Both can cause a need to pee, but they’re very different conditions.
Your bladder is c-r-a-n-k-y. That you know for sure. At the most inconvenient times—during an important business meeting, when you’re in line at the checkout counter, or even when you’re having sex—your bladder will just decide without warning or care that it needs to pee. Frankly, it’s awful.
You may assume your urges are symptoms of an overactive bladder, because hey, that’s what Google said it sounded like. The thing is, however, there are different conditions that can cause a high-maintenance bladder. If you’re not sure which one you’re dealing with, you may not get the right treatment to make it (and you) happy again.
“It’s very difficult to get the results you’re looking for with self-diagnosis and self-treatment,” says Lauri Romanzi, MD, a urogynecologist in New York City. Misdiagnosing yourself with a certain kind of incontinence or bladder problem may cause frustration and anxiety, especially if you’re trying to treat yourself and what you’re doing doesn’t seem to be working. “And, no surprise, the anxiety makes everything worse, particularly the overactive bladder,” says Dr. Romanzi.
The only way to know for sure what’s causing your bladder issues is to see your doctor. Still, knowing the three basic types of incontinence—stress incontinence, overactive bladder, and mixed incontinence—can help give you a clue to what’s going on down there. Here’s what each of them means, so you get on the right track to treat your symptoms.
1. Stress incontinence
“Stress incontinence is caused by a weakness in the urethral closure mechanism (sphincter), that allows urine to squirt out when there’s a lot of abdominal pressure,” says Dr. Romanzi. Typically, abdominal pressure increases when you sneeze, cough, change position, lift something heavy, or engage in high-impact physical activity, like running or jumping.
Stress incontinence is the most common type of incontinence in younger women, with the highest incidence occurring in women ages 45 to 49 years. Women who’ve been pregnant and had a vaginal delivery, or who have pelvic prolapse (when your bladder moves down from its normal place and pushes against the vagina) are also at increased risk for stress incontinence.
2. Overactive bladder
“Overactive bladder is caused by a bladder that is literally going into a urination reflex when you’re not on the toilet—so it really is overactive,” says Dr. Romanzi. The textbook definition of overactive bladder is urinary urgency with or without urge incontinence; there are four basic symptoms:
- Urgency: Needing to go to the bathroom suddenly
- Frequency: Needing to go to the bathroom often
- Nighttime voiding: Needing to use the bathroom at night
- Urge incontinence: Leaking urine because you couldn’t get to the bathroom fast enough
Overactive bladder and urge incontinence are more common in older women and may be associated with certain conditions that occur with age, like menopause, or cognitive and nerve problems.
3. Mixed incontinence
Mixed incontinence is when women have elements of both stress incontinence and overactive bladder symptoms. This tends to be more common in women who’ve had a few children, says Dr. Romanzi.
How to Treat OAB, Mixed and Stress Incontinence
Treatments options for incontinence depend on how the symptoms affect your life, but they usually include one or a combination of the following: lifestyle or behavior changes (such as avoiding bladder-irritating foods, drinking the right amount of water, or starting a bladder diary), medication, or surgery.
Kegel exercises can help treat overactive bladder, stress incontinence and mixed incontinence. “Kegel exercises can be done on your own, or you can get coaching with a pelvic floor physical therapist,” says Dr. Romanzi. Here’s more on how to do a Kegel exercise.
If Kegel exercises or lifestyle and behavioral modifications don’t work to alleviate your overactive bladder or stress incontinence, then your doctor may recommend surgery or medications. “Ultimately for stress incontinence you may have a surgical procedure, and with urge incontinence you’re more likely to end up on a chronic regimen of bladder medications,” says Dr. Romanzi.
Dr. Romanzi is a urogynecologist and reconstructive pelvic surgeon based in New York City.
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Any incontinence is distressing, and
often, patients will decide that
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they have the first type of incontinence
that they read about on the Internet.
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There are a few basic types of
incontinence that we typically treat.
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There's stress incontinence,
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which is caused by a weakness in
the urethral closure mechanism.
00:00:26,894 --> 00:00:31,500
That allows urine to squirt out when
there's a lot of abdominal pressure.
00:00:31,500 --> 00:00:33,990
Typically, you increase your
abdominal pressure when you cough,
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when you sneeze, when you lift,
when you change position.
00:00:37,000 --> 00:00:40,360
When you pick up something heavy,
when you're running, when you're jumping.
00:00:40,360 --> 00:00:42,462
The other major type
is overactive bladder.
00:00:42,462 --> 00:00:47,370
Overactive bladder is caused by a bladder
that is literally going into an urination
00:00:47,370 --> 00:00:51,580
reflex when you're not on the toilet,
so it really is overactive.
00:00:51,580 --> 00:00:55,920
Urgency is the feeling of needing to
urinate immediately that is difficult or
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impossible to control.
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When it's difficult to control,
you end up with frequency, urgency, and
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sometimes voiding at night, or nocturia.
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When it's impossible to control,
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we end up with overactive bladder that
is also causing urge incontinence.
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There's also mixed incontinence,
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especially in women who
have had a few children.
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Their incontinence is often mixed,
where they have a stress component, and
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also an overactive bladder component.
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You can treat both stress and urge and
mixed incontinence with Kegel exercises.
00:01:26,870 --> 00:01:29,940
Kegel exercises can be done on your own,
00:01:29,940 --> 00:01:33,380
you can get coaching with a pelvic
floor physical therapist.
00:01:33,380 --> 00:01:37,110
But if it doesn't work, then typically
what we end up with is, ultimately for
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you may have a surgical procedure.
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And with urge incontinence,
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you're more likely to end up on a chronic
regimen of bladder medications.
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The biggest challenge with
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is simply the prolonged anxiety and
quality of life impact.
00:01:54,050 --> 00:01:57,085
You become more worried that
maybe nothing's going to work.
00:01:57,085 --> 00:02:00,547
And usually patients who have
been trying to treat themselves,
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who come in after six months or a year,
have a significant anxiety component.
00:02:04,789 --> 00:02:08,143
And, no surprise,
the anxiety makes everything worse,
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particularly the overactive bladder.
00:02:11,150 --> 00:02:15,070
It is very difficult to get
the results that you're looking for
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with self diagnosis and self treatment.
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Three months of self treatment is enough.
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If you're not getting results,
go in and get some help.
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Bladder Control Problems in Women (Urinary Incontinence). National Institute of Digestive and Kidney Diseases. (Accessed on April 10, 2018 at https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-women) Stress Urinary Incontinence. U.S. Library of Medicine, MedlinePlus. (Accessed on April 10, 2018 at https://medlineplus.gov/ency/article/000891.htm)
Urge Incontinence. U.S. Library of Medicine, MedlinePlus. (Accessed on April 10, 2018 at https://medlineplus.gov/ency/article/001270.htm)
Evaluation of women with urinary incontinence. UpToDate. (Accessed on April 10, 2018 at https://www.uptodate.com/contents/evaluation-of-women-with-urinary-incontinence)