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Overactive bladder: causes

What is overactive bladder?  Well, there is actually a new definition:  It is simply what is too much for you.  If you feel like you go to the bathroom too often, then you have an overactive bladder.

If that is not helpful enough, what we traditionally consider normal is going 6-8 times daily and 1 time at night.  So during the day, that would be about every 2 hours.   Above that may be overactive bladder.  But, that depends on how much fluid you drink.   A voiding diary is very helpful because it really shows your intake and output and how they relate together.

Then there are two classifications:  overactive bladder DRY and overactive bladder WET.  Obviously, the wet kind means that you cannot make it to the restroom on time and you leak some urine.  That is also called urge incontinence.

Overactive bladder is a big bother.   You may find that you have to look for the bathroom everywhere you go.  You limit your intake to avoid going to the bathroom.  You can’t sleep because you wake up to use the bathroom so often.  You have to wear pads now for the leakage.  You may be becoming house-bound because going out causes too much anxiety as you worry about the bathroom all the time.  I have met some patients that go every 15 minutes.    It is not a minor issue.

There are many causes of overactive bladder:

By far the most common cause is idiopathic, which actually means that we don’t know the cause.  It just occurs for an unknown reason.

Constipation is a very common cause and that is why we will ask you about your bowel movements.  The full constipated rectum presses on the bladder and irritates it, causing you to go more often.

The uterus can sometimes be the culprit.  If there is uterine tilt or a large fibroid, that will irritate the bladder and cause you go more often.  Taking stool softeners and laxatives to effect normal bowel movements can make a huge difference.

If the bladder is dropped, which is called a cystocele, you may have overactive bladder because the sensors on the bladder base are stretched out and you will have to void more often.    You should have a pelvic exam when being evaluated for overactive bladder.

The most dangerous cause of overactive bladder is bladder cancer.   It is not a very common cause, but it needs to be considered.   I always check a urine sample for microscopic blood.  If you are high-risk:   smoker, family history of bladder cancer, have seen blood in your urine, recurrent UTI, then I will scope your bladder in the office just to be sure that you do not have a bladder tumor.