Irritable bladder also known as Overactive bladder is a problem with bladder-storage function that causes a sudden urge to urinate. The urge may be difficult to stop, and overactive bladder may lead to the involuntary loss of urine (incontinence).

If you have an overactive bladder, you may feel embarrassed, isolate yourself, or limit your work and social life. However, a brief evaluation can determine whether there's a specific cause for your overactive bladder symptoms.

Management of overactive bladder often begins with behavioral strategies, such as fluid schedules, timed voiding and bladder-holding techniques using your pelvic floor. If these initial efforts don't help enough with your overactive bladder symptoms, second line and third line treatments are available.

SYMPTOMS

With an overactive bladder, you may: feel a sudden urge to urinate that's difficult to control, experience urge incontinence — the involuntary loss of urine immediately following an urgent need to urinate, urinate frequently, usually eight or more times in 24 hours, awaken two or more times in the night to urinate (nocturia), although you may be able to get to the toilet in time when you sense an urge to urinate, unexpected frequent urination and nighttime urination can disrupt your life.

Although it's common among older adults, overactive bladder isn't a normal part of aging.

CAUSES.

The kidneys produce urine, which drains into your bladder. When you urinate, urine passes from your bladder through an opening at the bottom and flows out a tube called the urethra. In women, the urethral opening is located just above the vagina. In men, the urethral opening is at the tip of the penis.

As your bladder fills, nerve signals sent to your brain eventually trigger the need to urinate. When you urinate, nerve signals coordinate the relaxation of the pelvic floor muscles and the muscles of the urethra (urinary sphincter muscles). The muscles of the bladder tighten (contract), pushing the urine out.

Involuntary bladder contractions.

Overactive bladder occurs because the muscles of the bladder start to contract involuntarily even when the volume of urine in your bladder is low. This involuntary contraction creates the urgent need to urinate.

Several conditions may contribute to signs and symptoms of overactive bladder, including:

Neurological disorders, such as Parkinson's disease, strokes and multiple sclerosis, high urine production as might occur with high fluid intake, poor kidney function or diabetes, medications that cause a rapid increase in urine production or require that you take them with lots of fluids, acute urinary tract infections that can cause symptoms similar to an overactive bladder, abnormalities in the bladder, such as tumors or bladder stones, factors that obstruct bladder outflow — enlarged prostate, constipation or previous operations to treat other forms of incontinence, excess consumption of caffeine or alcohol, declining cognitive function due to aging, which may make it more difficult for your bladder to understand the signals it receives from your brain, difficulty walking, which can lead to bladder urgency if you're unable to get to the bathroom quickly Incomplete bladder emptying, which may lead to symptoms of overactive bladder, as you have little urine storage space left, Constipation and hormonal changes during menopause in women.

Often, the specific cause of an overactive bladder isn't known.

RISK FACTORS.

As you age, you're at increased risk of developing overactive bladder. You're also at higher risk of diseases and disorders, such as enlarged prostate and diabetes, which can contribute to other problems with bladder function.

Many people with cognitive decline — for instance, after a stroke or with Alzheimer's disease — develop an overactive bladder. Incontinence that results from situations like this can be managed with fluid schedules, timed and prompted voiding, absorbent garments, and bowel programs.

Some people with an overactive bladder also have bowel control problems.

COMPLICATIONS.

Any type of incontinence can affect your overall quality of life. If your overactive bladder symptoms cause a major disruption to your life, you might also have: Emotional distress, depression, sleep disturbances and interrupted sleep cycles.

Some women also may have a disorder called mixed incontinence, when both urge and stress incontinence occur. Stress incontinence is the loss of urine when you exert physical stress or pressure on your bladder, such as during activities that include running or jumping. Treatment of the stress incontinence is not likely to help the overactive bladder symptoms.

Older people may have a common combination of bladder storage and bladder-emptying issues. The bladder may cause a lot of urgency and even incontinence, but it doesn't empty well. A specialist may be able to help you with this combination of bladder problems.


TESTS AND DIAGNOSIS.

