It’s easy to take your bladder for granted. This unassuming, stretchable organ nestles in your pelvis, storing urine until convenience or necessity dictates that you empty it. In a healthy bladder, progressive expansion occurs without generating any unusual sensations or discomfort. As your bladder nears its capacity, it sends signals to your spinal cord and brain that remind you of the need to eliminate urine. Certain conditions that sensitize your bladder wall may trigger urinary urgency -- a sensation of pressure that compels you to empty your bladder -- even when little or no urine is present.
Acute cystitis, or bladder infection, is a frequent cause of constant urine pressure. Urinary tract infections are the most common bacterial infections in women, but men can suffer from UTIs, too. Symptoms of acute cystitis include painful urination, frequent voiding of small amounts of urine and urinary urgency. Some patients with UTIs have blood in their urine or pelvic pain. Your doctor can usually diagnose a bladder infection with a quick test of your urine. The discomfort of acute cystitis typically resolves a few days after antibiotics are administered.
Painful Bladder Syndrome
According to a 2011 review in “American Family Physician,” more than 1 million Americans, most of them women, suffer from interstitial cystitis/painful bladder syndrome. The cause of this condition is unknown, but affected people exhibit inflammation in the inner lining of their bladder wall that disrupts its normal protective functions. Symptoms of interstitial cystitis include urinary pressure, pelvic pain, painful urination and pain during sexual intercourse. Interstitial cystitis is a chronic and frequently stubborn condition. Since its symptoms overlap with those of a UTI or other conditions, it can be difficult to diagnose. Visual inspection of your inner bladder wall through a narrow scope may be part of your evaluation. Treatment may involve oral medications, such as pentosan polysulfate sodium (Elmiron), amitriptyline (Elavil) or cimetidine (Tagamet), or bladder irrigation with dimethyl sulfoxide (DMSO), bacille Calmette-Guérin (BCG) or Elmiron. Long-term treatment is usually required for interstitial cystitis/painful bladder syndrome.
Overactive Bladder Syndrome
Overactive bladder syndrome, or OAB, is a condition characterized by urinary urgency, with or without urinary leakage, when no other disorder is present. People with OAB may also complain of frequent urination and having to get out of bed at night to urinate. A 2012 report in the “International Journal of General Medicine” estimated that about 11 percent of adults worldwide suffer from OAB. As with interstitial cystitis, the underlying cause of OAB is unknown, but inflammation, abnormalities in the musculature of the bladder wall and disrupted nerve impulses appear to play roles. Once your doctor has ruled out other causes of your symptoms, such as UTI or interstitial cystitis, treatment may include bladder training, Kegel exercises to strengthen your pelvic muscles, biofeedback, electrical stimulation or oral medications, such as oxybutynin (Ditropan) or fesoterodine (Toviaz).
Although UTIs, interstitial cystitis and overactive bladder syndrome are relatively common causes of urinary urgency, a number of other disorders can trigger similar symptoms. Enlarged or cancerous pelvic organs -- prostate, uterus, ovaries or bowel -- can cause urgency by compressing the bladder. Women whose pelvic muscles have relaxed due to aging or childbirth may retain urine, which could lead to constant urgency. If you take a diuretic or are producing excess urine for any other reason, you could feel constant bladder pressure. Dietary items or medications that irritate the bladder wall, such as vitamin C, may cause urinary pressure. Bladder stones, a narrowed bladder outlet, genital herpes and even bladder cancer can cause persistent bladder pressure, as well. Your doctor might be able to diagnose your condition with a few questions and a simple urinalysis. If your diagnosis is not straightforward, you may be referred to a specialist for further evaluation.
- American Family Physician: Diagnosis and Treatment of Acute Uncomplicated Cystitis
- American Family Physician: Interstitial Cystitis/Painful Bladder Syndrome
- Canadian Urological Association Journal: Symptom-Based Diagnosis of Overactive Bladder -- An Overview
- International Journal of General Medicine: Overactive Bladder, Differential Diagnosis and Clinical Utility of Fesoterodine
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