When you always “have to go” – could it be overactive bladder?

Dr. Jennifer Rolef is a board-certified urologist at Inova. Her areas of specialization include diseases of the male and female urinary tract (kidney, ureters, bladder and urethra). She also specializes in video urodynamic testing for urinary problems.

If you know, you know: Urinary problems like overactive bladder can really mess up your life. Having to run to the bathroom all the time can be embarrassing, and anxiety about needing to go when you’re out and about can lead you to stop doing the things you love. But there is good news. There is a whole range of effective treatment options available, providing real symptom relief.

About overactive bladder

When the body’s bladder is performing normally, nerves tell the brain when the bladder is getting full, causing the familiar “I need to pee” feeling. But with overactive bladder, the bladder’s sensory pathway is altered in some way. This causes the nerves that regulate the bladder to fire more often, causing urinary symptoms.

Common symptoms of overactive bladder include:

• Frequent urination
• Urgency (feeling a sudden need to urinate)
• Getting up at night to urinate (called nocturia)
• Urinary incontinence (“leaking”)

These symptoms are also present when a person has a urinary tract infection (UTI). However, a person with a UTI usually has additional symptoms such as painful urination or blood in the urine.

In some cases, patient can have underlying neurologic conditions (e.g., multiple sclerosis, spinal cord injury, stroke, Parkinson’s disease) or back problems that contribute to their overactive bladder symptoms. Most of the time, we don’t know what is causing overactive bladder symptoms. 

Diagnosing overactive bladder

Generally, a urology provider diagnoses overactive bladder by taking a careful patient history and conducting a physical examination. We talk with patients about their symptoms and how those symptoms are affecting their quality of life. We also analyze the urine in the lab to rule out infection or blood in the urine, and we sometimes use a bladder scan to make sure the bladder is emptying adequately.

Overactive bladder can sometimes be confused with other conditions, commonly polydipsia, which means drinking too much fluid, or primary nocturnal polyuria, which is a condition where the body produces too much urine at night. Sleep apnea can also cause overproduction of urine, and an enlarged prostate can cause overactive bladder symptoms as well. It’s important to consult with a urology specialist to determine the specific cause of symptoms.

Treatment options

There are three broad types of treatment for overactive bladder:

• Behavioral treatment such as lifestyle changes (timed voiding, fluid modification) and pelvic floor physical therapy
• Timed voiding (i.e., using the bathroom before urgency hits) and fluid modification can be really helpful
• Medication
  • Most medications take six to eight weeks for patients to see full benefits.
• Procedures such as bladder Botox, implanted bladder stimulators and percutaneous tibial nerve stimulation (PTNS)
  • PTNS is a minimally invasive office procedure in which a needle is used to send an impulse through one of the nerves on the leg to reregulate the nerves going through the bladder

Having several treatment options available is beneficial for patients because there are many things patients and providers can try. If the first treatment is not successful, patients can try another treatment that may work better for them.

Other recommendations to reduce symptoms

Because overactive can cause nocturia, make sure to empty your bladder immediately before going to sleep. Stop all fluid intake at least two hours before bedtime. 

Some people with overactive bladder have dietary or environmental triggers that cause or exacerbate symptoms. Known bladder irritants include stress, caffeine, alcohol and spicy food, but I have seen all sorts of dietary factors contribute to symptoms of overactive bladder.  Sometimes an elimination diet can be helpful in identifying dietary triggers. 

In terms of alternative therapies, some patients report that acupuncture is helpful.

Managing overactive bladder long term

Overactive bladder is generally a chronic condition, which means it can be managed, but not cured. In some people, overactive bladder can be progressive (i.e., get worse over time), while in other cases, symptoms stay stable.

Overactive bladder is a quality-of-life issue. We work with patients to treat the symptoms depending on how much they are affecting a patient’s life, how bothersome they are and what the patient’s overall personal goals are. Whether it is medication or another treatment, we try to find a therapy that alleviates symptoms and is in line with patient goals regarding overall health. Once symptoms are under adequate control, I generally recommend yearly follow-up appointments.

Although we do not have a cure for overactive bladder, it is a very treatable condition. Most patients can achieve a good degree of symptom relief.

Regain control and reclaim your confidence

Discover how our specialized urologists provide personalized care and cutting-edge treatments for lasting relief from overactive bladder.