If you have an abnormal urge to urinate, your doctor will check to make sure that you don't have an infection or blood in your urine. Your doctor may also want to make sure that you're emptying your bladder completely when you urinate.
. The work-up will likely include a: Medical history, physical exam focusing on your abdomen and genitals, urine sample to test for infection, traces of blood or other abnormalities, focused neurological exam that may identify sensory problems or abnormal reflexes

Measuring urine left in the bladder is important if your bladder doesn't empty completely when you urinate or experience urinary incontinence. Remaining urine (postvoid residual urine) may cause symptoms identical to an overactive bladder.

To measure residual urine after you have voided, an ultrasound scan of your bladder is necessary.

Measuring urine flow rate. To measure the volume and speed of your voiding, you may be asked to urinate into a uroflowmeter. This device translates the data into a graph of changes in your flow rate.

TREATMENTS AND DRUGS.

Behavioral interventions. These are the first choice in helping manage an overactive bladder. They're often effective, and they carry no side effects. Behavioral interventions may include:

Pelvic floor muscle exercises. Kegel exercises strengthen your pelvic floor muscles and urinary sphincter. These strengthened muscles can help you stop the bladder's involuntary contraction. It may take as long as six to eight weeks before you notice a difference in your symptoms. If you're overweight, losing weight may ease your symptoms.

Weight loss may help if you also have stress urinary incontinence.

Fluid consumption. Your doctor may recommend that you cap the fluids you consume at a certain amount and may suggest appropriate times during which to consume them.

Double voiding. To help empty your bladder more completely, you wait a few minutes after urinating and then try again to empty your bladder again.

Scheduled toilet trips. Setting a schedule for toileting — for example, every two to four hours — gets you on track to urinate at the same times every day rather than waiting until you feel the urge to urinate.

Absorbent pads. Wearing absorbent pads or undergarments can protect your clothing and help you avoid embarrassing incidents, which means that you won't have to limit your activities. Absorbent garments come in a variety of sizes and absorbency levels.

Bladder training. Bladder training involves training yourself to delay voiding when you feel an urge to urinate. You begin with small delays, such as 30 minutes, and gradually work your way up to urinating every three to four hours. Bladder training is possible only if you're able to tighten (contract) your pelvic floor muscles successfully.

Medications. Medications that relax the bladder can be helpful for relieving symptoms of overactive bladder and reducing episodes of urge incontinence. These drugs include: Tolterodine, Mirabegron and Fesoterodine.

Common side effects of most of these drugs include dry eyes and dry mouth, but drinking water to quench thirst can aggravate symptoms of overactive bladder. Constipation — another potential side effect — can aggravate your bladder symptoms. Extended-release forms of these medications, including the skin patch or gel, may cause fewer side effects.

Treating the side effects of a medication that's working is more important than stopping the medication. For example, your doctor may recommend that you suck on a piece of sugar-free candy or chew sugar-free gum to relieve dry mouth, and use eye drops to keep your eyes moist.

Over-the-counter preparations, such as Biotene products, can be helpful for long-term dry mouth. To avoid constipation, your doctor might recommend a fiber-rich diet or use of stool softeners.

Bladder medications aren't likely to help with getting up during the night to urinate.

Nerve stimulation. Regulating the nerve impulses to your bladder can improve overactive bladder symptoms.

Surgery. Surgery to treat overactive bladder is reserved for people with severe symptoms who don't respond to other treatments. The goal is to improve the bladder's storing ability and reduce pressure in the bladder. However, these procedures won't help relieve bladder pain.  Interventions include:

LIFESTYLE AND HOME REMEDIES.

These healthy lifestyle choices may reduce your risk of overactive bladder:

Get regular, daily physical activity and exercise. Limit consumption of caffeine and alcohol. Quit smoking. Manage chronic conditions, such as diabetes, that might contribute to overactive bladder symptoms. Learn where your pelvic floor muscles are and then strengthen them by doing Kegel exercises — tighten (contract) muscles, hold the contraction for two seconds and relax muscles for three seconds. Work up to holding the contraction for five seconds and then 10 seconds at a time. Do three sets of 10 repetitions each day.

COPING AND SUPPORT

Living with overactive bladder can be difficult. Support groups offer the opportunity to voice concerns, learn new coping strategies, and stay motivated to maintain self-care strategies.

Educating your family and friends about overactive bladder and your experiences with it may help you establish your own support network and reduce feelings of embarrassment. Once you start talking about it, you may be surprised to learn how common this condition really is.