At times in life, we all reach a point where we feel like our bladder is about to burst unless we urinate as soon as possible. This usually arises when we have restrained ourselves from urinating for a long period of time, especially if we have consumed large amounts of fluid. This feeling is not unusual and most of us will not soil ourselves. After urinating the sensation subsides. However, there are times where a person experience this sensation on an ongoing basis and cannot hold back the urine despite their best efforts.
What is an impatient bladder?
An impatient bladder is just a common term used to describe sudden or persistent bladder urging and urinary incontinence. It is not a medical term. Urging is the sensation that alerts us that the bladder is filled with urine and normally eases after urination. Incontinence means an inability to hold back the urine until the situation is appropriate to urinate.
These conditions can be seen with a host of different diseases, most of which involve the bladder. However, certain kidney diseases, hormone disorders and even drugs may contribute to an impatient bladder. At times there is no specific cause that can be identified. It is therefore important to consult with a doctor to identify the underlying cause and undergo the appropriate treatments.
How does the bladder work?
It is important to first understand how the bladder works under normal circumstances to further understand what may cause the conditions referred to as an impatient bladder. Urine is produced in the kidneys and is then transported down the ureters to the bladder. Here it is stored until urination, which is the process whereby urine then passes through the ureter and into the environment.
The bladder is a muscular hollow organ. Its walls are made up of muscles that stretch as it fills with urine. This stretching provides signals to the central nervous system of the urine volume in the kidney. When the urinary bladder stretches sufficiently, we feel a strong urge to urinate which builds up over time. It compels us to find a suitable setting, usually a toilet, where we can pass out the urine.
Under the appropriate circumstances, the bladder wall muscles contract thereby pushing out urine from the bladder. The urethral sphincter opens thereby allowing this urine to flow out of the bladder. As the bladder empties during urination, the stretched bladder walls return to a normal state and the urging to urinate subsides until the bladder fills up again.
Causes of Impatient Bladder
The main reasons for the conditions and symptoms broadly referred to as an impatient bladder is some damage or disorder with the nerves and muscles that control bladder activity.
- Nerve damage may be seen with a host of conditions, such as Parkinson’s disease, stroke or multiple sclerosis.
- Weakening of the bladder muscles which more often occurs in older women.
- Overactivity of the bladder muscles.
- Enlarged prostate that blocks urine outflow. Constipation may also cause a bloackage.
- Use of diuretics (“water pills”) and other medication that increases urine production.
- Caffeine and alcohol consumption in high quantities.
- A mass in the bladder such as a bladder stone or tumor.
- Increased urine production with diabetes mellitus, diabetes insipidus and high fluid consumption.
- Urinary tract infections, like cystitis.
Often there are age-related changes of the bladder that can causes these symptoms even through no specific disease affects the bladder. Therefore this condition is more commonly seen in older people. There are instances where the exact cause of an impatient bladder is unclear.
Read more on weak bladder.
Signs and Symptoms
As previously mentioned, an impatient bladder is not a medical term. It is a common way to describe two main symptoms – urgency to urinate (also referred to as urinary or vesical tenesmus) and urinary incontinence. It is important to understand what these terms mean in order to be able to define the rather vague term “impatient bladder”.
Urge to urinate
Feeling the urge to urinate when the bladder is full is normal. However, this should only be intense once the bladder is filled to a significant degree of its capacity. It arises gradually and should be relieved by passing urine. However, in an impatient bladder the urge comes on suddenly and is intense despite only small amounts of urine being passed out. Furthermore the sensation may not subside after urination.
Inability to hold back urine
Urinary incontinence is a condition whereby a person cannot withhold their urine. This may cause partial or complete emptying of the bladder. As a result a person may not be able to reach a toilet in time to pass out the urine. Therefore the undergarments may be soiled. There are several consequences of soiling the clothing in this manner. It can irritate the skin, lead to itching and even skin infections, cause embarrassment and contribute to a bad body odor.
Other signs and symptoms
Depending on the cause there may also be other signs and symptoms such as:
- Frequent urination, often exceeding more than 8 times in a 24 hour period.
- Nighttime waking to urinate (nocturia) resulting in disturbed sleep.
- Straining to urinate with incomplete emptying of the bladder.
Read more on signs of bladder disease.
Treatment of Impatient Bladder
Firstly, the nature of the condition termed as an impatient bladder has to be clearly defined. It may have different meanings to different people. Secondly, the underlying cause has to be diagnosed which may require a host of tests and scans. Once the underlying condition causing the impatient bladder symptoms is identified, then treatment can be commenced. The treatment options may vary depending on the cause, severity of the condition and the person’s medical history.
This includes drugs such as:
- Anticholinergics like tolterodine and oxybutynin.
- Alpha blockers for men like tamsulosin and alfuzosin.
- Topical estrogen for women.
Certain medical devices and surgical procedures may also be indicated for the treatment and management. In addition, a host of dietary and lifestyle measures may be advisable such as reducing fluid intake, bladder training, double voiding and scheduling trips to the toilet to pass urine at regular intervals.