Urge urinary incontinence and bladder spasm

With urge urinary incontinence or bladder spasms, also called overactive bladder (OAB), you usually feel the need to go more than the normal four to eight times per day. You may also need to get up at night to urinate. For many people who live with these conditions, it’s necessary to adjust things in life, like your work environment or your travel habits, in order to avoid embarrassing accidents. In this article, we will share some of the most important things to know about bladder spasms and urge urinary incontinence, and what you can do to ease the symptoms.

Life with an overactive bladder or abnormal bladder function

A normally functioning bladder won’t send you exit alarms that makes you want to visit the toilet within seconds. Instead, you will probably feel an increasing need over time. That’s not the case when you suffer from bladder spasms or OAB, as the sensation usually occurs very sudden. If the bladder muscle starts to contract or squeeze without warning; creating this tightening spasm, it can cause involuntary loss of urine.

An abnormal bladder function can even make this happen without you being able to do so much about it, and that’s when we talk about urge urinary incontinence. It’s caused by heavy bladder contractions, that overrides the sphincter muscles of the urethra which usually keeps control over your bladder, resulting in leaks.

Living with any of these conditions can, for obvious reasons, affect your quality of life since you will need to keep track of the nearest toilet.

Why does it happen?

Sometimes the exact cause of this type of overactive bladder is not known, but here are some possible reasons why people get problems with bladder spasms and urge urinary incontinence:

Fluid intake

Drinking too much leads to large amounts of urine (polyuria), and can, therefore, cause urgency feelings and frequent visits to the toilet as the bladder quickly becomes full. Diabetes with high blood sugar (hyperglycemia) can cause increased thirst and large amounts of urine.

Better control of diabetes thereby reduces urinary incontinence.

Low fluid intake can cause urgency feelings too. For example, if you drink less in hope to reduce the urgency feelings it can actually make the problem even worse. That’s because concentrated urine tends to irritate the bladder lining, which results in smelly urine and, again, urge symptoms. Dehydration is also a risk factor for constipation which is a known risk to get a urinary infection.

Anyone at any age can get problems with bladder spasms or urge urinary incontinence with urine leakage, but here are some risk factors:

• You have a urinary tract infection (bacteria can irritate the inside of the bladder)

• A high intake of coffee and energy drinks

• Bladder stones

• Fragile post-menopausal mucous, that causes burning and irritation of the urethra in women

• Irritation to the bladder from the outside, such as a prolapse, an ovarian tumor or constipation

• Enlarged prostate

• Overweight

When to see a doctor

Seeing a doctor is the best way to find out the cause. He or she will probably take a sample of your urine to look for bacteria, blood or other signs of infection. It’s also common to keep track on what and how much you drink and test the bladder in different ways, to measure the speed, bladder pressure, and amount of urine left in your bladder after urination.

If you experience some of these symptoms, it’s a good idea to contact your doctor:

• A burning sensation when you urinate

• Urine leakage

• Blood in the urine

• Suddenly a more urgent need to use the bathroom

• Wake up several times a night to visit the toilet

What can you do about it?

If your bladder spasms or urge urinary incontinence is lifestyle dependent, there are things you can do. For starters, it can be a good idea to skip or reduce the intake of alcohol as well as things that contain caffeine, like tea, coffee, and energy drinks.

Training and exercises

Pelvic floor exercises, like Kegels, can be really useful for helping with an overactive bladder. To be able to squeeze the pelvic floor muscles properly when the urgent need suddenly appears can actually stop the urgency feeling.

To do a Kegel, simply squeeze your pelvic floor muscles together as hard as you can (similar to when you want to avoid to urinate, or pass gas) and hold it for at least five seconds and repeat this exercise to gradually build up the strength. A stronger pelvic floor increases your ability to resist the urge to urinate. Your doctor or physiotherapist can teach you exactly how to do this the right way.

Bladder retraining is commonly used to improve urge urinary incontinence. The purpose is to become aware of incontinence patterns, and re-learning skills necessary for storage and proper emptying of the bladder. This includes avoiding ‘just in case’ visits to the toilet as well as last-minute rushes. Examples of skills that are worked on:

Practicing the bladder's ability to hold urine. This means that you actively increase the amount of urine in the bladder, and delay the voiding intervals.
Not rushing to the toilet in the middle of an urgency feeling, but try and distract yourself.
Squeezing the pelvic floor muscle when feeling the urge to urinate.
Planning toilet visits to avoid feelings of stress and anxiety.

Times between toilet visits can be gradually extended in this way. A bladder diary could also be a helpful tool.

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