I’m a healthy, athletic, middle-aged woman with a bathroom problem. I suddenly have the urge to “go” as many as a dozen times a day. What’s wrong with me?
Overactive bladders can be more than a nuisance because they can interfere with living a normal life. While medications like Detrol can calm an overactive bladder, you really want to find out the cause of the problem, address it directly, and hopefully resolve the issue rather than taking medications indefinitely.
So what causes an overactive bladder? This can be something simple, like a bladder infection, or chronic, like interstitial cystitis (meaning chronic inflammation of the bladder wall), or even a sign of nerve damage as in multiple sclerosis.
The most obvious is a bacterial bladder infection, and a simple urine test can determine if you have one. If you do, you can take a short course of antibiotics or use herbal remedies such as cranberry or uva ursi. Bladder infections often occur after sex. So empty your bladder right after intercourse for a modicum of protection.
Other causes often get overlooked. The most common are undiagnosed food sensitivities. A food elimination diet can help here. Try stopping gluten (wheat), dairy, yeast, eggs, corn, soy, and nuts for a week and then adding them back in your diet one food at a time so you can see if it’s the cause.
Food additives also pose potential problems. Aspartame and food preservatives and additives rank high on the list of potential culprits. If there is an ingredient on a label you don’t recognize as a food, don’t eat it.
Hidden yeast infections can also cause an irritable bladder. These are often overlooked and left untreated for years. If you’ve had numerous courses of antibiotics or take birth control pills or other forms of estrogen, taken steroids like prednisone, or if you currently eat a diet high in flour and sugar, you may have developed an overgrowth of yeast. It won’t show up on a urine test.
Herbal or prescription anti-fungals and probiotics can provide effective treatment. Useful herbs include berberine, garlic, oregano, and undecylenic acid and plant tannins. Common prescriptions include nystatin, Diflucan or Sporanox. These sometimes need to be taken for a month or more to get rid of the yeast. Cutting down on sugar and flour, staying away from antibiotics, and taking a good probiotic (healthy bacteria) daily can keep this problem from recurring.
Nutritional deficiencies can also cause an overactive bladder. Magnesium deficiency can cause any part of the body to cramp or spasm, including the bladder. Try taking 200 to 600 mg of magnesium citrate or glycinate daily and see if it helps. Vitamin B12 deficiency can mimic symptoms of multiple sclerosis, one of which is bladder spasms. Have your doctor check the methylmalonic acid level in your blood—it’s a much more sensitive indicator of deficiency than your vitamin B12 level. You might need B12 under the tongue or even injections to address this.
Menopause can cause vaginal wall thinning, and thinning of the urethra (the tube that leads from the bladder to the outside), causing frequent urination and bladder irritability. Topical vaginal estrogen can sometimes be a safe and easy fix.
Lastly, you might have a more serious condition because of an autoimmune disease such as multiple sclerosis. There are many ways to address this condition besides medication, but you should see a neurologist to find out for certain if you have MS before starting treatment.
Though finding the cause of an overactive bladder isn’t always easy, following the trail of these causes and fixing them will often resolve the problem.
Mark Hyman, MD is a family physician, four-time New York Times bestselling author, and Chairman of the Institute for Functional Medicine.