Note: The causes of overactive bladder are varied. This problem should be discussed with your doctor so as to determine the best, most effective, therapeutic approach.

The treatment options available for overactive bladder includes the following:

Diet plays a major role in bladder function. Many foods and drinks are irritating to the bladder. At the top of the list of irritants is caffeine. Coffee, black tea, chocolate, and carbonated drinks tend to make overactive bladder symptoms much worse. Acidic beverages in general make matters worse. Trying to avoid coffee, tea, and alcohol can make a big difference in the severity of overactive bladder symptoms.

The amount of fluid you drink obviously determines the amount of urine you produce. Limiting your fluid consumption to 1500 cc (50 ounces) per day can improve symptoms in some cases. Avoiding fluids within two hours of bedtime is one way to reduce the number of times it is necessary to urinate during the night.

Many people use diuretics (water-pills) to control blood pressure and swelling. These medications cause the kidneys to produce more urine and therefore if at all possible they should be taken in the morning rather than close to bedtime.

There are many different medications that can suppress unwanted bladder contractions. In the past many patients have been unable to tolerate the very unpleasant side effects such as dry mouth. Newer formulations such as Ditropan XL and Detrol LA have improved on this problem somewhat. These newer products are quite a bit more expensive, however, and most insurance (including Medicare) require a trial of the older less expensive medications first. Patients with a special type of glaucoma should not use these medications.

Estrogen plays a critical role in maintaining the health and function of the vagina and bladder. After the menopause the ovaries no longer produce this hormone. Without estrogen the urethra and bladder can become overly sensitive. Taking estrogen by mouth is often not sufficient to improve this problem and topical estrogen, in the form of a cream or suppository, must be used. There are very few side effects associated with the use of topical estrogen.

The muscles of the pelvis that surround and support the urethra, bladder, vagina, and rectum are often weak in women with overactive bladder. These muscles can be stimulated (using a small vaginal probe) to contract using a very weak electrical signal. This type of therapy takes time but the results are fairly impressive. The program usually involves weekly visits to the doctor or physical therapist office for treatment sessions that generally last about a half hour. It seems that this type of therapy strengthens the muscles that surround the urethra and improves the functioning of the nerves that work to suppress unwanted bladder contractions. The treatment is not painful but does require a bit of a time commitment.

This type of therapy involves teaching patients how to contract the muscles of the pelvic floor more effectively. Up to one third of women are unable to perform a Kegel exercise on their own. Biofeedback allows patients to observe on a video screen the activity in the pelvic floor muscles in real time. This along with the help of a physical therapist or physician allows patients to learn how to better control and isolate these muscles. Once learned the muscles can be exercised more effectively and improved bladder function usually will follow. Like electrical stimulation this form of therapy takes time but the success rates are generally in excess of 80%.

There seems to be a communication between the nerves that supply the pelvic muscles and the bladder. Contraction of the pelvic muscles causes the nerves to send a message to the bladder that in turn causes the bladder to relax. Teaching patients to squeeze the pelvic muscles (a Kegel exercise) in response to a strong urge to urinate can often stop the urge altogether. This simple maneuver, called bladder retraining, often results in a dramatic improvement in bladder control. The correct technique is described below:

Begin with a plan to empty your bladder (whether you feel the urge or not) every 1 1/2 hours. If a strong urge to void occurs between these regularly scheduled trips to the bathroom do the following:

•As soon as a strong urge to urinate occurs rather than running the nearest bathroom contract (squeeze with) the pelvic floor muscles as if trying to hold back gas or a bowel movement.

• Perform five quick squeezed in a rapid series and wait for the urge to pass. In most cases the urge will only last thirty to sixty seconds.

•Once the urge has passed walk calmly to the bathroom and empty the bladder

• Slowly over time try to increase the time between trips to the bathroom by adding 15 minutes time between timed voids.

The trick is to break the habit of making a mad dash to the bathroom as soon as a strong urge occurs. By following these steps it is possible to "retrain" the bladder to function normally.

Traditionally surgery has not been considered a reasonable treatment for overactive bladder. Recent research has shown, however, that among patients with poor bladder support restoring normal anatomy can resolve overactive bladder symptoms in some patients (about 60%). This is not generally the first choice of treatment but for some patients has been quite helpful.

The most important thing you can do to improve you bladder symptoms is to speak to a physician about the problem.