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A constant urge to urinate may indicate a chronic bladder infection, which absolutely must be treated. But other causes can also be responsible for an overactive bladder.

Those who always need to go to the toilet may be suffering from a bladder infection, also called cystitis. Typical complaints are an uncomfortable burning or pain when urinating. Often there is an unpleasant feeling of pressure in the lower abdomen. "Women are generally more likely to suffer than men because their urethra is shorter, so the bacteria that trigger inflammation enter the bladder more easily," says Dr. Arndt Katzenwadel, Senior Physician in the Department of Urology at the Medical Center – University of Freiburg.

Normally, acute urinary tract infection can be effectively treated with antibiotics prescribed by a physician.

At the latest, a doctor should be urgently consulted with the arrival of sudden fever, chills, severe pain in the kidney area, nausea and general malaise. Because there is then a likelihood of pyelonephritis – kidney infection – which can be acutely threatening and in the long term even lead to a deterioration of kidney function.

Don't suppress pain: treat it

If the bladder is acutely inflamed, antibiotic treatment generally helps reliably. If the cystitis becomes chronic with insufficient healing of the inflammation, or if inflammation occurs very frequently, treatment is more difficult. "Chronic inflammation of the bladder is often preceded by multiple urinary tract infections that have not been adequately treated," says Dr. Katzenwadel. Using a urine culture, the physician determines which pathogens are present, and on this basis can select a suitable antibiotic for the treatment.

Urinary tract infections are promoted by bladder voiding disorders with incomplete emptying of the bladder, and by advanced age, menopause and estrogen deficiency. Some women get urinary tract infections almost regularly, a short time after sexual intercourse.

To prevent bladder infection, it is helpful to drink enough fluids and to avoid the cold. Going to the toilet should happen as regularly as possible. Because frequent intercourse, especially in young women, increases the likelihood of urinary tract infection, one should go to the toilet as soon as possible afterward, since emptying the bladder can rinse out germs that may have entered the urethra.

Irritable bladder often has no clear cause

But an actual inflammation is not always the reason for a constant urge to urinate. "Much more common than true urinary tract infections with bacteria are irritable bladder conditions with no detectable cause – also called 'overactive bladder'," says the Medical Center – University of Freiburg urologist. This manifests itself in a particularly frequent urgency to urinate, which can occur so abruptly and strongly that uncontrolled urine leakage (incontinence) is possible.

"The combination of the urge to urinate and uncontrolled urine leakage, up to complete unintentional voiding of the bladder, is especially stressful for those affected," says Dr. Katzenwadel. One cause of an irritable bladder is when the autonomic nervous system responsible for bladder control is irritated.

The exact causes can often not be clearly identified. However, diseases such as acute inflammation, kidney stones and tumors of the bladder area have to be ruled out. An intervertebral disk problem in the lumbar spine can also lead to an irritable bladder.

Simple measures for irritable bladder

To reduce symptoms of an overactive or irritated bladder, general measures such as stress reduction or abstinence from smoking, coffee, and alcohol may help. In addition, pelvic floor (Kegel) exercise is recommended: tensing and relaxing the pelvic floor muscles often has a positive effect on the bladder.

If this does not achieve sufficient improvement, it can be treated with bladder-suppressing drugs, called anticholinergics. "Unfortunately, side effects such as dry mouth or constipation can occur here. Newer drugs are better tolerated by most patients," says the Freiburg urologist.

If there is no improvement using medications, doctors can reduce bladder activity via endoscopic surgery. In this, the neurotoxin botulinum is injected under the bladder wall. However, the effect usually lasts only six to nine months, so the treatment then has to be repeated.

Generally, acute urinary tract infection can be effectively treated with antibiotics prescribed by a physician.