Does it feel like you're always hurrying to the bathroom, afraid that you won't make it on time? Do you have trouble sitting through meetings or social functions without taking a restroom break? If so, you may have an overactive bladder.

Overactive bladder is a problem with bladder function that causes a sudden urge to urinate. The urge may be difficult to suppress, and overactive bladder can even lead to the involuntary loss of urine (incontinence).

If you have overactive bladder, you may feel embarrassed, isolate yourself, or limit your work and social life. The good news is that after a brief evaluation to determine the cause, you can receive treatments that may greatly alleviate symptoms of overactive bladder and help you manage their impact on your daily life.

Signs and symptoms of overactive bladder may mean you:

• Feel a strong, sudden urge to urinate
• Experience urge incontinence, the involuntary loss of urine immediately following an urgent need to urinate
• Urinate frequently, usually eight or more times in 24 hours
• Awaken two or more times in the night to urinate (nocturia)

Although you may be able to get to the toilet in time when you sense an urge to urinate, frequent and nighttime urination, as well as the need to suddenly "drop everything," can definitely disrupt your life.

When to see a doctor
Fewer than half of women and less than one-quarter of men who experience incontinence ever talk to their doctor about the problem, according to a study in the Journal of Urology.

Although it can sometimes be difficult to discuss such a normally private matter with your doctor, it's important that you do, especially if you experience urge incontinence or if other symptoms of overactive bladder disrupt your work schedule, social interactions and everyday activities.

Don't avoid an evaluation and simply deal with the condition by wearing absorbent undergarments or pads. Treatments are available that might help you. Additionally, it's important to talk to your doctor because an overactive bladder and urge incontinence may occur as a result of a serious underlying problem, such as a cancerous tumor.

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Female urinary system

Filling and emptying your bladder is a complex interplay of kidney function, nerve signals and muscle activity. A problem anywhere throughout this system can contribute to overactive bladder and urge incontinence.

Normal bladder function
Your kidneys produce urine, which travels down a pair of long tubes from your kidneys to your bladder. Urine drains from your bladder through an opening at the bottom (neck) and flows out a short tube called the urethra (u-REE-thrah). In women, the urethral opening is located just above the vagina. In men, the urethral opening is at the tip of the penis.

Your bladder expands like a balloon to accommodate the flow of urine. When it's reached about half its capacity, nerve signals alert your brain, and you sense that your bladder is "full." By the time it's three-quarters full, you feel the need to urinate (void). When you urinate, nerve signals coordinate the relaxation of the pelvic floor muscles and the muscles surrounding the neck of the bladder and upper portion of the urethra (urinary sphincter muscles). The muscles of the bladder contract, forcing urine out.

Involuntary bladder contractions
The symptoms of overactive bladder occur in most cases because the muscles of the bladder involuntarily contract. This contraction creates the urgent need to urinate. The urinary sphincter may remain constricted and prevent the bladder from leaking. If the sphincter's strength is overwhelmed by the contraction, then a person experiences urge incontinence.

Causal or contributing factors
In many cases doctors can't exactly identify the causes of overactive bladder. Neurological disorders, such as Parkinson's disease, strokes and multiple sclerosis, are often associated with an overactive bladder.

Several factors may cause or contribute to symptoms similar to those of overactive bladder, and your doctor will try to rule them out during an evaluation because they require other specialized treatments. These factors include:

• High urine production as might occur with high fluid intake, poor kidney function, or diabetes
• Acute urinary tract infections that can cause symptoms very similar to an overactive bladder
• Inflammation of tissues near the urinary tract
• Abnormalities in the bladder, such as tumors or bladder stones
• Factors that obstruct bladder outflow — enlarged prostate, constipation or previous operations to treat other forms of incontinence
• Excess consumption of caffeine or alcohol
• Medications that cause a rapid increase in urine production or require that you take them with lots of fluids

As you grow older, you're at increased risk of developing overactive bladder, and you're also more susceptible to diseases and disorders that can contribute to problems with bladder function, such as enlarged prostate and diabetes. Although common among older adults, overactive bladder and urge incontinence shouldn't be considered a normal part of aging.

As might be expected, urge incontinence can affect your overall quality of life, but frequent urination and nocturia can also be detrimental to your well-being. People with significant disruption from an overactive bladder are more susceptible to:

• Depression
• Emotional distress

Some people may also have a disorder called mixed incontinence, when both urge incontinence and stress incontinence occur. Stress incontinence is the loss of urine when you exert physical stressors or pressure on your bladder, as when you cough or laugh.

