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Overactive Bladder vs. Incontinence: What's the Difference?

Urinary incontinence and overactive bladder have very similar symptoms, but they are not the same condition. Urinary incontinence is the involuntary loss of urine, whereas overactive bladder is the frequent and difficult to control urge to urinate. Being aware of the differences between overactive bladder and urinary incontinence is important, as each has different causes and treatments. This guide will walk you through the causes and symptoms of both so you can differentiate between them and learn their treatments.


Overactive Bladder 

Overactive Bladder (OAB) is characterized by an intense and frequent urge to urinate. Overactive bladder is caused by muscle spasms that take place in your bladder. There’s a muscle in your bladder called the detrusor muscle. This muscle is responsible for contracting and releasing urine. When your bladder gets full, your nerves tell your brain to signal your detrusor muscle, which then contracts and empties your bladder,

Overactive bladder occurs when these signals message your detrusor muscle to release or contract when your bladder may not actually be full. This causes the frequent and intense urges to urinate, characteristic of an overactive bladder. In addition, an overactive bladder may inhibit your ability to control the urge, so your detrusor muscle begins to release the urine, even if you aren’t near a bathroom.

According to the National Association For Incontinence, over 33 million Americans live with overactive bladder, and half of these also live with urinary incontinence.


Symptoms of Overactive Bladder 

There are a variety of symptoms unique to an overactive bladder (OAB) that can help you differentiate it from urinary incontinence. Below are some symptoms that might be indicative of OAB:

  • Urgency: If you experience the sudden urge to urinate even if you just emptied your bladder

  • Unintentional loss of urine: If you experience the unintentional loss of urine after feeling the urges that accompany an overactive bladder

  • Frequent urination: If you urinate more than eight times per day and have any other symptoms in this list 

  • Urinating in the middle of the night: If you are frequently awakened by your need to urinate at night 

 

Causes of Overactive Bladder 

The causes of an overactive bladder begin with a lack of coordination in the urinary system. When your kidneys filter out minerals and nutrients from your blood, they produce waste in the form of urine. The urine then travels to your bladder, where it is stored until your brain sends the appropriate signals for your detrusor muscle to contract and your urinary sphincter to relax. This is how our bodies know when to urinate!

Overactive bladder occurs when the signaling process from the brain to the bladder gets mixed up. The signals tend to be urgent and intense, even when your bladder is not completely full. For instance, most people can hold up to 2 cups of urine in their bladder before they have to urinate. For people with overactive bladder, you may get an urge to urinate with the same intensity as if your bladder was full, but it may only be half or less than half-way full.


Urinary Incontinence 

More than a third of those 65 and over live with some form of urinary incontinence. Urinary incontinence is the involuntary loss of urine, even if there is no urge to use the bathroom. There are multiple kinds of urinary incontinence you may experience.


Stress Incontinence 

Harvard Health describes stress incontinence as urine leaks that are caused by movement. These movements may be jumping, coughing, laughing, or sneezing. The pelvic floor muscles are muscles that control your bladder and contract the urethral sphincter. Stress incontinence is when these muscles have been weakened or damaged and can no longer contract the way they are supposed to in order to hold urine. When you jump and “stress” is placed on your bladder, your muscles are unable to hold urine in.


Causes of Stress Incontinence

One of the most common causes of stress incontinence is childbirth, but it often accompanies age as well. In women, this weakening may be due to an imbalance of estrogen levels, which can lead to decreased bone and muscle loss everywhere. For men, stress incontinence is most often caused by urinary sphincter damage from prostate surgery or injury.

There are other contributing factors to developing stress incontinence, such as obesity and high impact exercise. Lung conditions or respiratory issues caused by smoking or disease can also lead to stress incontinence as they may cause an increase in coughing.


Signs and Symptoms of Stress Incontinence

  •   You will not feel the urge to urinate
  •   Urinating when you cough or sneeze
  •   Urinating when you laugh, bend over, or lift something heavy
  •   Urinating during exercise or sex

 

Urge Incontinence 

Urge incontinence is very similar to an overactive bladder. Incontinence occurs when the signal for urgency is too strong, and your bladder muscles release before you can make it to the restroom.


Causes of Urge Incontinence

Urge incontinence may be caused by brain damage, which could prevent you from being able to counteract the signals sent to your brain to release your bladder. Similarly, if you’ve suffered from nerve damage or spine damage, this could result in an inability to stop a signal. Urinary infection could also cause urge incontinence and increase the urge to go, but these often go away when your infection does.

