Irritable bladder is a general term for any persistent condition that provokes the muscles in the bladder to contract involuntarily, resulting in a sudden, urgent, uncontrollable need to urinate (urge incontinence). Numerous stimuli can intermittently irritate the bladder and override conscious attempts to inhibit the voiding reflex, sometimes resulting in large-volume accidents that may occur either during the day or while sleeping. The mechanisms that trigger irritable bladder are sometimes difficult to determine; identifying an underlying cause often leads to effective treatment. Irritable bladder is fairly common, especially among women.
What Causes Irritable Bladder?
- Urinary tract infections (UTIs)
- Nervous tension
- Food sensitivities
- Bladder stones
- Damage to the nerves that control bladder function, which causes excessive contraction of the bladder.
- Obstruction of the outflow of urine, for example, because of a tumor, urethral stricture, or an enlarged prostate.
- A reaction to the use of a urinary catheter
- In many cases the cause is unknown.
Symptoms of Irritable Bladder
- Uncomfortable feeling in abdomen and distention
- Sudden, urgent need to urinate
- Accidental voiding of urine, sometimes in large volumes
- Frequent urination, both during the day and at night
Prevention of Irritable Bladder
- Because it is difficult to identify its underlying cause, irritable bladder is difficult to prevent.
Diagnosis of Irritable Bladder
- Patient history and physical examination
- A “voiding diary,” or record of the time, amount, and circumstances of urination
- Catheterization of the bladder to measure the amount of urine remaining after urination, and to document bladder pressure during filling of the bladder (cystometry).
- Microscopic examination and culture of urine, to determine if a urinary tract infection underlies the problem.
- Q-tip test (evaluates the change in the angle of the urethra at rest and when straining)
- Cytoscopy (use of a lighted scope to view the bladder)
- Voiding cystogram (an x-ray taken while the patient urinates)
How to Treat Irritable Bladder
- When irritable bladder is due to bacterial infection, antibiotics are given.
- In some cases bladder control can be regained or improved with a technique known as bladder training. The technique begins by scheduling a bathroom visit every two hours, whether the patient needs to urinate or not. The interval is gradually increased by a half hour at a time, toward a goal of four-hour intervals. In many cases the body adapts to this schedule, eliminating incontinence.
- Antispasmodics and other drugs may be prescribed to relax bladder muscles and so prevent uncontrolled contractions of the bladder.
- Although adult diapers and pads are widely advocated by advertisers, they may actually promote complications, so they are not recommended for anything but very short-term use unless otherwise advised by a doctor.
When to Call a Doctor
- Consult a doctor for any repeated episodes of urinary incontinence.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media