If your daily schedule is dictated by frequent and sudden urinary urges that leave you scrambling for the nearest bathroom, and you haven't already been to see your doctor -- it's time to make an appointment to get your overactive bladder treated.
Whether you see a primary care doctor, internal medicine practitioner, urologist, or gynecologist doesn't matter. What does matter is that you get help for symptoms such as urinary urgency, frequent urination, waking up often during the night to urinate, and urge incontinence (abnormal bladder contractions that cause uncontrolled leakage of urine).
Treatment is important because an overactive bladder can seriously interfere with activities, says Donna Y. Deng, MD, MS, a urologist and associate professor at the University of California-San Francisco who also serves on the board of directors at the National Association for Continence.
People may need to pull off the freeway immediately to find a restroom, or map out every public bathroom before they run errands. Some people are afraid to leave their homes and become isolated. “People really redefine themselves,” Deng says. “They really plan their lives around the bathroom. It’s definitely a great detriment to quality of life.”
In some cases, the urge is so strong that it overrides the urethral muscles that help control leakage from the bladder, and people can’t reach a toilet in time. “There’s very little warning time,” Deng says.
Talking About Overactive Bladder
Talking about such personal issues can be uncomfortable, but worthwhile, experts say. “Patients often don’t volunteer information,” says Tomas L. Griebling, MD, MPH, professor and vice chair of the department of urology at the University of Kansas and a faculty associate in the Landon Center on Aging.
Tell your doctor about overactive bladder problems, he says. “There are usually things that we can do to try to help people.”
When you start treatment for OAB, your doctor might ask you to keep a voiding diary. The diary can help your doctor see what symptoms you're having, and evaluate how well your treatment is working. In your diary, record when you urinate each time, how much urine you pass, whether you leak and how much leakage you have, what you were doing when the leakage occurred, and what/how much you drink and eat each day.
Questions Your Doctor Will Ask You
Your doctor will ask several questions to determine the cause of your bladder problems and find the right treatment.
- How often do you urinate each day?
- How much liquid do you drink each day (with meals and between meals)?
- Do you leak urine? Do you leak urine when you sneeze, cough, or exercise?
- Do you feel an urge when you have to urinate or have a sudden urge to urinate at inappropriate times? Do you have to rush to the toilet and sometimes not make it?
- How many times do you get up at night to use the toilet?
- Does it ever hurt or burn when you urinate? Does your urine have a bad odor, contain blood, or appear dark yellow or concentrated?
- If you wear pads, are there a few drops of urine in the pad or a bladder-full?
- Does your incontinence prevent you from participating in work or social activities?
- How often do you have a bowel movement? What’s the consistency of your stools? Are they easy or hard to pass?
Also, “patients with bowel problems often have urinary problems and vice versa,” Griebling says. Nerves that control the bladder also control the sigmoid colon, and some patients leak both urine and stool, he says.
Amy Rosenman, MD, a urogynecologist in Santa Monica, Calif., and a clinical assistant professor at the David Geffen School of Medicine at UCLA, also asks her female patients when they had their last bladder infection “because that can cause urgency and frequency,” she says.
Your doctor can rule out problems that can cause overactive bladder symptoms. “There are many things that cause the bladder to behave badly,” Rosenman says.
Even if your doctor hasn't found the cause of your overactive bladder, he or she can still treat the symptoms. Usually, the first treatment is with medications, which are often effective. “But if that doesn’t work, then we want [patients] to know that that’s not the end,” she says.
Don’t hesitate to seek out a specialist if you haven't been able to get your symptoms under good control, Rosenman says. Not all doctors are well-versed in the multitude of treatment options, such as biofeedback or electrical nerve stimulation, she says.
Questions to Ask Your Doctor
You can also take part in educating yourself and making decisions. Here are some questions to ask your doctor:
- What might be causing my overactive bladder?
- What are my treatment options?
- Do I need medication? Why?
- Does the medication have side effects?
- Are there any special instructions I should follow when using my treatment?
- How soon should my symptoms improve?
- What other treatments or products that I haven't already tried might help me? (For example, absorbent pads, bladder training, Kegel or pelvic floor exercises, exercises, biofeedback, surgery, or sacral nerve stimulation)
- What other steps can I take (for example, dietary changes) to cope with overactive bladder in my daily life?
Testing and Surgery
If your doctor recommends any testing, make sure that you understand the reasons:
- What will this test show?
- How accurate is it?
- How will it affect my treatment?
- Are there any risks or side effects?
- Do I need to do anything special before or after the test?
If you have a severe case of overactive bladder that hasn't responded to non-surgical treatments, your doctor might recommend surgery. If so, ask the following:
- What are the risks and benefits of surgery?
- How much improvement can I expect? When will I start to see improvements?
- Will I be hospitalized? How long is the recovery time?
- Can you refer me to another physician for a second opinion?