Suddenly Have a Weak Bladder, But Why? Plus, Relief

Bladder emptying relies on coordination between the kidneys, muscle contractions, and nerve signals. If something goes wrong with any of these, an overactive bladder can occur.

Up to 30% of men and 40% of women in the United States live with symptoms of overactive bladder.

Causes of New and Sudden Bladder Weakness

Overactive bladder can happen as a result of poor communication between nerve signals in the bladder and brain, with the brain signaling to the bladder to empty even when not full. It can also happen when the bladder muscles are too active and contract to pass urine before the bladder is full, causing a sudden, strong urge to urinate.

Bladder control problems, such as overactive bladder symptoms and urinary incontinence, can have a number of causes.

Risk factors and factors that can contribute to overactive bladder may include:

• Alcohol intake
• Benign prostatic hyperplasia (enlarged prostate not due to cancer) and other prostate conditions
• Bladder stones
• Caffeine intake
• Carbonated beverages
• Central nervous system (brain and spinal cord) conditions
• Having obesity
• Hormone changes
• Metabolic syndrome
• Neurological conditions or damage to the nerve signals between the brain and bladder
• Obesity
• Pelvic muscle spasms or weakness
• Pelvic organ prolapse
• Postmenopause
• Smoking
• Spicy foods
• Urinary tract infection (UTI)

Bladder muscles and nerves can be damaged or affected by conditions such as:

• Alzheimer’s disease
• Anxiety
• Brain or spinal cord injury
• Diabetes
• Heavy metal poisoning
• Pregnancy and childbirth
• Multiple sclerosis
• Parkinson’s disease
• Stroke
• Surgery for prostate cancer

Many conditions can have symptoms similar to overactive bladder. If you are experiencing symptoms of overactive bladder, talk to your healthcare provider to ensure an accurate diagnosis.

Medications With Overactive Bladder as a Side Effect

In some cases, overactive bladder may be caused by medications such as:

• Anticholinergics (helps relieve cramps of the stomach, intestines, and bladder)
• Diuretics (increase urine flow to reduce fluid buildup)
• Narcotics (type of painkiller)

Describing Weak Bladder Symptoms 

Overactive bladder syndrome can be described as urinary urgency (with or without urgency incontinence), usually with increased frequency during daytime and nighttime, and without the presence of infection or other abnormalities.

Overactive bladder with urge incontinence is called “overactive bladder-dry,” and accounts for about two thirds of people with overactive bladder. Overactive bladder with urge incontinence is called “overactive bladder-wet.”

Symptoms of overactive bladder may include:

• Frequent urination (typically more than eight times in 24 hours)
• Nocturia (waking up more than once at night to urinate)
• Strong, sudden urge to urinate
• Urge incontinence (inability to hold in urine after a strong, sudden urge to urinate)

Overactive bladder shares several symptoms with bladder pain syndrome (interstitial cystitis), but overactive bladder does not have bladder and/or pelvic pain or dyspareunia (pain associated with sexual intercourse) like bladder pain syndrome does.

Similarly, bladder endometriosis and uterine fibroids share symptoms with overactive bladder, but also have symptoms such as pelvic and/or back pain and pain with urination, which are not features of overactive bladder.

If you are experiencing pain, or other symptoms, let your healthcare provider know.

When Do Symptoms Warrant a Provider Visit?

See your healthcare provider if you have signs of overactive bladder, or other symptoms of bladder problems. Symptoms of a problem with the bladder may include:

• Blood in your urine
• Difficulty urinating or fully emptying your bladder4
• Frequent urination
• Leaking urine or involuntary urination
• Pain during or after sexual intercourse
• Painful urination, or other signs of infection
• Pelvic pain
• Waking at night to urinate or wetting the bed

Go to the emergency room right away if you have signs of spinal cord damage, such as:

• Loss of sensation around the genitals or anus
• Loss of sensation in the legs
• Weakness in the legs

While less likely than causes such as overactive bladder, changes in urination can be an indication of bladder cancer. Symptoms of bladder cancer may include:

• Feeling an urgent need to urinate, even when the bladder is not full
• Difficulty starting urinating, or a weak urine stream
• Increased need to urinate at night
• Increased urination frequency
• Pain or burning during urination

Larger bladder cancers or those that have spread to other parts of the body may cause other symptoms, such as:

• Inability to urinate
• Lower back pain on one side
• Feeling tired or weak
• Bone pain
• Loss of appetite and/or weight loss
• Swelling in the feet

See your healthcare provider if you have any questions or concerns.

How to Immediately Manage Sudden Bladder Weakness

Practicing what are known as “quick flicks” is a way to help lessen the urgent need to urinate. When you get the sudden urge, squeeze and release your pelvic floor muscles several times in a row as quickly as you can.

