Managing "Urge Incontinence"

By Judy Kirkwood

If you experience the urge to urinate day and night, even though you just went to the bathroom, you may have Overactive Bladder (OAB). A collection of urinary symptoms, the most prominent being an uncontrollable urge to urinate even though the bladder isn’t full, OAB affects millions of Americans. Although up to 40 percent of American women and 30 percent of men have been identified with OAB, there may well be more people who suffer from it because people don’t like to discuss this kind of problem.

The American Urological Association Foundation says it’s time to talk about Overactive Bladder and has created an educational website that offers support and tools for dealing with OAB: www.ItsTimeToTalkAboutOAB.org. In fact, the American Urological Foundation is kicking off a national contest via Facebook to encourage more women to (anonymously) share their stories about living with OAB. The three most inspiring stories submitted before the 8/31/12 deadline will win a tablet PC (go to www.facebook.com/voicesofoab to enter).

OAB is not the same as stress incontinence, which is leakage due to pressure on the pelvis from laughing, exercise, or sex. This condition has been worked into TV shows as one of the humorous aspects of post-partum recovery or of growing older. But OAB is no laughing matter. Also called “urge incontinence,” OAB is more sporadic and unexpected than stress incontinence, says Dr. Lisa Hawes, a specialist in female urologic conditions. “With OAB, women have no control or warning as there is no pressure on the abdomen.” Although we don’t hear as much about it, more women suffer from this kind of incontinence than stress incontinence, points out Hawes.

We’ve all experienced having to urinate more frequently when we’re excited or nervous, but what if it was happening 24/7? Although running to the bathroom all the time isn’t a life-threatening issue, it can curtail activities and negatively impact quality of life. Areas that suffer are sleep, which affects work; self-esteem, which affects relationships; and sexual performance, since the urge to urinate is ever-present. Some people restrict themselves to their homes or familiar surroundings because they are so nervous about not finding a bathroom when they need it.

The treatment for OAB is lifestyle change, including diet, behavioral therapy, and fluid management, as well as bladder training or pelvic floor muscle exercises. Some patients may require medications, called anti-muscarinics, or other treatment options.

“Overactive bladder can be triggered by diet and anxiety,” says Dr. Hawes. “It can also be muscular in origin due to muscle hyperactivity or nerve damage. Typically OAB is slowly progressive and does not resolve without lifestyle changes or possibly medical intervention.”

Diet changes include eliminating caffeine, which increases bladder activity: no caffeinated sodas, coffee, or tea. Alcohol is both a bladder stimulant and diuretic. Artificial sweeteners increase bladder activity as well. Foods that are highly acidic, loaded with sugar, or especially spicy may need to be eliminated, one by one. Increased water intake is preferred even though it means an increase in urine. The less concentrated the urine, the less chance of irritation to the bladder.

“The first physician to approach about these issues is your primary care doctor or OB/Gyn,” advises Hawes. “Often they will initiate discussion about diet and behavior changes, physical therapy, and even first-line medications. If these efforts prove insufficient, a urologist should be consulted.”

The “It’s Time to Talk About OAB” website offers a Bladder Diary to record how much you drink, how often you go to the bathroom, and when you have leakage so you can accurately present symptoms to your healthcare provider. A free Apple or Android app is also available.

The condition is manageable, but the first step is speaking up.