**By Una Lee, MD**
The bladder is an organ that you don’t really think about, until it stops working well. When all goes as planned, your bladder stores urine and empties on your schedule, not interfering with daily life. However up to 40 percent of women and 30 percent of men suffer from “overactive bladder,” or a frequent urge to urinate that disrupts everyday activities. The urge can come on so strong that people with overactive bladder may live in fear of having an accident trying to reach the bathroom. One of my patients tells me that when she’s rushing to the bathroom, her little dog knows to get out of the way!
Overactive Bladder: What to Try First
The first line of defense is to moderate fluid intake. If you tend to drink “gallons” of water, you will make “gallons” of urine and have to urinate more frequently. If you drink several cups of coffee, or caffeinated energy drinks, your sense of urinary urgency will increase because caffeine irritates the bladder. Alcohol is also a bladder irritant, so reducing or eliminating these beverages will help with bothersome bladder symptoms.
Another exercise to try is “urge suppression.” When you get the urge to urinate and want to delay the urge, squeeze your pelvic floor muscles five times fast (the same muscles that stop the flow of urine). This will send a message to your brain that you want to postpone urination. Also, try moving your attention to physical sensations, like your breathing, the feeling of the bottoms of your feet as you walk, or how your chair feels, helping to break the cycle of urgency by focusing your mind. Then walk to the bathroom without being stressed, with more control of your bladder urges. Mind over matter can work better than the pee-pee dance!
When to Get Professional Help
So what if you’ve sworn off excess water and double-shot espressos but your bladder is still screaming it’s time to go? The variety of therapies that successfully treat overactive bladder might surprise you. Two of the least invasive treatments are bladder training and pelvic floor physical therapy. Bladder training mainly involves urinating on a schedule and delaying urination incrementally, until the bladder learns a “new normal.” Pelvic floor physical therapy is guided by a physical therapist who helps patients identify the muscles that control the flow of urine, followed by targeted strengthening exercises.
Other medical therapies to treat overactive bladder include:
- Specialized medications. These drugs work on receptors in the bladder to decrease urgency and frequency, including incontinence associated with urgency.
- Tibial nerve stimulation. It may sound like science fiction, but stimulating the tibial nerve near the ankle with a mild electrical current can relieve overactive bladder symptoms. Using an acupuncture-like needle, the nerve is gently stimulated for 30 minutes once per week for 12 weeks. This works because the signals travel up the leg and to the brain and bladder, and most patients experience decreased urgency, frequency and incontinence following treatment.
- Botox® injections. Yes, the same Botox used to smooth wrinkles can be injected into the bladder, often significantly decreasing overactive bladder symptoms.
- The bladder “pacemaker.” An implantable device may be an option for some patients. Known as Interstim®, it works by way of a thin pacemaker wire we place near the nerves of the bladder (and bowel) to improve overactive bladder, urinary retention, and fecal incontinence. The gentle stimulation of the nerves blocks faulty signals and relieves symptoms.
With a better understanding of what causes overactive bladder, treatments have improved dramatically in recent years to help more people overcome this frustrating condition. My patients who have been successfully treated for their overactive bladder symptoms describe a deep sense of relief and freedom: no more pads to wear, constantly searching for bathrooms and embarrassment over an accident. Many describe their happiness to just feel normal again. Now that their bladder symptoms are under control, they report enjoying doing the things they used to do. That’s why I love my job. And that’s why your bladder matters.
Una Lee, MD, is board certified in Urology and subspecialty certified in Female Pelvic Medicine and Reconstructive Surgery at Virginia Mason.