• What is an overactive bladder?
• What are symptoms of overactive bladder?
• What are treatments for overactive bladder?
• What are treatments for the chronically incontinent?
• Overactive Bladder At A Glance

What is an overactive bladder?

An overactive bladder is a condition that results from sudden, involuntary contraction of the muscle in the wall of the urinary bladder. Overactive bladder causes a sudden and unstoppable need to urinate (urinary urgency). Overactive bladder is also referred to as urge incontinence and is a form of urinary incontinence (unintentional loss of urine).

Overactive bladder is especially common in older adults. Overactive bladder affects an estimated 1 in 11 adults in the United States. Overactive bladder, however, should not be considered a normal part of aging.

What are symptoms of overactive bladder?

The symptoms of overactive bladder include frequent urination, urgency of urination, and urge incontinence. Overactive bladder may cause significant social, psychological, occupational, domestic, physical, and sexual problems. Again, these symptoms should not be considered a normal part of aging.

What are treatments for overactive bladder?

The treatment for overactive bladder depends on the capabilities of the patient. Here are commonly recommended treatments:

Pelvic Muscle Rehabilitation - to improve pelvic muscle tone and prevent leakage.

• Kegel exercises: Regular, daily exercising of pelvic muscles can improve, and even prevent, urinary incontinence. This is particularly helpful for younger women. Should be performed 30-80 times daily for at least 8 weeks.
• Biofeedback: Used in conjunction with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles.
• Vaginal weight training: Small weights are held within the vagina by tightening the vaginal muscles. Should be performed for 15 minutes, twice daily, for 4 to 6 weeks.
• Pelvic floor electrical stimulation: Mild electrical pulses stimulate muscle contractions. Should be done in conjunction with Kegel exercises.

Behavioral Therapies - to help people regain control of their bladder.

• Bladder training teaches people to resist the urge to void and gradually expand the intervals between voiding.
• Toileting assistance uses routine or scheduled toileting, habit training schedules, and prompted voiding to empty the bladder regularly to prevent leaking.

Medications For Overactive Bladder - to improve incontinence medically.

• Oxybutynin (brand name: Ditropan) prevents urge incontinence by relaxing sphincter muscles.
• Tolterodine (brand name: Detrol, Detrol LA) is indicated for the treatment of an overactive bladder with symptoms of urinary frequency, urgency, or urge incontinence.
• Estrogen, either oral or vaginal, may be helpful in conjunction with other treatments for postmenopausal women with urinary incontinence.

What are treatments for the chronically incontinent?

Although many people will improve their continence through medications, pelvic muscle exercises, and bladder training, some will never achieve complete dryness. Sometimes treatment failures are due to concurrent use of necessary medications, such as diuretics (water pills that increase urination) that actually can cause incontinence. Others may have dementia or other physical impairments that keep them from being able to perform pelvic muscle exercises or retrain their bladders. Many will be cared for in long-term care facilities or at home. The following recommendations can help keep the chronically incontinent drier and reduce their cost of care:

• Scheduled toileting - take people to the toilet every 2 to 4 hours or according to their toilet habits.
• Prompted voiding - check for dryness and encourage use of the toilet.
• Improved access to toilets - use equipment such as canes, walkers, wheelchairs, and devices that raise the seating level of toilets to make toileting easier.
• Managing fluids and diet - eliminate dietary caffeine (for those with urge incontinence) and encourage adequate fiber in the diet.
• Disposable absorbent garments - use to keep people dry.

Overactive Bladder At A Glance

• Overactive bladder results from sudden, involuntary contraction of the muscle in the wall of the urinary bladder.
• Overactive bladder is a form of urinary incontinence.
• Overactive bladder is not a normal part of aging.
• Treatments available for overactive bladder include pelvic muscle strengthening, behavioral therapies, and medications.

Medical Author: William C. Shiel Jr., MD, FACP, FACR
Medical Editor: Dennis Lee, MD

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