woman with underactive bladder
Incontinence

Underactive Bladder: The Opposite Of Gotta-Go

Most of us have heard of an overactive bladder (OAB), but did you know there’s such a thing as an underactive bladder? Chances are, probably not. The media spends much more time showing us what “gotta-go, gotta-gotta-go, gotta-go right now” looks like due to how common OAB is. However, underactive bladder, or UAB, doesn’t get the attention it deserves. Here, we’re going to unravel what underactive bladder is all about and what you can do about it.

What is an Underactive Bladder?

As you might’ve imagined, an underactive bladder is the opposite of an overactive bladder. So, instead of having the frequent urge to urinate, you strain to even make a dribble. Or in some cases, you do pee but you’re not able to completely empty your bladder. 

Unlike OAB, where having just a little urine in your bladder could make you leak, a person with underactive bladder can hold a large amount of urine in their bladder. The challenge, however, is that their bladder isn’t able to sense that it’s full and needs to empty. 

Why Does This Occur? 

So you’re probably wondering, why wouldn’t a bladder be able to empty itself when it’s full? Well, it all comes down to your bladder’s nerves. We have nerve messages that go back and forth between the brain and the muscles that control bladder emptying. However, when those nerves are damaged, they can’t tell the bladder muscles when to tighten or relax. Individuals with a lack of bladder control due to a brain, spinal cord or nerve problem, have a neurogenic bladder

Individuals with an underactive bladder have sphincter muscles around the urethra that remain tight even when the bladder is full. As a result, these people have trouble fully emptying their bladder. Some are not able to empty their bladder at all. 

Symptoms of an Underactive Bladder 

No two individuals with underactive bladder are the same and so each person will experience different symptoms. Some of those symptoms include

  • Small amounts of urine when peeing 
  • Straining with urination
  • Urinary retention
  • Going to the bathroom multiple times but only a few drops come out each time
  • Spontaneous bladder leaks (aka incontinence)
  • Double voiding 
  • Recurrent UTIs 
  • Inability to tell when the bladder is full

What Causes an Underactive Bladder?

So who is exactly at risk of developing an underactive bladder? It turns out that there are a lot of risk factors associated with the condition. Consider the following

  • Spinal cord injury
  • Pelvic surgery 
  • Diabetes
  • Nerve damage
  • Increasing age 
  • Medications that block the chemical that relaxes the bladder muscle. Such as muscle relaxants and antidepressants. 
  • Obstructions that block urine flow such as an enlarged prostate or vaginal prolapse 
  • UTIs, which reduce bladder muscle contractility 
  • Aging 

How To Prevent and Treat an Underactive Bladder?

To date, healthcare professionals do not know how to prevent underactive bladder syndrome. There are some treatment options available to ease the symptoms, but there is no 100% cure. Consider the following treatment options: 

Medication

Prescription medications like Bethanechol, Doxazosin and Finasteride are used to stimulate the nerves of the bladder. With this newfound stimulation, the nerves should be able to tell the bladder, “hey, squeeze me,” which is a signal that it’s time to go. These prescription medications are typically used to treat benign prostatic hyperplasia (BPH), which is a condition that causes urinary retention. More research is needed on how the different layers of the bladder work together to develop a solid drug therapy for underactive bladder. 

Nerve Stimulation

Turns out, a little zip-zap could be just what your bladder needs to permit a drip. Nerve stimulation therapy would help you pee with a lot less effort all thanks to electrical pulses sent to the sacral nerves. This form of therapy doesn’t work for everyone, but it has a sort of try-before-you-commit deal. Therefore, if you try it and it doesn’t do anything for you, then your surgeon won’t implant it. 

Reflex Voiding

Double voiding and triggered reflex voiding are other treatments that might help. With double voiding, you’ll want to slightly change your position after peeing. For example, try leaning forward and see if that helps you pee again so you can empty your bladder.  Triggered reflex voiding is a little more interesting, but it helps to know what your trigger points are. You’ll have to try various simulation techniques to see if it’ll make you pee such as: 

  • Pulling your pubic hair
  • Stroking the skin of your thigh
  • Touching the sole of your foot

Urethral Flow Assist Device

In 2014, the FDA approved a device just for women who require catheterization, either intermittently or continuously. The device, called InFlow, is placed in the urethra for up to 30 days. When you’re ready to go, you can turn on the pump that’s inside the InFlow with a remote. Once it’s on, urine is pumped out of the bladder, through the InFlow, and out the opening of the urethra. 

Try Bladder Leak Pads

An underactive bladder could cause people to feel anxious about going to work, social engagements, or even going to sleep at night, especially if one of your symptoms is bladder leaks, or incontinence. However, absorbent products designed to stop leaks in their tracks could lessen those anxieties. You can choose between pads or underwear based on the fit you’re looking for, absorbency level, and more. If picking up a package of pads or underwear at your local grocery store doesn’t sound too appealing, try a service like Lily Bird. Having your products shipped discreetly to your home is a great way to take the stress out of buying them. 

Tell Your Bladder Who’s Boss Even With Underactive Bladder

Like other bladder conditions, an underactive bladder can be challenging to deal with, especially if you think you’re alone. While there’s not as much research done on this condition today, talking about it will bring awareness. If you think an underactive bladder is affecting you, speak with your doctor. You and your healthcare provider should be able to figure out a method that works best for you.

By Jessica Thomas, MPH