.
- Other treatment possibilities: botulinum toxin injections into the bladder wall, sacral nerve stimulation, surgery.
- There is a weak evidence of the effectiveness of hypnosis and acupuncture 4.
- References: 12,15
- Gosha-jinki-gan (7.5 grams/day), a mixture of herbs, improved symptoms in some women with overactive bladder but worsened them in others in one small Japanese study in y.2008 7.
- There is insufficient evidence of the effectiveness of other natural remedies, such as Buchu (Barosma betulina), cleavers, cornsilk, horsetail or saw palmetto in relieving overactive bladder symptoms 13.
- Psychosomatic origin of overactive bladder PubMed
- Overactive bladder treatment Mayo Clinic
- Kegel exercises Harvard.edu
- Hypnotherapy and overactive bladder PubMed
- Overactive bladder defined as hypersensitivity PubMed
- Fibromyalgia and frequent urination PubMed
- Gosha-jinki-gan PubMed
- OAB and fibromyalgia PubMed
- Kaplan SA et al, 2013, Systematic review of the relationship between bladder and bowel function: implications for patient management PubMed
- OAB and IBS PubMed Central
- Drugs for overactive bladder Healthline
- Overactive bladder Patient.info
- Herbal remedies for overactive bladder WebMD