If you suffer from myofascial pelvic pain syndrome, you may experience urge incontinence as a result. If you experience burning when urinating, pain, or feelings of heaviness in your bladder, speak to your physician. In men, urge incontinence is most commonly caused by surgeries to or damage to the prostate. This can include benign prostatic hyperplasia (BPH), which is an enlargement of the prostate, prostate cancer surgeries, or other prostate cancer procedures and treatments.


Signs and Symptoms of Urge Incontinence

  • An increased urge to urinate, even if you have just emptied your bladder
  • An inability to control these urges or wait
  • Being unable to make it to the bathroom in time

Mixed Incontinence 

Some people live with both stress incontinence and urge incontinence. This is often referred to as mixed incontinence. Mixed incontinence is most common in women due to menopause and childbirth. Men can experience mixed incontinence if they have had surgeries or damage to the prostate as well. Your chances of suffering from mixed incontinence also increase as you age, so understanding the signs of each type of UI and learning how to deal with it can be a beneficial factor in your journey! 


Overflow Incontinence 

Overflow incontinence is most often experienced in men. It can be caused by a blockage of complete urine passage, which prohibits the bladder to empty completely, thus causing leaks without the urge to urinate. This form of UI can also be caused by a weakening of the pelvic floor muscles or bladder inactivity.


Causes of Overflow Incontinence

If you have had a urine drainage bag, you may experience overflow incontinence due to the inactivity of your bladder. In addition, diabetes and multiple sclerosis can damage the nerves responsible for signaling fullness and emptiness, which can result in overflow incontinence. Bladder stones or urinary tract tumors can also cause overflow incontinence as they block the urinary tract and can prevent complete emptying of the bladder. Some medicines can even result in overflow incontinence. If you notice a change in your urinary habits after starting medicine, speak to your physician.


Signs and Symptoms of Overflow Incontinence

  • Releasing urine suddenly without the urge to go
  • Feeling like your bladder is full even after urination
  • Urination leakage while sleeping
  • Sudden stopping and starting of your urine stream while you’re urinating
  • Difficulty urinating even when you feel the urge to go

Reflex Incontinence 

Reflex Incontinence is characterized by the release of urine with no warning or urging. You will not feel like you need to urinate, and you may not even realize you’re leaking until you feel wet. Typically, reflex incontinence is due to nerve damage of the nerves responsible for signaling bladder fullness or emptiness. The most common appearance of this form of urinary incontinence is in people with severe brain damage or spinal cord damage, those with multiple sclerosis, or those who have undergone radiation treatments or specific surgeries.


Managing Overactive Bladder and Urinary Incontinence 

The first thing you should do if you recognize any symptoms of overactive bladder is to speak to your doctor. Your doctor will likely do testing to determine if you can be diagnosed with an overactive bladder. Many treatments of overactive bladder involve prescription medications that calm muscle spasms and potentially calm your urges.


Overactive Bladder Diet

One of the most popular natural ways to combat overactive bladder is by using the overactive bladder diet. Many foods can irritate our bladders, so keeping track of which foods seem to increase your urge to urinate can help you reduce your symptoms.

The overactive bladder diet typically cuts out sugar, spicy foods, citrus, and caffeine. Soda and carbonated drinks, gluten, and alcohol may also be causing your bladder to overact.


Kegel Exercises

Kegel exercises increase pelvic floor strength and minimize symptoms of overactive bladder and urinary incontinence. This exercise targets and strengthens your pelvic floor muscles. Kegel exercises have various benefits, including strengthening your pelvic floor muscles, improving sexual function, and controlling urinary incontinence, and can be done in men and women.

To perform kegel exercises, tighten your pelvic floor and hold this position for five-ten seconds. Repeat this exercise ten times during one kegel exercise and repeat the exercises two to three times a day.


Summary 

If you or a loved one live with overactive bladder or urinary incontinence, you are not alone. Being aware of the symptoms of overactive bladder and how they differ from the symptoms of urinary incontinence can help you identify both and help you know which treatment you should seek. Before partaking in any form of treatment, be sure to speak to your doctor about any underlying health conditions.

 

Sources:

Men · Working your pelvic floor (pelvicfloorfirst.org.au)

Overactive Bladder (OAB) and Urge Urinary Incontinence (UUI) (simonfoundation.org)

Overactive Bladder (OAB) Symptoms, Causes, and Treatment - (nafc.org)

Urinary Incontinence - Causes, Types, Symptoms, Treatments - (nafc.org)

Types of urinary incontinence - (health.harvard.edu) 

Overflow Incontinence (uofmhealth.org)

Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain (ncbi.nim.gov)

Stress incontinence - Symptoms and causes (mayoclinic.org)

Evidence profile: urinary incontinence (who.int)

How Overactive Bladder Differs From Urinary Incontinence (healthgrades.com)

Overactive bladder - Symptoms and causes (mayoclinic.org)