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If You've Always Gotta "Go," Go to the Doctor

An overactive bladder can cause problems including incontinence, urinary frequency and urgency

A middle-aged woman enjoys a thoughtful moment while seated in a pleasant beach environment.

by Scott Simon, MD

Ever since she was a teenager, Anna has been afraid to leave her house. Sometimes when she does, she’s terrified she won’t be able to find a bathroom.

Denise’s situation is just as uncomfortable. Nearly every time she puts her house key in the door, she suddenly has to “go” and sometimes can’t make it to the bathroom in time.

Anna and Denise are just two of an estimated 33 million men and women in the U.S. who have problems with an overactive bladder. Often caused simply by abnormal bladder activity, an overactive bladder can lead to urinary incontinence or the uncontrollable leaking of urine — a problem that can result in embarrassment, anxiety and discomfort.

Even if incontinence is not an issue, an overactive bladder can also cause debilitating symptoms such as urinary frequency (the need to go often or to always be near a bathroom) and/or urgency (a sudden, compelling need to go).

If you wake up several times during the night because you have to use the bathroom, or you’re reluctant to be away from a bathroom for more than an hour or so, you know how difficult life with an overactive bladder can be.

Why it happens

There are several types of urinary incontinence, but the one most associated with an overactive bladder is urge incontinence. This type of leaking occurs when you get a strong, sudden urge to go to the bathroom immediately followed by a strong contraction of the bladder, which results in a loss of urine.

While urge incontinence can result from a number of factors, including infections of the bladder, many times we don’t know the specific cause.

Treating the problem

Urge incontinence is a condition that is not only common, but highly treatable. In the past, patients were reluctant to mention it to their doctors, often because they were embarrassed or chalked it up to an unavoidable side effect of aging. Fortunately, physicians and patients alike are becoming aware of a number of effective treatments for this problem.

Treatments generally begin with conservative approaches, such as changes in diet and decreased fluid intake. Biofeedback has proven successful in helping many patients learn to re-train their bladder to be less active and to gain better control over their sphincter muscles.

Medications, such as Detrol or Ditropan, can help calm an overactive bladder as well. However, medications may cause side effects such as dry mouth or digestive problems.

Outpatient surgery as an option

If these treatments don’t resolve overactive bladder symptoms, or patients cannot tolerate the side effects of medication, we may recommend a relatively new approach known as InterStim.

Almost like a pacemaker for the bladder, InterStim is a surgically implanted device that delivers mild electrical stimulation to the sacral nerves that control the bladder to reduce overactivity.

InterStim decreases urge incontinence — as well as urgency and frequency problems associated with an overactive bladder — in about 80 percent of cases.

InterStim insertion is an outpatient procedure done in two stages. The first stage is a test; the patient wears a temporary, external stimulator for one week to determine how well the treatment works for him or her. If it is successful, the entire device is then implanted under local anesthesia via a small incision. It can be adjusted or deactivated at any time.

For one patient, Marilyn, the device literally changed her life.

“I feel normal again,” she says. “I actually went running today which I would never have considered one month ago.”

If you have an overactive bladder or urinary incontinence, chances are you don’t have to live with it. Call your physician to discuss treatments that can help.

This Scripps Health and Wellness information was provided by Scott Simon, MD, a urologist at Scripps Memorial Hospital La Jolla.