What is an overactive bladder?
Overactive bladder (OAB) is a very common condition that affects one in three Australians, according to the Continence Foundation of Australia. It causes a combination of symptoms related to involuntary urination. Here are the signs and symptoms you should know.
You get sudden urges to go
One of the classic overactive bladder symptoms is a sudden, uncontrollable urge to go. “We spend our younger years learning how to have our brains control our bladder, letting us empty our bladders when it is socially acceptable,” says urologist, Dr Aisha Khalali Taylor. “As we age as women, our bladders become defiant and start to want to overrule the brain, causing bladder contractions or spasms at times when it’s not socially acceptable.”
Pregnancy and childbirth, as well as lower levels of oestrogen after menopause, can contribute to OAB in women. And although OAB is more common with age, it should not be considered a ‘normal’ part of ageing.
You have to go all the time
Along with a sudden urge, you may feel like you have to urinate constantly. This happens for one of two reasons, “Either the nerves that provide information about sensation [sensory nerves] receive, or think they receive, information about being full or irritated; or the nerves that send signals to the muscle of the bladder are too active, and the muscle contracts,” explains urogynecologist, Dr W. Thomas Gregory.
You often go only a little bit
With an overactive bladder, even though you may feel the urge to hit the bathroom all the time, not much comes out. “Sudden urge to urinate occurs because the muscles of the bladder start to contract involuntarily, even when the amount of urine in the bladder is low,” Dr Taylor says. “This involuntary contraction makes women feel an urgent need to urinate, which signals OAB, as the bladder lining becomes ‘hypersensitive’ to the smallest volumes of urine.”
Note: this particular symptom could also be a symptom of a urinary tract infection (UTI). “The only way to truly tell the difference between a UTI and OAB is to obtain a urine culture to see if bacteria is growing in the urine,” Dr Taylor says. A urine culture is a very easy test that can be done in most labs.
You feel like you have to go even if you’ve just gone
You’ve just used the bathroom, but there it is again – that feeling of ‘gotta go,’ so you turn around and head back in. If that happens to you, it could be OAB. This constant need for the bathroom can be disruptive, but luckily, there are natural remedies for overactive bladder that can help. “Sometimes we have to use our brains and emotions to retrain our bladder what is the right amount of urine to hold before going to the bathroom,” Dr Gregory says.
Pelvic floor exercises called Kegels can help you control those muscles, especially if they’re done with a qualified pelvic floor therapist using a device such as InTone, which offers feedback on your progress. Then you can attempt bladder training, which involves “training yourself to delay urination when you feel the urge to urinate,” Dr Taylor says. “You start with small delays such as five to 10 minutes, and work your way up to three to four hours.”
You wake up to go to the bathroom
It can be normal to wake up to go at night, but if your sleep is constantly disrupted due to multiple trips to the toilet, it can affect your cognitive function the next day. Disrupted sleep can even lead to depression. You might think not drinking before bed will resolve the problem, but reducing your total fluid intake is a bad idea. That will only make your urine more concentrated, which is irritating and can make overactive bladder symptoms worse. What’s more, “the kidneys produce urine all the time, even if you haven’t had anything to drink. “This is especially true at night when you lay down to go to sleep,” Dr Gregory explains.
“Fluid in your body has an easier time getting back to the heart because it doesn’t have to work as hard against gravity.” High urine output at night could also indicate other conditions such as congestive heart failure, sleep apnoea, diabetes, or poor kidney function, so see a urologist if you’re constantly waking up to pee to make sure it’s not something else.
You have accidents
All of a sudden having to go may mean that you end up going when you don’t want to – even if it’s just a few drops of urine. “The amount of urine one leaks is not necessarily correlated with severity of OAB,” Dr Taylor says. “What counts the most is the level of bother a patient feels. Some women are comfortable wearing pads and leaking large amounts of urine, while some are very bothered by the slightest drops.” Triggers for such accidents may be touching or hearing running water, drinking a small amount, or even briefly being in a cold environment, such as reaching into the freezer at the grocery store.
To identify your personal triggers, keep a bladder diary. “If you leak urine, marking down what you were doing and feeling can help you and your provider understand that better,” Dr Gregory says. Retraining the bladder by scheduling bathroom trips at regular intervals can also help. “As infants we learn to control our bladder and go to the bathroom when it is socially acceptable,” Dr Gregory says, and you may need to do the same thing again now.
It doesn’t necessarily happen when you cough, sneeze, or jump
You may think you don’t have OAB because you don’t leak when you sneeze or cough – but that isn’t a symptom of OAB. Instead, ‘stress incontinence’ is actually a different type of bladder issue caused by a weakening of the pelvic floor muscles, according to the Australian Government Department of Health. “Leaking a few drops at a time can be a sign of stress urinary incontinence, when moving, coughing, sneezing, standing up, jumping and jogging put stress on the bladder to cause the leakage,” Dr Gregory says.
But it’s possible to have both urgency incontinence, a symptom of OAB, and stress incontinence together. “Some women have a disorder called mixed incontinence when leakage occurs with both urge and coughing/straining activity,” Dr Taylor says. “It is important to discuss these concerns with a physician to tease out what is going on.”
Certain foods and drinks trigger symptoms
Spicy or acidic foods, sugar, alcohol, and caffeine can all be irritants, so you might notice your overactive bladder symptoms getting worse after you consume them. “Alcohol acts as a diuretic, causing more urine to be filtered through the kidneys, increasing subsequent urine production and the feeling of OAB,” Dr Taylor explains. “Caffeine acts as both a diuretic and also makes the bladder more sensitive by lowering the threshold at which a bladder contraction will occur.”
Dr Gregory says that some people just have a lower tolerance for certain foods that irritate the bladder’s lining. “If you have that type of sensitivity, then a good strategy is to identify and avoid your trigger foods,” he says. Culprits often include red chillies, tomato sauce, wasabi, and even cranberry juice.
You don’t have pain, burning, or blood
Another way you can tell if it’s OAB or something else is whether you have pain, burning, or blood in your urine in addition to your other symptoms. Having to go all the time is a real pain, but it shouldn’t actually hurt. If urinating causes pain, it could be a urinary tract infection, a sexually transmits infection, bladder, or kidney stones. If you have any of these symptoms, see your doctor ASAP. If you don’t have these symptoms, it could be OAB.
You’re always scoping out bathrooms
Studies have shown that overactive bladder symptoms can really affect your quality of life. You may become reluctant to be in public situations where you’re unsure if there will be a bathroom readily available; and when you are out and about, you might find yourself always on the lookout for a restroom. “If you have any of the quality of life issues – knowing all the bathrooms, afraid to be in social settings – it’s time to talk with a doctor,” Dr Taylor says.
Many OAB sufferers are often embarrassed to bring up the subject, but overactive bladder treatment is available, and there are completely natural remedies such as exercises and bladder retraining. If those don’t work, there are medications and procedures as a next step. “If you are changing the way you live – not seeing friends or family, not exercising or doing the things you like – then you should seek assistance,” Dr Gregory says. “These problems can often be addressed and improved.”