You're likely to start by first seeing your family doctor or a general practitioner. However, he or she may refer you to a urologist or a urogynecologist for diagnosis and treatment. When you make your appointment, ask your doctor if you should keep a bladder diary for a few days. You record when, how much and what kind of fluids you consume; when you urinate; whether you feel an urge to urinate; and whether you experience incontinence. Your diary may reveal patterns that help your doctor understand your symptoms and identify contributing factors.

Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of all the medications you take, as well as any vitamins or supplements.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For overactive bladder, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there any other possible causes for my symptoms?
• What kinds of tests do I need? Do I need to do any special preparation for these tests?
• Is my condition likely temporary or chronic?
• What treatments are available?
• Which do you recommend?
• Are there any dietary restrictions that I need to follow?
• Do I need to see a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor may use an overactive bladder screening questionnaire to make a preliminary assessment of your symptoms. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• Do you ever unexpectedly leak urine?
• Do you ever leak urine when you cough, laugh or sneeze?
• Do you ever leak urine on your way to the bathroom?
• Do you need to use pads or extra cloth in your underwear to catch urine?
• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or occasional?
• What activities do your symptoms keep you from doing?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

Your doctor will also want to know if your bladder symptoms are causing problems in your daily life, such as interfering with work or social interactions.

In a basic diagnostic workup, your doctor will look for clues that may also indicate contributing factors. The exam will likely include:

• A medical history
• A physical examination with particular focus on your abdomen and genitals
• A urine sample to test for infection, traces of blood or other abnormalities
• A focused neurological exam that may identify sensory problems

Specialized tests
Your doctor may order urodynamic tests, which are used to assess the function of your bladder and its ability to empty itself steadily and completely. These tests usually require a referral to a specialist in urinary disorders in men and women (urologist) or urinary disorders in women (urogynecologist). Tests include:

• Measurements of postvoid residual urine. When you urinate or experience urinary incontinence, your bladder may not empty completely. The remaining urine volume (postvoid residual urine) may cause symptoms identical to an overactive bladder. To measure residual urine after you have voided, a thin tube (catheter) is passed through the urethra and into your bladder. The catheter drains the remaining urine, which can then be measured. Alternatively, a specialist may use an ultrasound scan, which translates sound waves into an image of your bladder and its contents.
• Uroflowmetry. A uroflowmeter is a device into which you urinate to measure the volume and speed of your voiding. This device translates the data into a graph of changes in your flow rate.
• Cystometry and pressure-flow studies. Cystometry measures bladder pressure during filling. Pressure-flow studies measure the amount of pressure needed to urinate and the speed of the urine flow. A catheter is used to fill your bladder slowly with water. Another catheter with a pressure-measuring sensor device will be placed in your rectum or for women, in your vagina. This procedure can identify any involuntary muscle contractions, indicate the level of pressure at which you feel an urge or experience leakage, and measure pressure needed to empty your bladder.
• Electromyography. Electromyography assesses the coordination of nerve impulses in the muscles of the bladder and the urinary sphincter. Sensors are placed either on or in the skin in your pelvic floor.
• Video urodynamics. These procedures use either X-ray or ultrasound waves to create pictures of your bladder in combination with cystometry and a pressure-flow study as your bladder is filling and emptying. Your bladder is filled with the use of a catheter, and you urinate to empty your bladder. The fluid will contain a special dye that's detected by X-ray technology.
• Cystoscopy. A cystoscope, a thin tube with a tiny lens, enables your doctor to see the inside of your urethra and bladder. With the aid of this device, your doctor can check for abnormalities in your lower urinary tract, such as bladder stones or tumors.

Your doctor will review the results of these tests with you and suggest a treatment strategy.

Your doctor is likely to recommend a combination of treatment strategies to alleviate your symptoms.

