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Overactive Bladder and Incontinence: What to Know

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Posted by Joshua Cohn, MD, FPMRS

Bladder problems, such as overactive bladder (OAB) or urinary incontinence, affect millions of Americans. But many patients are hesitant to bring them up when they talk to their doctors. They may not feel comfortable talking about the issues they are having. They’re not alone — bringing up bathroom issues makes many of us a little red in the face.

As a physician who specializes in the urinary tract, helping patients with issues like incontinence is a big part of my job. One of my goals as a urologist is to encourage more people to be open with their doctors about urinary problems. That starts with understanding your symptoms and what they might mean — and knowing that treatment can help.

Urinary incontinence and OAB are two of the most common conditions that can affect normal urination. Many patients confuse these terms, though. It’s important to understand the differences and explain how both can be managed.

Both conditions have some things in common, and sometimes a person can have both. Still, they're not quite the same thing. OAB involves the urge to urinate, whereas urinary incontinence involves involuntary urination.

So, let's take a closer look at these two closely related conditions. Understanding the details of each can help you discover what you might be dealing with and what your provider can do to help you feel better.

Understanding overactive bladder

If you have a frequent, immediate need to urinate, you may have OAB.

When I talk to my patients about OAB, I often start by explaining what the urinary tract is and how it typically functions. The urinary tract includes the kidneys and bladder, which work to process and eliminate waste products from the body. Each day, the kidneys produce 1 to 2 quarts of urine, which travels through tubes, called ureters, to the bladder. When the bladder is about halfway full, the brain gets the message that it may be time to use the bathroom. When a person is ready to urinate, the bladder muscles contract, the sphincter muscles relax, and urine is released.

This system goes awry with OAB. Instead of the bladder muscles contracting only when the bladder is close to full, they may contract involuntarily even when the bladder contains only a little bit of urine. This can create a sudden, intense urge to urinate — even if you just went a little while ago.

You may have OAB if you:

  • Need to urinate eight or more times per day.
  • Need to urinate two or more times a night.
  • Frequently have sudden, strong urges to urinate. These urges can sometimes be triggered by the sound of running water, pulling into your driveway, or opening the front door.
  • Experience incontinence after a sudden need to urinate.

Understanding urinary incontinence

If you leak urine after experiencing a strong urge to go (or when you laugh or cough), you likely have urinary incontinence — and you are not alone. As many as 1 in 3 Americans experience urinary incontinence.

Urinary incontinence is basically a loss of bladder control. It can involve just a few drops of urine or can be enough to saturate your clothing. It can be caused by other conditions, such as weakness of the muscles that support and close the urethra (urine tube that you urinate through) or damage to nerves or the bladder muscle.

Many factors can increase the risk of developing urinary incontinence, including:

Anyone can experience urinary incontinence, but women are twice as likely to develop urinary incontinence as men, especially after menopause. The female urethra is shorter, and there is less muscle holding urine in until it is ready to be released. That means any damage or weakness is more likely to cause incontinence. And pregnancy, childbirth, and menopause all affect the pelvic muscles and raise the risk of incontinence.

Treating OAB and incontinence

OAB and incontinence are common, but they are not an inevitable part of life or aging. One of the best parts of my work is helping my patients feel more in control of their body — and their life. That’s why I encourage people to tell their doctor about any urinary problems they have. Plus, seeking treatment for OAB or incontinence in its early stages may help keep the problem from getting worse.

For many of my patients, that treatment starts with at-home strategies. I'll often recommend that patients with OAB or incontinence:

  • Use the bathroom at set times. We call this bladder training or timed voiding.
  • Practice pelvic floor exercises. Pelvic floor exercises, such as Kegel exercises, can strengthen the bladder and reduce urges and leakage. They involve tightening and relaxing the pelvic muscle, and they can be done by both women and men. These are recommended to help with urine leak caused by coughing or sneezing and to help with sudden urinary urgency. However, in women with pelvic muscle pain, Kegel exercise can make the problem worse and are not recommended.
  • Maintain a healthy weight. Excess weight can make it harder to control OAB or incontinence.
  • Manage underlying conditions. Uncontrolled diabetes or high blood pressure can worsen bladder problems.
  • Cut back on alcohol and caffeine. Both can irritate an overactive bladder and cause the kidneys to make more urine.
  • Eat a fiber-rich diet. Constipation can worsen incontinence.
  • Use absorbent products. Minor leakage can sometimes be managed with pads or protective garments.

When lifestyle changes don’t help, I typically recommend more advanced therapies. The options include:

  • Medications. Drugs to calm the bladder muscles and nerves can often be effective in treating OAB. For men, medications can shrink the prostate and improve the flow of urine.
  • Medical devices. For women, a vaginal ring or tampon-like device called a pessary can press against the bladder and urethra to provide added support and reduce leakage.
  • Interventional therapies. Injections of Botox and bulking materials, like Bulkamid, can stop or reduce leakage.
  • Electrical stimulation. Here, electrical pulses are used to normalize the bladder's reflexes.
  • Surgery. Surgical procedures can address or correct the underlying causes of incontinence by removing a blockage, enlarging the bladder, or supporting its optimal positioning, for example.

Treatment can help you take control of your symptoms

The urologists at Temple are experienced in managing a wide range of bladder and urinary problems. We work with you to find the best solution for your needs, including advanced therapies. If you are living with OAB or incontinence, specialized care can improve your quality of life. Schedule your appointment online or call 800-TEMPLE-MED today.

Helpful Resources

Looking for more information?

Joshua Cohn, MD, FPMRS

Dr. Cohn is a urologist specializing in the medical, procedural, and surgical management of urinary symptoms in men and women including urinary leakage and difficulty urinating, female urethral disorders, pelvic organ prolapse, and bladder dysfunction caused by a neurologic condition, injury, or cancer treatment.

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