Overactive Bladder: Causes, Symptoms, and Treatments

What is overactive bladder syndrome?

Overactive bladder syndrome is a diagnosis we make when a patient regularly feels a strong urge to pass urine, even though the bladder is not full.  The bladder will involuntarily squeeze and contract making you feel you need to pass urine and the sensation is very difficult to defer. On occasion it may even give mild incontinence. Nobody really knows why the bladder muscle starts to squeeze too early, when the bladder isn’t even half full, but we do know how troublesome a symptom it can become.

It is sometimes called detrusor sensitivity or an irritable bladder as the detrusor muscle is the muscle involved.

How can you recognise the symptoms of an overactive bladder?

Urinary urgency and possible incontinence

If your bladder squeezes (contracts) without any warning it can give you an urgent need to pass urine, that is ‘when you have to go, you have to go’. This gives you little or no time to get to the toilet and is called urinary urgency. If the need to pass urine is so intense that you cannot hold onto it, it can lead to involuntary leakage of urine which is called urgency urinary incontinence. This is different from stress incontinence, which is leaking of urine when you cough or sneeze and is generally due to weakness of the pelvic floor.

Sometimes urgency will come on as you get to your door – and we call this door handle urgency or latch key urgency.

Urinary frequency

If you have urinary frequency, this means that you need to pass urine often and more frequently than usual and in small volumes.  Most people pass urine 6-8 times per day, but it may be less if you don’t drink much or more if you take a diuretic.  Normal urine frequency depends on how much you drink in the day and what types of fluid you drink. Most patients with overactive bladder are passing urine more than 8 times a day, and some patients many times more.

Getting up at night to pass urine

Overactive bladder can also cause you to get up more than twice per night to pass urine but there are other reasons patients get up at night to pass urine too. In children an overactive bladder can contribute to bed wetting.

Who is affected by overactive bladder, and why does it happen?

Your bladder can become overactive at any age. We see it in children and it can be a reason for wetting at school or not being able to become dry at night. It is common in adults (about 12% of adults, and in women more than men). It is more common in patients with other neurological illness such as Parkinson’s disease or after stroke and more common in those who are anxious.

These symptoms also occur with infection or with a large prostate in older men or with bladder stones, so other causes need to be excluded before we can definitely diagnose an overactive bladder.

Symptoms can be made worse by caffeine in tea, coffee, coca cola etc and are also worsened after drinking alcohol.

What lifestyle adjustments and initial treatments can help?

The first and most important treatment is bladder training as it is all that is needed in about half of patients. Specialist physiotherapists and incontinence advisors can teach bladder training and sometimes pelvic floor strengthening is helpful too.

The aim is to slowly stretch the bladder so that it can hold larger and larger volumes of urine and there are special techniques that help with this. In time, the bladder muscle should become less overactive and you should become more in control of your bladder. This means that more time can elapse between feeling the desire to pass urine and having to get to a toilet. Leaks of urine are then less likely.

Occupational therapists help make your toilet easier to get to and more accessible and can advise on incontinence aids, commodes etc.

Cutting down on caffeine and alcohol can make a huge difference, and so can drinking more fluids during the day. Patients often come in having cut down on fluids hoping that will mean they need to go to the toilet less, but ironically if you are dehydrated your urine will become concentrated and irritate the bladder further. Aim to drink a normal amount of fluid every day- enough to quench your thirst. We always aim to treat constipation too, as constipation can worsen an overactive bladder. If you are overweight, just losing 5-10 % of your body weight will lessen your incidence of incontinence considerably and we can help with this.

If bladder training is not helping sufficiently there are many different medications we can try. The first line of medication is often from a family of drugs called anti-muscarinics (sometimes called anti-cholinergics) eg oxybutynin or tolterodine. Trospium, propiverine or solifenacin may also be considered. These medicines work by relaxing the bladder muscle and so increasing the bladder capacity but unfortunately these often have side effects and may not be suitable for some patients. They may give a dry mouth, drowsiness or confusion.

Mirabegron and Vibegron are a different class of drug (beta 3 agonists), so may be prescribed even if an anti-muscarinic has not been helpful previously or has given you side effects. They also help the bladder to relax and can be very effective with fewer side effects than anti-muscarinics (although occasionally they give headaches or diarrhoea). Mirabegron has been available previously and in July 2024 Vibegron has been authorised by the MHRA, which may be even more effective with fewer side effects.

What advanced treatment options are available when symptoms persist?

Very occasionally urologists will need to recommend other strategies. Some patients are more comfortable self-catheterising. Other patients are given Botox treatments in the bladder, and very rarely surgical treatment may be appropriate.

When should you seek help for overactive bladder?

Overactive bladder syndrome is troublesome and life wrecking at any age. If you are experiencing any or all of these symptoms, however trivial, do please come in and discuss in more detail with one of us as there is so much we can advise to help.

To book an appointment online click here or call us on 0207 245 3999.