Irri­table blad­der / over­ac­tive blad­der (OAB)

Irritable bladder
Irritable bladder

Irritable bladder is quite common, particularly among women. In this condition, the muscles in the bladder are provoked to contract involuntarily, leading to a sudden, urgent, uncontrollable need to urinate. Sometimes, the causes of the condition are difficult to find. However, if an underlying cause is identified, irritable bladder may be treated effectively. Management often starts with behavioral strategies, e.g. fluid schedules, timed voiding and bladder-holding techniques using the pelvic floor.

Symptoms of irritable bladder
  • Urgent feeling to urinate
  • Going to the bathroom frequently
  • Leaking urine before the toilet is reached (urge incontinence)
  • Frequent urination – night and day

Causes and origin of irritable bladder

This condition occurs because the muscles of the bladder begin to contract involuntarily even if the volume of urine in the bladder is low. The involuntary contraction results in an urgent need to go to the toilet.
The causes of irritable or overactive bladder are often not found.

However, quite a few diseases and conditions might contribute to symptoms of overactive bladder, such as:

  • Parkinson's disease
  • Strokes
  • Multiple sclerosis
  • Poor kidney function
  • Diabetes
  • Medications that lead to a rapid increase in urine production
  • Acute urinary tract infections
  • Tumors or stones in the bladder
  • Enlarged prostate
  • Constipation
  • Excess consumption of caffeine or alcohol
  • Declining cognitive function due to older age
  • Walking difficulties
  • Incomplete bladder emptying

Consequences of irritable bladder

People with this bladder condition might also suffer from:

  • Emotional distress
  • Sleep disturbances
  • Interrupted sleep
  • Depression

Some women also might develop “mixed incontinence” – when urge and stress incontinence occur at the same time. In stress incontinence, they lose urine if physical stress or pressure on the bladder is applied, e.g. while running, jumping or during other activities. Older people might develop a common combination of bladder storage and bladder-emptying issues: Although the bladder may cause a lot of urgency and incontinence, it doesn't empty well.

Prevention and therapy of irritable bladder
Irritable bladder can be very uncomfortable
Irritable bladder can be very uncomfortable

Treatments for overactive bladder can be classified into three categories:

  • Nonmedical therapy (behavioral therapy)
  • Medical therapy
  • Surgical therapy (seldom)

The combination of behavioral therapy and medications has been particularly effective in treating irritable bladder.

Nonmedical (behavioral) therapy

This treatment can be done at home. It often includes five steps:

  1. Education (understanding the causes and risk factors, recognizing the signs, implementing a therapy plan)
  2. Lifestyle and dietary changes (e.g. limiting the consumption of alcohol, caffeinated drinks, carbonated sodas)
  3. Bladder training (scheduled voiding times with progressively less frequent intervals in order to reduce the number of incontinence episodes)
  4. Pelvic floor muscle therapy (exercises to improve function and strength of muscles of the pelvic floor)
  5. Voiding diaries

Medical therapy

To treat overactive bladder, the doctor often prescribes anticholinergic drugs. They diminish the activity of the detrusor muscle and help the muscle relax. However, the medications also have side effects, such as dry mouth, constipation, blurry vision. Older people might even suffer from confusion. Therefore these drugs should only be taken under the supervision of the prescribing physician. Postmenopausal women with incontinence sometimes use estrogen preparations. Which medication works best, should be talked through with the doctor.

Quite a few people might prefer herbal medicaments: Although natural remedies for irritable bladder have been traditionally used for many years, their effectiveness is greatly unknown. That’s why it’s recommendable to take them with caution.

Surgical therapy

Surgery is only reserved for patients with severe symptoms who don't respond to all other forms of therapy. The aim is to improve the bladder's storing ability and reduce pressure in the bladder. However, bladder pain won’t disappear.
There are two types of interventions: surgery to increase bladder capacity and bladder removal (a replacement or opening in the body is constructed to attach a bag on the skin to collect urine). Reconstructive bladder surgery is the most commonly performed operation.

Preventive measures

Although there is no specific prevention for irritable bladder, healthy lifestyle changes might reduce the symptoms:

  • Daily physical activity
  • High-fiber diet
  • Limited consumption of caffeine and alcohol
  • Avoidance of spicy foods, chocolate, carbonated beverages
  • Quitting smoking
  • Managing chronic conditions, e.g. diabetes
  • Strengthening of pelvic floor muscles, e.g. with Kegel exercises