The urinary system is composed of two kidneys, two ureters, a bladder, and a urethra. The kidneys remove waste products from the blood and continuously produce urine. The muscular, tube-like ureters move urine from the kidneys to the bladder, where it is stored until it flows out of the body through the tube-like urethra. A circular muscle, called the sphincter, controls the activity of the urethra and keeps urine in the bladder until it is time to urinate.  

In a normal person without overactive bladder, the bladder wall is relaxed while storing (or filling with) urine and the urethra is closed off by the sphincter. Muscles of the pelvic floor also make a contribution to keeping the bladder outlet closed during filling by supporting the urethra. 

When the bladder is properly under control, we pass urine by a process which starts with a deliberate decision. Signals first move from the bladder up the spinal cord to the brain and inform us first subconsciously and then consciously about how full the bladder is. At the same time during storage, messages pass from the brain down the spinal cord and out through nerves that run through the pelvis to activate the sphincters and keep them closed and prevent the bladder muscle from contracting.  

When the bladder is full, we assess the social appropriateness of passing urine (a complicated neurological process in itself!) and consider if the time and place are right. If so, we switch on a program of activity which causes the pelvic floor as well as muscles at the outlet of the bladder to relax and open up. As this occurs, the muscle in the wall of the bladder (detrusor muscle) begins to contract and continues contracting until the bladder is completely emptied.  

The process of bladder filling and emptying is very complex. When any part of the urinary system or pelvic floor does not work correctly, incontinence can result. 

Prevalence

An estimated 33 million people in the United States suffer from an overactive bladder and an estimated 12.2 million of these adults have urge incontinence.¹ Although overactive bladder is most common among older adults and women, it does not discriminate. In fact, starting at age 60, men who report symptoms of overactive bladder begin to outnumber women who do so, with about 42% of men over age 74 reporting symptoms compared with 32% of women in the same age group.² Anyone, at any age, can suffer from the symptoms of this problem.

Research indicates that most people believe the symptoms of an overactive bladder (urgency, frequency, and/or urge incontinence) are an inevitable and normal part of growing older, rather than a treatable medical problem. They do not mention their symptoms to a doctor, assuming nothing can be done about the condition. Fewer than half of individuals with incontinence actually consult a healthcare provider about their problem. And healthcare providers often don’t ask patients about these symptoms. In fact, NAFC research revealed that 9 out of 10 patients who discussed their OAB symptoms with their doctor disclosed that they were the party initiating the discussion, as opposed to the physician.²

Job Security Endangered 

• Regular absences from work
• Frequent breaks while at work  
• Having to make unplanned toilet trips while driving
• Inability to concentrate

Vitality Fatigue 

• Disturbed sleep due to regular nighttime trips to the bathroom, resulting in constant tiredness  

Psychological Problems, Psychological well-being damaged  

• Depression, loss of self-confidence, guilt and fear of being a burden 
• Anxiety of over the potential of a public accident
• Embarrassment and concern of public disclosure
  

Living this way is not only unnecessary, but can cause physical and emotional problems. Untreated overactive bladder can take a toll on almost every aspect of life: relationships, fitness and recreational activities, social life, work productivity and career prospects. Overactive bladder is a common problem, but it should not be accepted as a normal part of anyone's life. It is important to remember that if you or someone you know has overactive bladder, you are not alone.

OAB in Children

While the majority of children have voluntary control of bladder fullness between 2 and 4 years old, children of all ages can experience symptoms of overactive bladder. OAB in children is most prevalent in children ages 5 to 7, and is most commonly observed in girls.  

Clinical evaluation of childhood OAB and urge incontinence is unique from adult OAB because a couple of factors must first be considered:

• whether the parent or child is most concerned by the symptoms of OAB, 
• and whether the child’s symptoms are medically or socially related. A mental health assessment may be needed to eliminate psychological problems as the basis for symptoms (ie., divorce, family death, stress at school, etc. )  

And, similarly to evaluating OAB in adults, a doctor must determine whether or not symptoms are present during the day, during the night, or during both day and night. Additionally, doctors need to assess the child’s bowel health, as constipation can cause overactive bladder. If the child is not having daily bowel movements of a reasonable size, then treating constipation needs to be a part of the initial treatment.  

If a child is diagnosed with OAB, treatment may involve a combination of behavioral and pharmacologic therapy. First, dietary changes may be needed, such as minimizing caffeine intake to reduce any stimulatory effect that it might have on the bladder. In general, behavioral approaches that include parental involvement and focus on rewards and/or goals often work well in children. For example, a parent may reward a child with a prize for each day that he or she voids every three hours, in an effort to establish a regular voiding routine. Additionally, doctors may prescribe medication for children. Some medications used in adults have been shown to be both effective and safe in children. One anticholinergic medication used in adults, oxybutynin, is available in liquid form for children who have trouble swallowing pills.

If children are not successful with either behavioral therapy and/or medication, more aggressive therapy may be recommended, such as intermittent catheterization, urethral dilatation, and augmentation.

