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Q
Overcoming Over-Active Bladder?

I am a 50-year-old woman who suffers from urge incontinence. My doctor does not seem to want to investigate this disorder any further other than prescribing a medication. Is this the only way to go? This is something that I have had to deal with for almost two decades, and it is getting worse.

A
Answer (Published 1/5/2007)

Urge incontinence, sometimes called "overactive bladder," is the sudden and strong urge to urinate and is more common in women than in men (as is stress incontinence, the leakage of urine due to movement caused by laughing, sneezing, coughing or exercise). Urge incontinence is due to involuntary contraction of the detrusor muscle of the bladder more frequently than normal and at inappropriate times, such as when the bladder is only partially full.

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The cause is unknown but the disorder has been linked to drug side effects, nerve damage, stroke, and such neurological diseases as multiple sclerosis and Parkinson's disease. Other possible causes are urinary tract infections, bladder cancer and, in men, benign prostatic hyperplasia (BPH). Some evidence also suggests that overactive bladder is more common in people with depression, anxiety, attention deficit disorder, fibromyalgia, and irritable bowel syndrome.

Although the drugs used to treat overactive bladder (Detrol and Ditropan), do work well, they have unpleasant side effects, such as dry mouth, constipation, blurred vision, and even memory problems. I recommend that you try the approaches below before resorting to drugs:

  • Watch your weight - excess pounds can stress the bladder and increase the risk of incontinence.
  • Don't smoke. Incontinence is twice as common among smokers as it is among nonsmokers.
  • Avoid bladder irritants such as caffeine, alcohol, and spicy foods.
  • Avoid feminine deodorants, which can irritate the urethra.
  • Practice Kegel exercises to strengthen pelvic-floor muscles and improve bladder control.
  • Consider biofeedback, which can help you identify and strengthen your pelvic floor muscles and can help with Kegel exercises.
  • Discuss bladder retraining programs with your physicians. These can help you control the urge to "go" by scheduling bathroom trips and gradually lengthening the time between them.

In addition, try keeping a bladder diary, which may help reveal what triggers your urge symptoms.

Andrew Weil, M.D.

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