Duke Medicine: Overactive bladder and urinary tract infections

Overactive bladder and urinary tract infections have some similar symptoms, but it’s important to determine which problem you have and treat it properly.

Duke urologists Dr. Aaron Lentz and Dr. Charles Viviano, answer our burning questions.

Overactive bladder is defined as a sudden, compelling desire to urinate (known medically as urgency), with or without involuntary leakage, occurring more often than usual (known as frequency) during the day and night.

The symptoms of a urinary tract infection vary, but usually include painful urination, frequency or urgency, and pain occurring above the pubic bone. Bloody or bad-smelling urine are common. If a woman has even one of these symptoms, there’s a 50 percent chance that she has a UTI; with a combination of these symptoms, the odds are 90 percent.

There are a small number of bacterial pathogens, all well understood and treatable, that cause UTIs when they enter the urethra. For women, E. coli is the cause in 75 to 90 percent of cases. In men, E. coli and other enterobacteria are the most common causes.

Chronic recurrent UTIs can be caused by bacterial persistence, in which bacteria linger in the urinary tract and re-emerge after antibiotic use. They can also be recurring new infections from bacteria outside the urinary tract.

Although there is no established strategy for preventing overactive bladder, there are some behavioral therapies that may improve bladder control. When started early, patients may not require additional treatment.

Conservative management for overactive bladder includes weight loss, quitting smoking, decreased use of caffeine, decreased intake of spicy food, decreased alcohol use, and changes in diet.