We’ve all had that feeling of really needing to go to the bathroom, but for most people, it’s something that only happens on long road trips or when you’re consuming that extra-large soda during a three-hour movie. For some, however, that feeling of needing to go urgently happens all the time.
The condition is overactive bladder, “a constellation of symptoms that’s described by urinary urgency, urinary frequency, nocturia — which means you’re getting up multiple times overnight to void your bladder — and some people have leakage of urine,” said Dr. Sara Lenherr, an assistant professor of surgery in the Department of Surgery, Division of Urology, at the University of Utah.
“The main risks that we can identify are gender (it’s slightly more common in women), things like urinary tract infections, or other types of medical comorbidities,” such as being on a diuretic, or having diabetes, according to Lenherr. “A lot of times we just don’t know why some people would get overactive bladder versus others.”
Doctors will check to make sure that a patient’s overactive bladder isn’t linked to a more serious problem like bladder cancer, but for most people it’s a quality of life issue — frequent bathroom trips during the day and night, and suffering from urinary leakage and other symptoms can be a hassle and an embarrassment.
An assessment usually starts with questions to find out just how much it’s impacting your daily life. These questions are used to assess what Lenherr called a “bother score” to decide on treatment.
It’s also important to see a doctor about overactive bladder if it could affect your safety; for example, getting up multiple times during the night to urinate could put an elderly person at higher risk of a fall, or could prevent a person from getting deep, restful sleep.
“There are treatment pathways for overactive bladder that are well validated,” said Lenherr. “We rule out risk factors, look for things that could cause overactive bladder that are bad, and go through a least-invasive-to-most-invasive treatment pathway.”
The American Urological Association recommends patient education as first-line treatment. For example, talking to patients about things that can lead to more frequent or urgent urination, such as drinking a lot of caffeine, taking diuretics right before bed, or consuming beverages that are high in sugars or artificial sugars.
Even consuming lots of water isn’t always a great idea for someone with overactive bladder, says Lenherr. “You have to educate people that the bladder is still only a certain size, so if you’re drinking a lot of fluid you will have to pee more.”
Giving patients more information about simple things they can do to limit symptoms helps them feel empowered, and sometimes small changes to daily behaviors can take overactive bladder from a significant problem to a manageable issue.
Part of patient education is also letting people know they shouldn’t just hold it — the more you experience urinary urgency, the more irritated your bladder becomes, and the lower its tolerance for holding it in the future.
“I encourage patients to go before your bladder tells you to go — just like you tell your kids to go before you get in the car — even if they don’t think they need to go to avoid that episode of urgency,” said Lenherr.
It’s best to try and go on a schedule so you never have to hold it more than three to four hours. That time interval can be longer at night, since the body compensates and doesn’t make as much urine, but if you’re getting up more than once in the night to go on a regular basis, talk to your doctor.
If behavioral changes aren’t enough, the next step is medication. Physicians have long prescribed anticholinergics, which block a receptor in the bladder that contracts and alerts you to urinate. More recently, beta 3-receptor agonists became available and provide the same relief without some of the negative side effects.
“Anticholinergics can cause dry mouth, constipation, and specifically in the elderly, a safety issue, confusion and falls,” said Lenherr. “There is new evidence that was published in JAMA Internal Medicine in 2015 indicating that [these drugs can] cause long-term dementia.”
With fewer side effects and less risk of long-term impact, these medications are worth a try, says Lenherr. “Only a quarter of people who start anticholinergics are still on those medications at the end of one year. There’s a very high discontinuation rate because of the side effects.”
The third– and fourth-line treatments are more invasive, involving neuromodulation and potential surgery. They include Botox, which paralyzes the muscle in your bladder and reduces contractions that cause a feeling of urgency, and PTNS (percutaneous tibial nerve stimulation), which sends an electrical signal, up the tibia nerve through a small needle inserted near the ankle, and reprograms the bladder to reduce urgency, says Lenherr.
The most invasive surgical treatment options are rare, such as inserting a small electrical lead alongside the sacral spinal nerve three (S3) under the skin, similar to a cardiac pacemaker, or surgery to completely denervate the bladder and require the use of a catheter.
“We’re dealing with a quality of life issue most of the time, so it’s not something that we frequently do a huge surgery to make their bladder be completely dependent on a catheter or give them a big reconstruction, but those are options for extreme circumstances,” said Lenherr.
For those who are experiencing urgency, the first step is to talk to your doctor. He or she may have you keep a diary of your fluid intake, how often you need to void your bladder, and how urgently you feel the need to go. In addition to the treatment pathways that are available, there is some evidence that weight loss, physical therapy, and pelvic floor training can help relieve urgency symptoms and relax the bladder.
“Many people, women especially, feel like it’s just part of getting old, but it’s not something that just needs to be put up with,” said Lenherr. If you always feel like you need to go to the bathroom, visit a urologist today to find out what you can do to reduce or eliminate the symptoms.
Concerned about overactive bladder? Call 801-213-9500 to schedule an appointment at a University of Utah Health community clinic near you.