Behavioral interventions
Behavioral interventions can help you manage overactive bladder. If you experience urge incontinence, these interventions alone aren't likely to result in complete dryness, but they will likely reduce the number of incontinence episodes. The interventions your doctor will recommend may cover the following areas:

• Fluid consumption. Your doctor may recommend the amount and timing of your fluid consumption. If caffeinated and alcoholic beverages worsen your symptoms, it might be wise to avoid these.
• Fiber intake. Eat a diet rich in fiber, or take fiber supplements if instructed by your doctor, as constipation is commonly associated with bladder problems.
• Bladder training. Occasionally, your doctor may recommend a strategy to train yourself to delay voiding when you feel an urge to urinate. You'll begin with very small delays, such as 10 minutes, and gradually work your way up to urinating every three to five hours.
• Double voiding. Some people have problems with emptying their bladder. This is diagnosed by significant elevations of residual urine volumes and may be helped by double voiding. After urinating, you wait a few minutes and then try again to empty your bladder completely. Your doctor will let you know if this is something that might help you.
• Scheduled toilet trips. Your doctor may recommend a schedule for toileting so that you urinate at the same time every day — every two to three hours as recommended — rather than when you feel the urge to urinate.
• Pelvic floor muscle exercises. Exercises called Kegel exercises strengthen your pelvic floor muscles and urinary sphincter — muscles that are critical for holding urine even if your bladder muscles involuntarily contract. These strengthened muscles are then contracted when you feel urge so that you can successfully suppress the bladder's involuntary contractions. Your doctor or a physical therapist can help you learn how to do these exercises correctly. It may take as long as eight weeks before you notice a difference in your symptoms, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
• Intermittent catheterization. You can learn how to empty your bladder by passing a catheter periodically to empty it completely. This is a very safe and comfortable procedure. It does not make the bladder lazy; contrary to that old tale, it simply helps the bladder do what it can't do itself. Your doctor will let you know if this is right for you.
• Absorbent pads. You can wear absorbent pads or undergarments to protect your clothing and avoid embarrassing incidents if you do experience incontinence.
• Maintaining a healthy weight. If you're overweight, losing weight may ease your symptoms because extra weight is associated with more urge incontinence. Heavier people are also at greater risk of stress urinary incontinence.

Medications
Medications that relax the bladder can be effective for alleviating symptoms of overactive bladder and reducing episodes of urge incontinence. These drugs include tolterodine (Detrol), oxybutynin (Ditropan), an oxybutynin skin patch (Oxytrol), trospium (Sanctura), solifenacin (Vesicare) and darifenacin (Enablex). These medications are usually used in combination with behavioral interventions.

Common side effects of these drugs include dry eyes and dry mouth, but drinking water to alleviate thirst can exacerbate symptoms of overactive bladder. Extended-release forms of these medications and the skin patch may cause fewer side effects.

Your doctor may recommend that you suck on a piece of sugar-free candy or chew sugar-free gum to alleviate dry mouth, and use eyedrops to keep your eyes moist. Over-the-counter preparations, such as Biotene products, can be helpful for chronically dry mouth.

Botulinum toxin
This medication, sold under the brand name Botox, is a protein from the bacteria that cause botulism illness. However, in small doses directly injected into tissues, this protein paralyzes those muscles, and research has indicated that it may be useful for severe urge incontinence. But, it's not approved by the Food and Drug Administration for this purpose, and the effects are only temporary, lasting only about six months. Additionally, botulinum toxin carries a risk of worsening bladder emptying, especially in older adults.

Surgery
Surgery to treat overactive bladder is reserved for people with severe cases who don't respond to other treatments. The goal is to improve the bladder's storing ability and reduce pressure in the bladder. Surgical interventions include:

• Sacral nerve stimulation. The sacral nerves are a primary link between the spinal cord and nerves in the bladder's tissues. Modulation of these nerve impulses can improve overactive bladder symptoms. In this procedure, a thin wire is placed near the sacral nerves as they pass near your tailbone. Your doctor will then use a device to deliver electrical impulses to your bladder, similar to what a pacemaker does for the heart. If successful at reducing your symptoms, the wire is eventually connected to a small battery device that's placed under your skin.
• Augmentation cystoplasty. This major surgical procedure, intended to increase the capacity of your bladder, uses pieces of your bowel to replace a portion of your bladder. If you undergo this procedure, you may need to use a catheter intermittently for the rest of your life to empty your bladder. Because this is a major surgical procedure with the potential for serious side effects, this surgery is reserved for people with severe overactive bladder that hasn't improved despite other treatments.

Living with overactive bladder can be difficult. Organizations such as the National Association for Continence can provide you with resources and information about joining a support group of people who experience overactive bladder and urge incontinence. Support groups offer a venue for voicing concerns and learning new coping strategies and often provide motivation to maintain self-care strategies.

Educating your friends and co-workers about overactive bladder and your experiences with it may help you establish your own support network and alleviate some of the embarrassment you may feel.

Healthy lifestyle choices that may reduce your risk of overactive bladder include a regular exercise routine, a high-fiber diet, and limited consumption of caffeine and alcohol.