Q: I’m finding that I have a near-constant urge to urinate, and I don’t always make it. What are my options?
A: It sounds like you have an overactive bladder, or “urge incontinence.” This is defined as frequently sensing a need to urinate (and to do so immediately!) and if a toilet is not in the immediate vicinity, unwanted loss of urine.
First a quick 101 on bladder physiology: The bladder opening (urethra) is surrounded by sphincters that keep the urethra closed and urine stored within. When nerves from the bladder let you know it’s full and it’s time to void, your brain then sends signals to the bladder to contract while the sphincters open. This wondrous concurrence of sensation and direction is something we learn during toilet training.
But alas, as we get older, the sphincters can become weakened and the urethra may lose its support, in which case urine is lost when there’s a sudden increase in pressure (such as when you cough or sneeze). This condition is called stress incontinence.
With overactive bladder (OAB), in contrast, it’s not the support that’s “lost” it’s the bladder muscle that is overstimulated. It contracts involuntarily, so urine comes out before you’re consciously ready to urinate.
Often, the reason your bladder contracts is that it’s over-distended and that contraction is really a protest of “Help, I’m too full and confused as to how often you plan to empty me.” So, before I tell you about medication to treat OAB, I suggest you simply try bladder training.
If you’re waiting too long to go to the bathroom, start making regular trips — first, every two hours, then every two hours and fifteen minutes, and so on. Make sure you go even if you think you don’t have to.
You can also try using Kegel exercises to strengthen the muscles that support the bladder (for instructions, go to the Web site of the National Association for Continence: ).
Stay away from certain foods and drinks that irritate the bladder, including caffeine, citrus, alcohol, sugar and even sugar substitutes. Don’t over-distend your bladder by trying to drink huge amounts of water. Your fluid intake should be determined by thirst, unless you are exercising or in hot climates.
Your doctor may ultimately prescribe medication to treat OAB. These drugs work by relaxing the bladder muscles and allowing the bladder to hold more urine. The medication that has been used for the longest time is oxybutynin (Ditropan). This originally came in the form of a short-acting tablet that had significant side effects, including dry mouth and constipation. There are now two new forms of long-acting tablets taken once daily and a patch used twice weekly that cause fewer side effects.
Another medication that is frequently prescribed, tolterodine (Detrol), is very similar to Ditropan. Some studies found that Detrol might be slightly less effective, but it is also less likely to cause dry mouth.
Three new medications — trospium (Sanctura), solifenacin (VESIcare) and darifenacin (Enablex) — work on the same principle as the older drugs, but may provide more “warning time” before loss of urine. They are likely to be more expensive because they are new, and if your doctor prescribes any of them, you and she should check whether or not your insurance will cover it. (Note: if you respond well to medication, you’ll likely have to continue using it for rest of your life.)
If bladder training and medication don’t work, many urologists offer biofeedback and electrical biofeedback training.
Dr. Reichman’s Bottom Line: OAB is very common, but should not be accepted as an inevitable condition. A variety of treatments are available, so don’t be ashamed to talk to your doctor and work with her to ensure your “right to dryness."
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.