Overactive bladder is a condition in which the bladder squeezes urine out at the wrong time. You may have overactive bladder if you have two or more of these symptoms:

• You urinate eight or more times a day or two or more times at night
• You have the sudden, strong need to urinate immediately
• You leak urine after a sudden, strong urge to urinate

You also may have incontinence, a loss of bladder control. Nerve problems, too much fluid, or too much caffeine can cause it. Often the cause is unknown.

Your doctor may prescribe a medicine that can calm muscles and nerves. The medicine may come as a pill, a liquid, or a patch. The medicines can cause your eyes to become dry. They can also cause dry mouth and constipation. To deal with these effects, use eye drops to keep your eyes moist, chew sugarless gum or suck on sugarless hard candy if dry mouth bothers you, and take small sips of water throughout the day.

What is urinary incontinence (UI)?

Urinary incontinence (UI) is the loss of bladder control, or being unable to control urination. It is a common condition. It can range from being a minor problem to something that greatly affects your daily life. In any case, it can get better with proper treatment.

What are the types of urinary incontinence (UI)?

There are several different types of UI. Each type has different symptoms and causes:

• Stress incontinence happens when stress or pressure on your bladder causes you to leak urine. This could be due to coughing, sneezing, laughing, lifting something heavy, or physical activity. Causes include weak pelvic floor muscles and the bladder being out of its normal position.
• Urge, or urgency, incontinence happens when you have a strong urge (need) to urinate, and some urine leaks out before you can make it to the toilet. It is often related to an overactive bladder. Urge incontinence is most common in older people. It can sometimes be a sign of a urinary tract infection (UTI). It can also happen in some neurological conditions, such as multiple sclerosis and spinal cord injuries.
• Overflow incontinence happens when your bladder doesn't empty all the way. This causes too much urine to stay in your bladder. Your bladder gets too full, and you leak urine. This form of UI is most common in men. Some of the causes include tumors, kidney stones, diabetes, and certain medicines.
• Functional incontinence happens when a physical or mental disability, trouble speaking, or some other problem keeps you from getting to the toilet in time. For example, someone with arthritis may have trouble unbuttoning his or her pants, or a person with Alzheimer's disease may not realize they need to plan to use the toilet.
• Mixed incontinence means that you have more than one type of incontinence. It's usually a combination of stress and urge incontinence.
• Transient incontinence is urine leakage that is caused by a temporary (transient) situation such as an infection or new medicine. Once the cause is removed, the incontinence goes away.
• Bedwetting refers to urine leakage during sleep. This is most common in children, but adults can also have it.
  • Bedwetting is normal for many children. It is more common in boys. Bedwetting is often not considered a health problem, especially when it runs in the family. But if it still happens often at age 5 and older, it may be because of a bladder control problem. This problem could be caused by slow physical development, an illness, making too much urine at night, or another problem. Sometimes there is more than one cause.
  • In adults, the causes include some medicines, caffeine, and alcohol. It can also be caused by certain health problems, such as diabetes insipidus, a urinary tract infection (UTI), kidney stones, enlarged prostate (BPH), and sleep apnea.

Who is at risk for urinary incontinence (UI)?

In adults, you are at higher risk of developing UI if you

• Are female, especially after going through pregnancy, childbirth, and/or menopause
• Are older. As you age, your urinary tract muscles weaken, making it harder to hold in urine.
• Are a man with prostate problems
• Have certain health problems, such as diabetes, obesity, or long-lasting constipation
• Are a smoker
• Have a birth defect that affects the structure of your urinary tract

In children, bedwetting is more common in younger children, boys, and those whose parents wet the bed when they were children.

How is urinary incontinence (UI) diagnosed?

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms. Your provider may ask you to keep a bladder diary for a few days before your appointment. The bladder diary includes how much and when you drink liquids, when and how much you urinate, and whether you leak urine.
• A physical exam, which can include a rectal exam. Women may also get a pelvic exam.
• Urine and/or blood tests
• Bladder function tests
• Imaging tests

What are the treatments for urinary incontinence (UI)?

Treatment depends on the type and cause of your UI. You may need a combination of treatments. Your provider may first suggest self-care treatments, including

• Lifestyle changes to reduce leaks:
  • Drinking the right amount of liquid at the right time
  • Being physically active
  • Staying at a healthy weigh
  • Avoiding constipation
  • Not smoking
• Bladder training. This involves urinating according to a schedule. Your provider makes a schedule from you, based on information from your bladder diary. After you adjust to the schedule, you gradually wait a little longer between trips to the bathroom. This can help stretch your bladder so it can hold more urine.
• Doing exercises to strengthen your pelvic floor muscles. Strong pelvic floor muscles hold in urine better than weak muscles. The strengthening exercises are called Kegel exercises. They involve tightening and relaxing the muscles that control urine flow.

