We’ve all heard of overactive -bladder—that “gotta-go” feeling that so often strikes at the worst possible times. It’s annoying—especially when it leads to embarrassing dribbles (incontinence). But there could be a hidden side to this problem that you and your doctor are overlooking.

For some people, those too-frequent trips to the bathroom occur because of “underactive bladder,” in which sufferers don’t empty their bladders completely when they urinate, so they soon make additional trips to the toilet.

About half of women and one-third of men in the US suffer from underactive bladder at some point in their lives. Key facts to know…   

What Goes Wrong

Under normal conditions, urine, which is made by your kidneys around the clock, trickles into your bladder all the time. A well-functioning bladder stores the fluid until it gets full enough to send a “time to go” signal to your brain.  

Ideally, you heed that sensation and get to a toilet. Then your brain sends signals back to the bladder, causing it to contract and squeeze out urine. At the same time, the brain tells several sets of sphincter muscles to relax, allowing urine to pass through the urethra. The process is the same in men and women, even though the anatomy is slightly different. When the waterworks do not work, symptoms of underactive bladder might include… 

Feeling that you need to go again right after you pee, resulting in frequent trips to the toilet.

• Weak urinary stream.

• Urges to strain, push and bear down to empty your bladder.

• Swelling, tenderness or pain below your belly button.

If the problem becomes chronic, partial emptying of your bladder may allow urine to collect bacteria, leading to recurrent urinary tract infections.  

Finding the Root Cause

Underactive bladder is largely due to two main culprits—obstructions and impaired bladder contractions. 

Some causes of obstruction…

• Prostate enlargement. For men, this is the most common cause. With prostate enlargement, this walnut-shaped gland surrounds the urethra at the neck of the bladder and grows as a man ages. 

• Constipation. In both men and women, hard, impacted stools can press on the bladder and urethra, interfering with the bladder’s ability to empty.

• Weak pelvic floor muscles. These muscles may be weak in men due to prostate removal. In women, multiple vaginal deliveries can damage or weaken pelvic structures and nerves, leading to a sagging bladder and/or uterus, which can interfere with bladder function. After menopause, the decline in a woman’s estrogen levels causes the pelvic floor to thin and weaken.

Note: Research on supplemental estrogen has been mixed. Kegel exercises that strengthen pelvic muscles can help women—and men—who need to build up these muscles to improve their bladder control. 

If Kegels are new to you, here’s the basic idea:While sitting or standing, tighten the muscles you would use to stop your stream of urine and those used to keep from passing gas for three seconds (without clenching your abdomen or buttocks), then relax for three seconds. Repeat in sets of five, starting with just a few sets at a time. Slowly work up to 10 sets of five per day.  

• Fibroids. These benign tumors in the uterus can obstruct the neck of the bladder. 

Among the causes of impaired bladder contraction…

• Years of holding in your urine. This was once called “schoolteacher’s bladder,” because schools used to forbid teachers to take bathroom breaks except at lunchtime. As a result, the bladder can “forget” how to function. 

• Conditions that involve nerve damage, such as stroke, Parkinson’s disease, diabetes and multiple sclerosis. 

• Medications, including muscle relaxants, sedatives, antihistamines, tricyclic antidepressants, such as amitriptyline (Elavil), and decongestants. 

How to Get Relief

If your no-go symptoms haven’t become so severe that they are significantly interfering with your life, just improving a few bathroom habits can help. Here’s what to try first… 

• Urinate at least every two to three hours during the day, even if you do not feel the urge. Helpful: Use a smartphone timer to remind yourself to go on this schedule. If you feel much more frequent urges, try to stretch out your bathroom visits by at least 15 minutes at a time, which will train your bladder to wait.

• Do your best to find private bathrooms if you are prone to “bashful bladder,” which occurs when you need to urinate but aren’t able to do so in the presence of another person. 

• Don’t push or strain to urinate…but try shifting your position. For example, some women and men find that it helps to lean forward or press a hand gently against the lower abdomen to help push urine out of the bladder. 

• Try double voiding. Urinate, then wait a minute and go again. That can help drain the bladder and prevent the feeling that you need to go again the minute your pants are zipped. 

To Get More Help

If you’re still struggling after trying the steps described above, talk to your doctor, and be clear about what’s bothering you. A good workup will include a lab check of your urine to ensure that you don’t have a urinary tract infection…and—after you return from giving your urine sample—a simple ultrasound test to see how much urine is left in your bladder. There will always be some, but more than 100 to 150 milliliters, depending on your age, indicates a problem.

Be sure to ask your doctor if any of your medications could be contributing to your problem. Important: Never discontinue a prescribed drug without checking with your doctor. 

If you have a medical condition that increases your risk for underactive bladder (such as those mentioned earlier), be sure to get proper treatment for it. In other cases, you may have an underlying cause that requires surgery, such as pelvic floor reconstruction for a sagging bladder. Or the doctor may refer you to a physical therapist or other professional who will help you with behavior changes that give you more control over your bladder function.

Also helpful: In some cases, you may be asked to try using a disposable strawlike catheter to empty your bladder several times a day. It’s easier than you might think and is sometimes the best way to get on with a normal life.

Easy Self-Care Steps

If you’re having problems with bladder control, here are some other factors you may not think of…

• Drinking too much—or too little. Downing too many fluids is a risk for anyone prone to leakage. But drinking too little can be a problem, too. This can lead to concentrated urine that irritates the urinary tract, setting you up for infection, which increases the risk for incontinence. 

• Eating (or drinking) the wrong things. Spicy foods and acidic fruits, such as oranges and strawberries, can all cause bladder irritation and contribute to bladder control problems—so can coffee, caffeinated tea and alcohol. Eliminate each of these for a two-week period to see which foods and/or drinks are a trigger for you.

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