Do you go to the bathroom so much that it interferes with your daily life? Or have intense, hard-to-control urges to urinate? If so, you might have overactive bladder.
That means the muscles of the bladder, which you use to push out urine, have started to contract involuntarily. This can cause a variety of problems, from pain to frequent urination to accidents.
Most people with this condition can manage or even cure it with treatment. But to get treatment, you first have to tell someone you have a problem — which, considering the problem's nature, is sometimes easier said than done.
Frequent urination is a common sign of overactive bladder. So, what does "frequent" mean?
Elterman says eight times every 24 hours is considered normal. But even if you take 10 or 12 bathroom breaks a day, don't worry.
"It's an individual thing," Elterman says. "Some people feel fine going to the bathroom every couple of hours, but going that often might bother someone else."
See your doctor if you go so much that it bothers you, or if you wake up two or more times each night to go to the bathroom. Other symptoms for which you should seek treatment include urinary incontinence (unintentional urination) and pain while urinating.
Overactive bladder has many possible causes, including urinary tract infection, enlarged prostate, diabetes and kidney disease. Often, doctors can't pinpoint the precise cause. But, says Elterman, it's never a normal part of getting older.
The condition is more common in older men and women, but that's largely because some of the conditions that can cause it — such as enlarged prostate or weakened pelvic muscles — become more common as people age. So anyone who has symptoms of overactive bladder, no matter his or her age, should see a doctor.
Many people have had this problem for years but haven't sought help because they didn't want to talk about it. When they come in there's often emotional and physical relief, because usually we can find a treatment that works.
Talking to a doctor might seem embarrassing, but suffering in silence can be harder.
"Studies have shown that overactive bladder can decrease the quality of life more than diabetes or heart failure," Elterman says. So don't hesitate to speak up.
"I see many patients who have had this problem for years but haven't sought help because they didn't want to talk about it," Elterman explains. "When they come in there's often emotional and physical relief, because they know they have a team on their side, and usually we can find a treatment that works."
Elterman usually begins by advising his patients to regulate their fluid intake. "For example, if you're going to be sitting in a movie or a long meeting, avoid drinking right beforehand and make sure to use the restroom," he says.
He also recommends avoiding or limiting coffee and other caffeinated drinks, which can irritate the bladder.
If lifestyle changes don't solve the problem, Elterman moves on to other possible solutions. If overactive bladder has been caused by problems with the pelvic muscles, physical therapy can sometimes cure it. And many patients can get relief from medicines that relax the muscles in the bladder.
For some, though, medications may not do the trick. In these cases, patients may benefit from injections of botulinum toxin (commonly known as Botox) into the bladder, which temporarily stop its muscles from contracting.
A longer-lasting option is sacral nerve stimulation, in which a doctor implants a small device under the patient's skin (near the bottom of the spine) to stimulate the nerves that control the bladder.
Of course, some patients end up needing treatment not for overactive bladder but for its underlying cause.
Elterman once saw a young man, for example, who had started having nighttime accidents. When Elterman examined him, the patient mentioned that he had recently gained weight and had problems snoring at night. Elterman promptly sent the man to a sleep specialist, who diagnosed him with sleep apnea.
"People with sleep apnea tend to produce a lot of fluid, which is why he was having accidents," Elterman says. "But once he got his sleep apnea under control, the accidents stopped as well."
More important, the man lowered his risk for heart problems and diabetes, two other issues associated with sleep apnea.
Because so many serious problems (including bladder cancer and neurologic disorders) can cause overactive bladder, seeing a doctor can serve more than one purpose. "Not only can we usually solve the urinary symptoms, we can make sure nothing more serious is going on," Elterman says.
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