Overactive Bladder: when good organs go rogue
Photo by Aaron Burden on Unsplash
I have found that there is nothing like a good road trip to test a bladder. You always realize you have to go just as you pass the sign stating there are no exits for 100 miles. It's ridiculous. And you know when you start shifting uncomfortably that time is running out. But feeling a gradul urge come on with plenty of time to figure out which ladies room will meet your needs is totally normal. In the case of overactive bladder, or OAB, your bladder would tell you to pull over now, or else.
OAB frequently starts without a known cause. The most common symptom reported is more frequent trips to the bathroom, however it can start subtly and may not be noticed for awhile. The increase in urge to use the restroom can come on faster than might feel normal, and the amount of urine voided may be less than you would expect compared to how strong the urge was. Leakage can also occur due to the strength of the urge. And this affects up to 13% of the world’s population. That’s more than one in every ten people!
Before going further into 'rogue' bladders, what's considered normal? A healthy bladder can hold around 300-400 mLs of volume at full capacity. Think less than a quarter of a 2 liter soda bottle. And adults normally urinate 5-7 times per day and up to once at night. If normal voiding allows for 50 to 100 mLs of urine to remain in the bladder (the exact definition of normal has some variation), one would typically pass between 1.25 to 3.1 liters per day. That’s a lot of fluids to ingest to maintain hydration!
And while the bladder seems to be just a glorified water balloon, it’s actually a pretty complex organ. Compared to other visceral organs out of our control, the bladder is under voluntary control after the age of three to five. Its combination of voluntary and involuntary (we don’t ‘tell’ it to fill) control requires a complex neural setup. To allow filling from the kidneys, the bladder is prevented from contracting by thoracic nerves 10-12 (T10-T12). And nerves originating in the sacral spine are responsible for contracting the bladder to void (it is a muscle that squeezes to return to empty). This is a very simplistic overview, if you are curious about a more in-depth explanation refer to this video.
Now, back to when the bladder goes rogue. Earlier in this post I mentioned that OAB often starts without a cause (slight rant here: nothing in your body starts without a cause in my humble opinion, we just haven’t figured out why some things happen yet), however there are some pathologies that are linked to an increase in incidence. Diabetes, prostate issues (in males) and cognitive decline are linked to OAB. And post-menopausal women are especially at risk due to their reduction in estrogen production. Estrogen is responsible for maintaining healthy pelvic tissues (think good blood flow, healthy ligaments, healthy muscles, etc), and in this capacity helps maintain continence. Postpartum women also experience a drop in estrogen immediately postpartum, and breastfeeding contributes to sustained lowered levels of estrogen usually until it is stopped so postpartum and breastfeeding women can also be at elevated risk of developing OAB. And most interestingly, vitamin D and magnesium deficiencies are known to have a role in bladder spasm and overactivity. Vitamin D deficiency affects approximately 40% of the population, and has been linked to multiple pelvic floor disorders.
So what do you do if you find yourself with OAB? My first suggestion would be to determine if you are affected by vitamin deficiencies, as those are the easiest to treat. A naturopath or your primary care provider can run blood tests to determine if this is the case. The next step is to follow up with a specialist. OAB is treatable, but complicated. It is best to see a PT or urogynecologist to determine what your specific cause is, and to develop a treatment program that will best address your cause. Bladder retraining is the primary treatment, and there is a lot of education and small steps that are important to address. In the mean time, consult this list of irritants. Some of these may be triggers for your bladder (yes, the bladder has specific foods and drinks that irritate it) and reducing their intake may significantly improve your symptoms.
OAB can really affect quality of life, and getting help sooner than later can make the recovery process faster and easier. Comment if you have any questions after reading, and don’t suffer with a rogue bladder!