Irritable Bladder – Causes, Symptoms, and Treatment for Urinary Urgency

An overactive bladder is a form of incontinence. Despite having a bladder that is not very full, those affected often experience a very sudden, urgent need to urinate.

This results in more frequent than average urination in small amounts (also known as pollakiuria). Involuntary urine leakage is also possible. Other terms for an overactive bladder include hyperactive or overactive bladder.

In an overactive bladder, the brain mistakenly receives the signal to empty the bladder even though it is not yet full. The bladder wall muscles contract, causing the sudden urge to urinate that is typical of an overactive bladder.

In general, a condition is considered an overactive bladder when the affected person

• more than eight times a day and
• more than twice a night

.

An overactive bladder is a common condition that can affect people of all ages and both genders. In Germany, millions of adults suffer from an overactive bladder.

However, women—especially those between the ages of 30 and 50—are affected far more frequently than men.

The exact causes of an overactive bladder are still unknown. In women, hormonal changes and imbalances during pregnancy or menopause may be responsible for an overactive bladder.

Other possible causes include exposure to cold and moisture, as well as psychological and emotional stressors such as

• stress,
• nervousness, and
• anxiety.

In addition, an overactive bladder can also occur as a side effect of diuretics or other medications.

Conditions in which an overactive bladder may occur as a concomitant symptom include

• cystitis,
• changes in the bladder lining,
• narrowing of the urethra and the bladder outlet, such as due to foreign bodies or tumors in the bladder or prostate, as well as
• neurological diseases and disorders such as multiple sclerosis.

In addition, the following conditions may also be potential causes of an overactive bladder:

• chronic infections,
• urinary stones,
• instability, overactivity, or dysfunction of the bladder muscle, as well as
• coordination problems in the pelvic floor and bladder muscles.

The main symptom of an overactive bladder is a sudden, urgent need to urinate, even though the bladder is only slightly full.

As a result, those affected urinate more frequently than average and pass only small amounts of urine each time. They often wake up at night to use the restroom. These sleep disruptions have a significant impact on their well-being.

Involuntary urination can also occur in those affected. This often happens during sudden physical exertion or jerky movements, such as when

• coughing,
• sneezing,
• laughing,
• lifting, or
• carrying.

This form of overactive bladder is also referred to as stress incontinence.

Frequent trips to the bathroom and disrupted sleep can dramatically impair quality of life.

A sudden, strong urge to urinate is the main symptom of an overactive bladder © 9nong | AdobeStock

The diagnosis is made through a process known as differential diagnosis. The treating urologist conducts a series of tests for this purpose. The goal is to rule out organic or physical causes of the symptoms. Ultimately, an overactive bladder is the only remaining diagnosis.

The tests performed as part of this process of differential diagnosis include, among others,

• a thorough urological or gynecological examination,
• a urinalysis,
• a urethral swab,
• a blood test
• and an ultrasound or X-ray of the urinary tract and bladder.

In addition, bladder pressure can be measured. This helps determine how much urine the bladder can hold and whether the bladder muscles are functioning properly.

Keeping a voiding diary can also be helpful in making a definitive diagnosis of an overactive bladder. In this diary, the patient notes, among other things, in which situations and how often the urge to urinate occurs, as well as how much they drink each day.

Various measures can be considered for treating an overactive bladder. These include targeted pelvic floor exercises as well as so-called bladder or continence training.

For many people, psychological or emotional stress or conflict situations trigger a sudden urge to urinate. Therefore, psychotherapy may also be helpful in some cases.

In addition,

• medications,
• relaxation exercises, and
• warm sitz baths 

can alleviate the symptoms of an overactive bladder.

One effective way to prevent an overactive bladder is

• losing excess weight,
• quitting smoking, and
• avoiding excessive alcohol and coffee consumption.

Bladder or Continence Training

The goal of bladder training or continence training is for those affected to specifically train their bladder muscles. This helps them learn to control their urge to urinate.

As part of this training, the person deliberately suppresses the urge to urinate. In this way, they try to delay going to the bathroom and emptying their bladder for as long as possible.

In addition, they set regular times to use the restroom.

In the case of an overactive bladder, the bladder muscles can also be trained by drinking plenty of fluids. This helps the person increase their bladder’s capacity.

Medication

Medications can also provide relief for an overactive bladder and improve bladder function. These include, among others, herbal supplements such as capsules containing

• cranberry,
• bearberry leaves, or
• ingredients derived from pumpkins.

So-called anticholinergics or antispasmodics are also often used to treat an overactive bladder. They are intended to relax the bladder muscles.

Anticholinergics are medications that act on the bladder muscles and the nervous system, thereby relieving spasms in the bladder muscles. Antispasmodics are medications that reduce the bladder muscle’s tendency to contract. For women with an overactive bladder, treatment with estrogen-containing medications is also an option.

What is an overactive bladder?
An overactive bladder is a functional disorder of the bladder characterized by frequent and sudden urges to urinate. An overactive bladder often leads to a constant need to use the restroom, even when only a small amount of urine is present. Many people affected find the symptoms of an overactive bladder highly distressing.

What are the symptoms of an overactive bladder?
Typical symptoms of an overactive bladder include frequent urges to urinate, nighttime trips to the bathroom, and difficulty urinating. Some patients also suffer from urge incontinence or involuntary bladder leakage. The symptoms of an overactive bladder can significantly impair quality of life.

What causes an overactive bladder?
The exact causes of an overactive bladder are not always clear. Bladder muscles, menopause, estrogen deficiency, or psychosomatic factors often play a role. Bladder infections, bladder stones, diuretic beverages, or spicy foods can also trigger or exacerbate an overactive bladder.

How is an overactive bladder treated?
Bladder training, pelvic floor exercises, and medication are commonly used to treat an overactive bladder. Anticholinergic medications or botulinum toxin help calm the bladder muscle and relieve a strong urge to urinate. In severe cases, electrical stimulation or sacral neuromodulation may be used.

Is an overactive bladder curable?
Whether an overactive bladder is curable depends on the cause and course of the condition. Many patients experience significant improvement through treatment for an overactive bladder, home remedies, and changes in bladder function. Regular diagnostic testing, a physical examination, and, if necessary, a cystoscopy performed by a urologist are important.