When You Need to Go, Go, Go

Find Relief

Reviewed by Gary D. Vogin, MD

There you are in a deep sleep when it happens again: Themounting 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 also will 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 Kenneth Goldberg, MD, a Dallas urologist. "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 aging, says Wendy Leng, MD, 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 Gary Leach, MD, 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. If your primary care doctor can't determine what is causing problems, the next step is to see a urologist. The specialist will test the blood and urine and may also perform other tests, checking for infection, cancer, and other illnesses associated with urinary problems.

Doctors also will ask about fluid intake and the typical number of 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 also can 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 repetitively contracting the pelvic floor muscles for a few seconds and repeating the exercise several times a day.

Some common-sense measures also can help. Avoid drinking beverages containing caffeine and alcohol, which 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 usually can be reduced. Although people may be reluctant to discuss this problem with their physician, doing so can help them reclaim their quality of life.