Both OAB and urge incontinence are treatable in children and efforts made to address both conditions should always be positive and encouraging. Children should never be blamed or ridiculed for their symptoms. To read about pediatric bedwetting, click here.

How to Prepare for a Doctor's Appointment

 
If you have a bladder control problem, a variety of medical professionals can assist you in addressing the problem. You can seek help from a urologist, primary care physician, geriatrician, urogynecologist, gynecologist, pediatrician, nurse practitioner, physician’s assistant, neurologist, occupational therapist, physical therapist, or continence nurse specialist. All of these medical professionals can recommend or perform tests to decide the best way to improve your condition. Not all, however, will necessarily be well versed in treatment options or trained in how to deliver the best treatments. In many instances, you may benefit most from a team of experts.

If you would like to search for a continence care specialist in your area, visit the NAFC homepage and search our Find An Expert database by your zip code (www.nafc.org). We encourage you to make an appointment so can get on a path to treatment.
Once you make an appointment, please review the six tips we’ve listed for you to prepare for your doctor’s appointment.

#1. Fill out the Overactive Bladder Awareness Tool form and NAFC’s bladder diary to take with you to your appointment.

In preparation for your appointment, download the PDF below, answer the questions, and give it to your doctor when you see him/her for your first visit.
Overactive Bladder - Validated 8-question Awareness Tool (Pfizer Inc, New York, NY.)
Also download and fill out NAFC's bladder diary for about 2 days before your appointment so that you can record your symptoms.

#2 – Make a list of all of your doctors and medical conditions.

Take a list of all your doctors, medical conditions, such as diabetes, sleep disorders, or heart problems, to your appointment.

• If you suspect you may be experiencing mixed incontinence (both stress and urge incontinence) be sure to communicate both of these symptoms.
• For men, be sure to ask your healthcare provider if an enlarged prostate may be the cause of your urinary urgency and/or frequency.
• For women, talk to your provider about the possibility of pelvic organ prolapse contributing to your symptoms.
• If constipation may be a factor, speak to your doctor about possible remedies.

#3 – Complete a list of any operations or procedures you have had.

Take a list of any operations or procedures you have had (at least in the past 10 years) and when you had them.  

Women should list their:

• number of pregnancies,
• number of deliveries, 
• weight of their babies, and whether they were delivered vaginally or by Caesarean section.   

#4 - Show the doctor all your medications.  

We suggest you get three food-storage size bags. In one, put all the prescription medicines you are taking that have been prescribed or refilled during the last 30 days. In the second bag, put all the prescriptions that you keep in the house but that you don't take regularly. In the third, put all the over-the-counter medicines, vitamins, and other supplements that you take. 

#5 - Be prepared to describe how incontinence affects your daily life.

Make a list of the most bothersome problems related to your incontinence.

#6 – Be prepared for your appointment.

On the day of your appointment, expect to be asked for a urine specimen. Talk with the doctor's receptionist when you make the appointment and when you arrive, to see if there are tests, or preparations for tests, that you should know about, eg. fasting after midnight. 

Treatment

Overactive bladder and urge urinary incontinence are generally treated with one or a combination of two or more approaches:

• Behavioral approach: dietary changes, fluid management, pelvic muscle exercises, biofeedback, and/or bladder retraining
• Drug therapy
• Percutaneous tibial nerve stimulation
• Sacral nerve stimulation
  

Dietary Changes  

There is no “diet” to cure incontinence. However, there are certain dietary matters you should know about, as diet can have a profound effect on your voiding patterns. There are symptoms you may be able to manage just by altering your diet. You may want to complete a bladder diary and monitor your food and fluid intake to see if you are able to find any relationship between
your intake and urination.  

Remember that certain “natural” or “energy” supplements may also contain ingredients that irritate the bladder, so read labels carefully. You may want to see if eliminating one or all of the items discussed in this section improves your bladder control.

• Caffeine is a powerful substance that can increase bladder activity. It is naturally present in coffee beans, tea leaves, and cocoa beans. Drinking sodas, coffee, tea, eating foods, or consuming over-the-counter medications that contain caffeine may result in urgency, frequency, and/or incontinence. Studies have demonstrated that individuals with bladder symptoms who have reduced caffeine intake to less than 100mg/day noted improvement in symptoms. If you choose to limit products containing caffeine, do so slowly over a period of several weeks, as strong headaches may result during the withdrawal period.
• Alcohol has also been shown clinically to act as a bladder stimulant, triggering symptoms of urgency. In addition, it acts as a diuretic and may induce greater frequency of urination.
• Artificial sweeteners (sodium saccharine, acesulfame K, and to a lesser degree aspartame) have been shown in limited studies to negatively affect bladder function. In research, episodes ofIdaytime frequency of urination, urgency, and nocturia all increased with the consumption of dietary beverages compared to drinks with sugar or unsweetened. 

