Sudden Urge to Urinate

In people with OAB, the bladder muscle is overactive and squeezes too often. These bladder spasms make it feel like you need to urinate often and quickly, even if there isn’t much urine in your bladder. You feel a sudden urge to urinate, sometimes followed by leaking. Sometimes the whole bladder empties.

Diagnosis

Bladder issues can feel embarrassing, but you are not alone. As a first step to taking back your life, talk to your doctor. Discuss when and how often you leak urine. A physical exam helps identify other conditions that influence the bladder, such as prolapse. Additional tests might include a urinalysis to check for a urinary tract infection and blood in your urine, ultrasound to assess how much urine remains in your bladder after urinating, or urodynamics to provide information on your bladder and urethra.

Terminology

Urinary urgency (“gotta go right now”): sudden, strong desire to pass urine, which is very difficult to postpone.

Urinary frequency (“gotta go often”): urinating eight or more times per day.

Nocturia: need to urinate one or more times during sleeping hours.

Urinary urge incontinence (UUI): urinary leakage that occurs with the sudden, strong desire to pass urine.

Overactive bladder: urinary urgency, usually with frequency and nocturia, and sometimes with urinary urgency incontinence.

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Coffee, tea, sodas and other beverages with caffeine worsen symptoms. Artificial sweeteners, fruit juices and alcohol can also cause bladder spasms.

People with OAB go to the bathroom often. This causes your bladder to hold less urine, leading to even more frequent bathroom trips. Bladder re-training involves using your pelvic floor muscles and “mind over bladder” techniques to gradually increase time between bathroom visits.

The many OAB medicines on the market are formulated to help your bladder hold more urine for longer periods of time and reduce urine leakage. Your urologist may have you try several different medicines before determining which works best for you.

Pelvic floor muscle exercises can help improve symptoms. For optimal results, your urologist may recommend working with a specialized physical therapist to learn specific techniques. Your doctor can refer you to an appropriate therapist. It may take a few months of regular pelvic floor muscle exercise to see results.

Botox is used to relax the bladder muscle and thus improve overactivity. This allows more urine to be held in the bladder before you have to go to the bathroom. Under a local anesthetic in the office, your doctor uses a small camera and needle to inject Botox into the bladder wall. Typically, the injection needs to be repeated 2 to 3 times a year.

With PTNS, a small needle is inserted near a nerve in the ankle and connected to an external device that delivers small pulses to the nerve. This changes the messaging to the bladder to improve urinary issues.

Sacral nerve stimulation uses a small electric generator implanted near the spine to modulate the bladder nerves to improve urinary control. Typically, a short test is performed without need for anesthesia to see if a more permanent implant would be of benefit.

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