This can help tell your nervous system to send a message to your bladder to stop contracting, and lessen the urge to urinate. It is particularly helpful if you can relax, be still, and concentrate on the exercise when you do it. It may not completely get rid of the urge, but it might buy you enough time to get to the toilet.

Other things that may help include:

• Distracting yourself
• Holding still
• Taking long, relaxing breaths

Lifestyle Habits for Better Bladder Control

Treatment for overactive bladder often starts with conservative measures such as lifestyle changes. Your healthcare provider may suggest:

• Attaining and maintaining a weight that is healthy for your body
• Being physically active
• Bladder training using scheduled voiding times and urge control techniques, such as “quick flicks”
• Delayed voiding (practicing waiting to use the washroom, even when you have the urge, gradually increasing the time between trips to the washroom) done under the guidance of your healthcare provider)
• Double voiding (urinating, waiting a few seconds, and trying again), which may help with fully emptying the bladder)
• Finding the right balance of fluids while ensuring you still stay properly hydrated (everyone’s fluids needs are different; check with your healthcare provider)
• Keeping a “bladder diary” to help track when and how often you urinate, and what seems to make your symptoms better or worse
• Practicing relaxation exercises for your bladder muscle
• Preventing constipation with measures such as increased fiber intake, or using stool softeners or laxatives if directed by your healthcare provider
• Reducing or avoiding bladder stimulants, such as caffeine, alcohol, smoking, tomato-based foods, spicy foods, chocolate, some citrus fruits, and carbonated beverages

Pelvic Floor Muscle Exercises

Pelvic floor muscle exercises can strengthen the muscles that control urine flow and help reduce leaks.

A physical therapist can help with pelvic floor muscle exercises. Biofeedback (uses computer graphs and sounds to monitor muscle movement) may help with learning how your pelvic muscles move and how strong they are.

You can also do some exercises at home, making sure you are doing them properly.

Kegels are a helpful pelvic floor exercise. It helps to lie down when you are first learning how to do Kegels.

To do Kegels:

1. Squeeze the pelvic floor muscles (muscles in your genital area), as though you were stopping the flow of urine or preventing passing gas. Try not to also squeeze your stomach, legs, or buttocks muscles while you’re squeezing your pelvic floor muscles. Hold for three seconds.
2. Relax for three seconds, then squeeze the muscles again for three seconds. Aim for 10 repetitions each of squeezing then relaxing, three times a day.
3. Try to work up to holding squeezes for 10 seconds each.

Once you have the hang of doing Kegels, you can do them sitting or standing, and you can practice them while you are doing other activities, such as sitting at your desk, doing chores, or waiting in line. To not weaken the pelvic floor exercises over time, do not do Kegels while urinating.

Some people see symptom improvement with Kegels and some don’t. It may take four to six weeks before you start to see a positive difference in your symptoms. Keep doing the exercises, even if symptoms improve.

How to Treat Overactive Bladder

Medications

Medications that your healthcare provider may prescribe for overactive bladder include:

• Antimuscarinics and beta-3 adrenoceptor agonists: Can help stop the bladder from squeezing when not full. May be taken orally, or topically as a gel or transdermal patch
• Topical estrogen: Used in people who have been through menopause, as there is an overlap in the diagnosis of overactive bladder and genitourinary syndrome of menopause
• Anticholinergic medications: Block the acetylcholine neurotransmitter synapse in the central and peripheral nervous systems, reducing the movement of smooth muscles, such as those in the bladder

Minimally Invasive Procedures

Procedures your healthcare provider may suggest for overactive bladder include:

• Bladder Botox (onabotulinumtoxinA) treatment: A cystoscope (thin tube with a lens and a light) is inserted into the bladder to help the medical professional see inside the bladder. Tiny amounts of Botox are then injected into the bladder muscle to relax the bladder wall and reduce urgency and urge incontinence.
• Nerve stimulation: This procedure sends electrical pulses to the nerves along the pathway from the brain to the bladder to promote better communication.

More Invasive Surgical Procedures

Surgical options your healthcare provider may suggest to help overactive bladder include:

• Bladder augmentation cystoplasty: Enlarges the bladder by adding a piece of the bowel into the bladder wall
• Urinary diversion surgery: Reroutes the flow of urine

These surgeries carry significant risks and are only offered when no other options are appropriate or effective.

Summary

Overactive bladder can cause frequent urination and strong sudden urges to urinate, even when the bladder is not full.

It can be caused by factors such as communication problems between the brain and the bladder, or by bladder muscles that are too active and contract more than they should.

Overactive bladder is typically managed with conservative measures such as reducing triggers, bladder training, and pelvic floor exercises. Occasionally, more extensive measures are needed, such as medications or surgery.

Talk to your healthcare provider if you have symptoms of overactive bladder.