When you need to go, go, go

February 11, 2000
Web posted at: 3:08 PM EST (2008 GMT)

(WebMD) -- There you are in a deep sleep when it happens again. The mounting pressure on your bladder, the sensation to urinate, the inability to avoid leaking a little before making it to the bathroom. It happens several times a night. And you may have been living with this discomfort and inconvenience for years.

This frequent urge to urinate during the night or day, perhaps even to the point where it's almost impossible to "hold it," may be due to an overactive bladder. According to the American Foundation for Urologic Disease, overactive bladder affects about one out of every 11 adults, and this is likely an underestimate because many people are too embarrassed to talk about the problem with their doctor. Some people will also leak urine when they feel the urge to urinate, a condition called urge incontinence.

The condition often affects sleep quality, but it can be just as troubling during the day. "This translates to someone who can't go an hour or two without urinating, someone who constantly searches for bathrooms and plans outings based on this," says Dr. Kenneth Goldberg, a urologist in Dallas, Texas. "It's a problem that has serious impacts on lifestyle and quality of life. Some people are miserable. Most of the time we really don't know why it's occurring."

Bleak as this may sound, there's hope -- in the form of treatments and common-sense measures that can make life nearly normal again, or at least better.

Although researchers have not been able to nail down a single cause, some things are known. The symptoms of overactive bladder can be the sign of an underlying problem such as a urinary tract infection. When the infection is treated, symptoms will clear. But in many other cases, overactive bladder occurs when no other illnesses can explain it.

For instance, the condition is associated with the aging process, says Dr. Wendy Leng, a urologist at the University of California at San Francisco Medical Center. "Just as with other parts of the body, with wear and tear the bladder just doesn't perform its function as well as it used to."

Men with prostate conditions are more likely to have problems with urination. With women, postmenopausal hormonal changes, which can weaken tissue tone, and childbearing can play a role.

"Clearly there's a relationship between having kids and being incontinent," says Dr. Gary Leach, a urologist at Cedars-Sinai Medical Center in Los Angeles. This may be due to the downward pressure of the fetus pushing on the bladder, or to the vaginal birth process, which can damage muscles and nerves near the bladder and urethra, he says.

The most important step in finding the right treatment -- and getting life back to normal -- is receiving an accurate diagnosis. Provided you've seen your primary care doctor and the diagnosis still isn't clear, the next step is to see a urologist. Using blood, urine, and other tests, doctors will check for infection, cancer, and other illnesses associated with urinary problems.

Doctors will also ask about fluid intake and the typical number of your daily bathroom visits to get an idea of the scope of the problem. They may also do more specialized testing such as post-void residual measurement, which determines if any urine remains after you have attempted to empty your bladder.

If the diagnosis is overactive bladder, "something can be done," Leach says. "It's not something you have to accept."

Standard treatments include biofeedback training, in which patients gradually learn to tighten their bladder muscles. Medications can also help. Surgery, including a procedure to restore the support of the pelvic floor muscles, is another option.

Pelvic floor strengthening exercises, called Kegel exercises, can help. This involves contracting the pelvic floor muscles for a few seconds and repeating the exercise several times a day. . Some common-sense measures can also help. Avoid drinking beverages containing caffeine and alcohol, both of which are diuretics that prompt the body to urinate. Cutting down on liquids before bedtime is recommended. Some people with overactive bladder may take this step and still have problems, however.

The discomfort and inconvenience associated with overactive bladder can usually be reduced. Although people may be reluctant to discuss this problem with their physician, doing so can help them reclaim their quality of life.

Copyright 2000 by WebMD/Healtheon. All rights reserved.

RELATEDS AT :

Urinary Incontinence
Incontinence Can Be Controlled

National Association for Continence
American Urological Association

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