An overactive bladder usually gets all the attention in TV commercials. Incontinence is the big bathroom problem for aging bladders.

What few people realize: An estimated 20 million Americans are living with a different condition, which actually has the opposite effect on the bladder, but the problem is not getting diagnosed or treated by most doctors.

Known as underactive bladder (UAB), this disorder can make something as simple as going to the bathroom a chore... damage the kidneys... and even land a person in a nursing home.

Red flags of UAB

UAB occurs when the bladder loses its ability to contract and fully empty. Part of what makes this condition so vexing is that the symptoms can come and go, and they often mimic those of other diseases, such as prostate enlargement and urinary tract infections-both of which can cause frequent urination, another UAB symptom.

With UAB, sufferers have a hard time telling when their bladders are full. When they do have the urge to urinate, it may be painful, the urine may dribble or it may not come at all. In fact, it may take several minutes to start a stream of urine. They also may feel that there's urine left behind and end up heading to the bathroom again a short time later.

Of course, when the bladder does not completely empty, urine builds up. This can lead to embarrassing episodes of leakage from overflow incontinence... recurring urinary tract and kidney infections... and, in severe cases, kidney damage.

What causes UAB?

As we age, the muscles of the bladder lose some of their elasticity and ability to contract. However, UAB is not a normal part of aging.

When messages between the brain and the bladder are short-circuited in any way, your body doesn't register the normal urge to urinate when the bladder is full.

This breakdown in communication may be triggered by a stroke, Parkinson's disease, acute urinary tract infection, radiation therapy to the pelvic area, nerve damage after pelvic surgery or even a herniated disk.. In people under age 40, multiple sclerosis is a common culprit, as is diabetes, which can damage peripheral nerves in the lower spinal cord that supply the bladder.

Even overactive bladder can be a trigger: In some cases, overactive bladder thickens the bladder wall in a way that interferes with the bladder's ability to contract during urination... leading to underactive bladder.

Certain medications can also lead to UAB: These may include antidepressants, antihistamines, blood pressure drugs and cholesterol-lowering statins.

Do you have UAB?

If you're suffering from any of the symptoms of UAB, see your primary care doctor soon. He/she may refer you to a specialist either a urologist or a uro-gynecologist, who treats urologic problems in women.

To find out whether you have UAB, the specialist will take your medical history... do a physical exam... and order blood and urine tests to see how well your bladder and kidneys are functioning. A cystoscopy, ultrasound or CT scan might also be ordered to determine whether your bladder muscles and nerves are working normally.

Helpful: Keeping a diary that lists how often and how much you urinate (using a measuring cup) can give your doctor valuable information. For a free online diary to track your bladder activity, go to

How to Cope with UAB

Doctors are still clearly defining UAB and working to understand what therapies are most effective. But if you've got this condition, you want help now! The research is ongoing, but here are some ways to cope with the condition-go ahead and bring up these approaches with your doctor. Not all physicians are familiar with them...

Double-voiding. This technique gives you extra time to empty your bladder.

What to do: After urinating, stay at the toilet for a few additional minutes. After this short break, try to urinate again. If your bladder has not fully emptied, you will often be able to pass more urine.

Triggered-reflex voiding. This involves the use of various stimulation techniques to trigger the brain signals that jump-start contractions of the bladder and the flow of urine. The technique may work for anyone with UAB but can be especially useful for a person with a spinal cord injury who still has some reflexes but may not be able to feel whether the bladder is full.

What to do: Rub the area just above the pubic bone... tug on your pubic hair... or gently squeeze the head of the penis. Test different trigger zones to see which one might work for you.

Medications. Men with UAB may get relief from a drug often used for prostate enlargement, such as doxazosin (Cardura). It helps a man empty his bladder by relaxing the muscle of the urethra (the tube through which urine flows).

Catheterization. This is another way to empty the bladder. With self-catheterization, you insert a catheter, a strawlike tube, into your urethra to drain urine from your bladder. For people who are unable to do this, an "indwelling" catheter can be inserted into the urethra by a health-care professional to automatically drain urine into a pouch for a set period of time. However, if the catheter is not changed every two to four weeks, it can injure the urethra and/or cause infection.

For people who can't tolerate an indwelling catheter, a suprapubic catheter may be used. It requires a surgical procedure to insert it through a small hole in the abdomen directly into the bladder.

Surgery. When the therapies described above are not effective or practical, the only option is surgery-either to enlarge the bladder by using a small section of the stomach or bowel that helps the bladder to stretch more easily... or to insert a mesh stent that allows the bladder to empty into a pouch outside the body.

Promising new approach: Stem cell therapy is being studied as a possible treatment for UAB. Researchers theorize that transplanting stem cells to help the bladder regenerate new, fully functioning tissue could be an effective solution for UAB sufferers.

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