If these treatments do not work, your provider may suggest other options such as

• Medicines, which can be used to
  • Relax the bladder muscles, to help prevent bladder spasms
  • Block nerve signals that cause urinary frequency and urgency
  • In men, shrink the prostate and improve urine flow
• Medical devices, including
  • A catheter, which is a tube to carry urine out of the body. You might use one a few times a day or all the time.
  • For women, a ring or a tampon-like device inserted into the vagina. The devices pushes up against your urethra to help decrease leaks.
• Bulking agents, which are injected into the bladder neck and urethra tissues to thicken them. This helps close your bladder opening so you have less leaking.
• Electrical nerve stimulation, which involves changing your bladder's reflexes using pulses of electricity
• Surgery to support the bladder in its normal position. This may be done with a sling that is attached to the pubic bone.

Call the healthcare provider right away if you have any of these:

• Fever of 100.4° F ( 38°C ) or higher, or as directed by your provider

• Symptoms don't get better, or get worse with treatment

• Trouble peeing because of pain

• Back or belly pain

Your healthcare provider will examine you and ask about your symptoms and health history. You may also have one or more of these tests:

• Urine test. Urine samples are taken and checked for problems, especially signs of infection.

• Urinary diary. You record how much fluid you take in and pee out for 3 days.

• Bladder ultrasound. This studies the bladder as it empties. Ultrasound uses sound waves to make detailed images of the inside of the body.

• Cystoscopy. This test lets the provider look for problems in the urinary tract. The test uses a thin, flexible scope (cystoscope) with a light and camera on the end. The scope is put into the tube that takes urine out of the body (urethra).

• Urodynamic studies. This is a group of tests. They measure and record many aspects of urinary bladder function. This includes pressures, volume, and urine flow.

Treatment depends on the cause and severity of your OAB. Treatments may include:

• Changing your peeing habits. Your healthcare provider may advise certain methods, such as delayed voiding or timed urination.

• Making dietary changes. Stay away from certain foods and drinks that are known to irritate the bladder. These include caffeine, alcohol, spicy foods, citrus foods, and chocolate.

• Exercising your pelvic muscles. This can help strengthen pelvic muscles used when you pee. These exercises are called Kegels. They include contracting as if you were stopping your urine stream. And tightening your rectum as if trying not to pass gas. Your provider can help you learn how to do Kegels.

• Biofeedback. This can help you learn to control the movement of your bladder muscles. Sensors are placed on your belly. They turn signals given off by your muscles into lines on a computer screen.

• Medicine. This may be given to relax the bladder muscle. Medicine can also help ease bladder contractions. This reduces the urge to urinate. You may need to take medicine for months or years.

• Neuromodulation. This may be done if medicine and behavioral changes don’t work. Electrical pulses are sent to the nerves that affect the pelvic area (sacral nerves). These pulses help relieve OAB and urge incontinence.

• Botulinum toxin shots. These can be injected into the muscle of the bladder to relax the muscles.

• Surgery. When less invasive treatments don't work, surgery to make the bladder larger may be done in severe cases.

With treatment, OAB can be managed. You may need to continue muscle-strengthening exercises and make changes in your daily routine. This may include going to the bathroom more often than you think you need to or developing a timed schedule. Your healthcare provider can tell you more.

Medicines for bladder control generally work by blocking signals that may cause muscle spasms in the bladder. A group of drugs called antispasmodics are usually the first drugs your doctor will consider for treating bladder control problems. Another group of medicines, called tricyclic antidepressants, may be considered, although these drugs are primarily intended to treat depression. Tricyclic antidepressants can calm nerve signals and decrease spasms in the bladder muscles.

Antispasmodics

Extended-release forms of oxybutynin and tolterodine are now available.

Oxybutynin also comes in a patch that may decrease the side effects.

Side effects. Antispasmodics can cause your eyes to become sensitive to light. These medicines also keep you from sweating and can cause dry mouth. If you take any of these medicines, you may need to take a few steps to deal with side effects.

• Wear sunglasses if your eyes become more sensitive to light.
• Take care not to become overheated.
• Chew gum or suck on sugarless hard candy to avoid dry mouth.

Tricyclic Antidepressants

Side effects. Tricyclic antidepressants can cause your vision to blur when you read, dry mouth, constipation, and light-headedness when you stand after sitting.

Antidiuretic

Desmopressin is a man-made form of a natural hormone that your body makes. The hormone, called antidiuretic hormone (ADH) or vasopressin, directs the kidneys to make less urine. The urine is therefore more concentrated. Desmopressin is not usually prescribed for adult women with overactive bladder or stress incontinence. It is more often used to treat bedwetting in children. It is also used to treat a condition called diabetes insipidus.

