Watch For These Bladder Warning Signs
Should I worry if I have Overactive Bladder symptoms?
Most people with symptoms of Overactive Bladder (OAB) such as frequent or urgent urination do not require extensive or invasive evaluation. However, you should be aware that certain symptoms increase the possibility of a more serious condition and should have a more extensive evaluation by a health provider. For instance, sudden onset of symptoms, especially if accompanied by pain (which is not a symptom of OAB), often indicates another problem such as infection or urinary tract stone. Blood that you see mixed into your urine is also not a symptom of Overactive Bladder and should be investigated by a urologist.
What are other warning signs that my Overactive Bladder symptoms should be looked at more closely?
In addition to blood in the urine and pain, there are several additional warning signs that you may need to see a urologist who specializes in pelvic health
Symptoms started after an incontinence surgery such as a mid-urethral sling
You had a vaginal prolapse repair with synthetic mesh
You have trouble emptying your bladder
You have a neurologic disease such as Multiple Sclerosis, spina bifida, or Parkinson disease
You have had pelvic radiation
Your symptoms started soon after a hysterectomy
It feels like I don’t empty my bladder but I was told I empty just fine.
It is very common for patients that I see with Overactive Bladder (OAB) to report that they feel like they do not empty their bladders all the way. If I urinated every 30 minutes (as some of my OAB patients do) I too would think I wasn’t emptying very well. But most of these patients do empty completely, they just feel as if they do not. We can check how well patients empty with a test of the “post-void residual” (PVR), which is the amount left in your bladder after you are done urinating. This is checked by either scanning the bladder with a portable ultrasound machine or (more rarely) placing a small catheter into the bladder to see how much is left behind. It can be important to evaluate this as some OAB medications can make problems with emptying your bladder even worse.
What happens if I have Overactive Bladder symptoms and blood in my urine?
If you have blood in your urine that you can see (along with a history of frequent or urgent urination), and no signs of a urinary tract infection, you should be evaluated by a urologist. Your urologist will often evaluate your kidneys with a CT scan as well as take a good look at in bladder with small scope called a “cystoscope”.
Blood in your urine that is only seen with a microscope may not require as extensive of an evaluation. Depending on your age, the amount of blood that was seen under the microscope, and your risk factors such as smoking and family history, your urologist may recommend several different options. These can range from simply repeating a urine test in 6 months to a more extensive evaluation with a kidney ultrasound, a kidney CT and looking into your bladder with a scope.
What if I have Overactive Bladder symptoms and urinary tract infections?
It is not unusual for me to see patients who have both frequent and urgent urination and a history of recurrent urinary tract infections (UTI). I suspect this is because both are so common and may also be because urinary incontinence is actually a risk factor for UTI. I always ask if the bladder symptoms completely go away when the infections are treated. If they do respond I generally recommend that we get the infections under control before starting treatment for the Overactive Bladder. This is because the symptoms may resolve completely once the infections are stopped.
However, it is also common for patients to report that the OAB symptoms started before the infections and do not go away with treatment of the infections. In these patients, it can make sense to begin treating the Overactive Bladder at the same time, especially if we suspect that urine leakage is increasing the risk of the UTI.
How is treating Overactive Bladder symptoms different in patients who have a neurologic disorder?
Treating OAB symptoms in patients with neurologic diseases such as multiple sclerosis, Parkinson disease, diabetic neuropathy or stroke in many ways is very similar to doing so in those without a neurologic diagnosis. We often start with behavioral therapies and often add medications if symptoms are more bothersome. Even third-line therapies such as botulinum toxin injections and neuromodulation are used.
But, in other ways, treating these patients can be much different. While it depends on the neurologic disease, some of these patients are at higher risk for complications including not emptying the bladder (urinary retention), urinary tract infection, or risk to the kidneys. Patients with bladder symptoms from neurologic causes (neurogenic bladder) may also be harder to treat and less likely to respond to therapy. Patients with neurogenic bladder should probably be followed by a urologist, perhaps even one who specializes in bladder health, if available in you region.