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 Aaron Lentz, MD, and Charles Viviano, MD, PhD, answer our burning questions.

Aaron C. Lentz, MD

What’s the difference between overactive bladder and a urinary tract infection (UTI)?

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.

Charles J. Viviano, MD, PhD

It’s important to differentiate between overactive bladder and UTI.

While they can have similar symptoms, the therapies to treat each are quite different. Incorrectly diagnosing the symptoms often leads to ineffective care and patient frustration.

Physicians diagnose patients with painful urination, frequency, and urgency based on their medical history, a physical examination, and a urine test.

What are the most common causes of UTIs? What causes them to become chronic?

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.

The distinction is important: if there’s an abnormality in the urinary tract that’s causing the bacterial persistence, correcting that abnormality usually cures the problem.

Women with reinfection often do not have an alterable urologic abnormality, and require long-term medical management. Reinfections in men are uncommon and may be associated with an underlying abnormality such as a narrow urethra.

The next step in therapy for chronic UTIs is intermittent or continuous low-dose antibiotic use. To prevent bacterial resistance, physicians might switch the antibiotic used.

Why is overactive bladder more prevalent in senior citizens?

At any age, continence depends on not only the health of your urinary tract, but also the presence of adequate mental capacity, mobility, dexterity, and other factors. All of these things can change, sometimes dramatically, during the aging process, which is why urinary incontinence is a major problem for the elderly.

It afflicts 15 to 30 percent of older people living at home, one-third of those in acute-care settings, and half of those in nursing homes.

The lower urinary tract changes with age, even in the absence of disease. In both sexes, the ability to postpone urinating declines, while the prevalence of involuntary bladder contractions increases, leading to more episodes of nighttime urination. Overactive bladder is the most common type of lower urinary tract dysfunction in incontinent senior citizens. 

What can I do to prevent and treat overactive bladder?

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.

Lifestyle interventions include pelvic floor muscle training and bladder retraining. If the patient has urgency triggered by running water, “key in the door” syndrome (urgency upon arrival at home), getting up from a seated position, etc., then contracting the pelvic floor muscles prior to the activity may prevent the urge to urinate.

Bowel regularity is crucial because constipation makes bladder symptoms worse. Some patients may also benefit from a voiding schedule (urinating every hour, for instance) and gradually increasing the intervals between voids.

What can I do to prevent and treat recurrent UTIs?

There is no established method for preventing the development of chronic UTIs in someone who doesn’t already have that problem. In general, patients are advised to maintain a healthy weight and stay well hydrated.

Constipation may increase the risk of urinary tract infections. UTIs associated with sexual intercourse may benefit from a single dose of antibiotics after sex.

Postmenopausal women may benefit from a short course of topical estrogen if they suffer from vaginal dryness and irritation.

A lot of people ask whether cranberry supplements help prevent UTIs. There’s no real evidence that it works, but we don’t discourage it if the patient wants to try. Factors that are often cited but are not documented sources of recurrent infection include hygiene, frequency and timing of urination, wiping patterns, use of hot tubs, and type of undergarments. 

Aaron Lentz, MD, and Charles Viviano, MD, PhD, treat patients at Duke Urology of Raleigh, located on the campus of Duke Raleigh Hospital. They offer advanced care for everyday urological concerns and complex conditions.