Side effects. Desmopressin rarely causes side effects, but you should call your doctor if you have headaches, stomach cramps, nausea, reddening of the skin, a stuffy or runny nose, or pain in the genital area.

Interstitial Cystitis Medicine

Pentosan is approved to treat the symptoms of bladder pain, urinary frequency, and urinary urgency that characterize interstitial cystitis, also known as painful bladder syndrome. Doctors do not know exactly how it works, but one theory is that it may repair defects that might have developed in the lining of the bladder.

Side effects. Pentosan's side effects are limited primarily to minor gastrointestinal discomfort. A small minority of patients experience some hair loss, but hair grows back when they stop taking the drug. Researchers have found no negative interactions between pentosan and other medications.

Your doctor will order regular blood tests to monitor your liver function while you take pentosan.

Because pentosan has not been tested in pregnant women, the manufacturer recommends that it not be used during pregnancy, except in the most severe cases.

People rarely talk about bladder health, but everyone is affected by it. Located in the lower abdomen, the bladder is a hollow organ, much like a balloon, that stores urine. Urine contains waste and extra fluid left over after the body takes what it needs from what we eat and drink. Each day, adults pass about a quart and a half of urine through the bladder and out of the body.

As people get older, the bladder changes. The elastic bladder tissue may toughen and become less stretchy. A less flexible bladder cannot hold as much urine as before and might make you go to the bathroom more often. The bladder wall and pelvic floor muscles may weaken, making it harder to empty the bladder fully and causing urine to leak.

While you can’t control everything that affects your bladder, here are 15 steps you can take to keep it as healthy as possible:

1. Use the bathroom often and when needed. Try to urinate at least once every 3 to 4 hours. Holding urine in your bladder for too long can weaken your bladder muscles and make a bladder infection more likely.
2. Be in a relaxed position while urinating. Relaxing the muscles around the bladder will make it easier to empty the bladder. For women, hovering over the toilet seat may make it hard to relax, so it is best to sit on the toilet seat.
3. Take enough time to fully empty the bladder when urinating. Rushing when you urinate may not allow you to fully empty the bladder. If urine stays in the bladder too long, it can make a bladder infection more likely.
4. Wipe from front to back after using the toilet. Women should wipe from front to back to keep gut bacteria from getting into the urethra. This step is most important after a bowel movement.
5. Urinate after sex. Sexual activity can move bacteria from the bowel or vaginal cavity to the urethral opening. Both women and men should urinate shortly after sex to lower the risk of infection.
6. Do pelvic floor muscle exercises. Pelvic floor exercises, also known as Kegel exercises, help hold urine in the bladder. Daily exercises can strengthen these muscles, which can help keep urine from leaking when you sneeze, cough, lift, laugh, or have a sudden urge to urinate. These exercises also may help avoid infections by strengthening the muscles that help empty the bladder.
7. Wear cotton underwear and loose-fitting clothes. Wearing loose, cotton clothing will help keep the area around the urethra dry. Tight-fitting pants and nylon underwear can trap moisture and help bacteria grow.
8. Exercise regularly. Physical activity can help prevent bladder problems as well as constipation. It can also help maintain a healthy weight.
9. Keep a healthy weight. People who are overweight may be at higher risk for leaking urine. Making healthy food choices and being physically active can help keep a healthy weight.
10. Watch what you eat. Some people with bladder problems find that some foods and drinks, such as sodas, artificial sweeteners, spicy foods, citrus fruits and juices, and tomato-based foods, make bladder problems worse. Changing your diet may help you feel better.
11. Drink enough fluids, especially water. More than half of the human body is made up of water, so it is important that you are drinking enough. How much water you need can vary based on your size, activity level, and where you live. In general, drink enough fluids so that you need to urinate every few hours. Some people need to drink less water because of certain conditions, such as kidney failure or heart disease. Ask your health care provider how much fluid is healthy for you.
12. Limit alcohol and caffeine. For many people, drinking alcohol can make bladder problems worse. Caffeinated drinks (like coffee, tea, and most sodas) can bother the bladder and increase symptoms such as frequent or urgent need to urinate. Cutting down may help.
13. Avoid constipation. Too much stool built up in the colon, called constipation, can put pressure on the bladder and keep it from expanding the way it should. Eating plenty of high-fiber foods like whole grains, vegetables, and fruits), drinking enough water, and being physically active can help prevent this from happening.
14. Quit smoking. Bladder problems are more common among people who smoke. Smoking can also increase the risk for bladder cancer. If you smoke, take steps to quit.
15. Know your medications. Some medications may make it more likely for your bladder to leak urine. Medications that calm your nerves so you can sleep or relax may dull the nerves in the bladder, and you may not feel the urge to go to the bathroom.