While not demonstrated scientifically, other foods and beverages are thought to contribute to bladder control problems in some, but not all, people. Their effect on the bladder is not always understood, but you may want to see if eliminating one or all of the following items mentioned can improve your bladder control. You should broadly consider categories of foods and beverages that have a high acid (citrus juices or citrus fruits) or high sugar content or are highly spicy as being potential culprits. Elimination of these may decrease symptoms of frequency and urgency. Again, we remind you to make one change at a time and allow yourself time to evaluate the effect. In this way, you can determine if the change you made had an impact on your symptoms.

The best beverage for your bladder is water. A very thin slice of lemon (not enough citrus to irritate the bladder) may improve the taste of water enough that you will find it more enjoyable. Many people who have bladder control problems reduce the amount of liquids they drink in the hope that they will need to urinate less often. While less liquid through the mouth does result in less liquid in the form of urine, the smaller amount of urine may be more highly concentrated and thus, irritating to the bladder surface. Highly concentrated (dark yellow, strong-smelling) urine may cause you to go to the bathroom more frequently, and it encourages growth of bacteria. It is recommended that you drink a total of six to eight 8-ounce glasses of fluid throughout the day. A rule of thumb is 30 mls for every kilo of body weight. Do not restrict fluids to control incontinence without the advice of your physician and always follow their instructions. 

Some foods cause urine to smell bad or peculiar. The most notable of these foods is asparagus. Another cause of foul-smelling urine, and the most dangerous cause, is a urinary tract infection. If you notice that your urine has a strong odor, and you have not eaten any foods that would cause this, you should have a specimen of your urine tested for infection. Cranberry juice (or cranberry tablets that can be purchased in most pharmacies) and cherry juice may help control urine odor, and there is strong evidence for using cranberry to prevent urinary tract infections. Some medicines may also cause your urine to have an unusual odor or be discolored such as
those you may take for bladder inflammation or urine tests. If your urine has a peculiar odor or color, consult your physician. 

In addition to diet, constipation may also contribute to or cause incontinence. Click here to read more about bowel health. 

Pelvic Muscle Exercises

Assisted Pelvic Muscle Exercises

Bladder Retraining and Bladder Diary  

Combination therapy 

Medications

Click here to view a list of the currently approved medications for treating overactive bladder. Drugs with anticholinergic and direct bladder muscle relaxant effects are often prescribed to relieve symptoms of urgency and frequency. 

These drugs may have side-effects including dry mouth, constipation, blurred vision, gastroesophageal reflux, and urinary retention. To minimize side-effects, extended-release formulations and transdermal patches for drug delivery have been developed.

New agents and methods of administration are currently being investigated in attempts to improve tolerability of treatments for OAB. The FDA has recently approved once-daily TOVIAZ™ (fesoterodine fumarate) for treating OAB symptoms.  Already available in Europe, TOVIAZ exhibited benefits as early as week two in clinical trials, in which a low incidence of constipation was witnessed.  The FDA has also approved Gelnique™, the first and only topical gel for the treatment of OAB. It is applied once daily to the thigh, abdomen, upper arm, or shoulder.

Several classes of medicines affect the bladder muscle and the bladder outlet muscle.  Sometimes these medicines are prescribed for conditions outside the urinary system and cause unwanted changes in bladder control.  At other times, these changes are desirable and the same class of medicine is prescribed to treat incontinence. To view a chart of medications that may affect bladder control, click here.  

Percutaneous Tibial Nerve Stimulation, Urgent® PC Neuromodulation System

There is a treatment option for individuals with urge incontinence who have not responded to medication and/or behavioral treatment and who do not want to have surgery. Percutaneous tibial nerve stimulation (or PTNS) involves the delivery of electrical stimulation to the sacral nerve via the tibial nerve, accessed at the ankle. The treatment is called The Urgent® PC Neuromodulation System and many patients respond to this therapy.⁵
More specifically, this in-office procedure uses a stimulator and a lead set. The stimulator generates a specific kind of electrical impulse that is delivered to the patient through the lead set. Using a needle electrode place near the ankle as an entry point, the stimulator’s impulses travel along the tibial nerve to the nerves in the spine that control pelvic floor function.

The principle behind this treatment is that stimulating the nerves of the pelvic floor through gentle electrical impulses (neuromodulation) can alter the activity of the bladder.
Each treatment lasts approximately 30 minutes, in an initial series of 12 treatments, typically scheduled a week apart.  After the initial 12 treatments, your healthcare professional will discuss your response to the PTNS treatments and determine how often future treatments are needed to maintain results.
The Urgent® PC Neuromodulation System is designed to treat urinary urgency, urinary frequency and urge incontinence, symptoms associated with overactive bladder, Interstitial Cystitis, and Post-Radical Prostatectomy. 

Sacral Nerve Stimulation, Interstim® Therapy

For patients with symptoms caused by OAB who have not had significant success or could not tolerate conservative treatments such as behavioral treatments or medication, there is a treatment that allows the delivery of electrical stimulation to the sacral nerves, called sacral neuromodulation or sacral nerve stimulation. This therapy was FDA approved in 1997 and nearly 50,000 devices have been implanted worldwide to date (2008). It has been shown to be successful in 4 out of 5 patients with urge incontinence and successful in two-thirds of patients with urgency-frequency.⁶