The Connection Between IBS and Bladder Problems
If you have IBS, you may know that you have an increased risk of also having other diseases. In a large US study, researchers found that IBS patients have an increased risk of migraine (1.8 times as likely), fibromyalgia (4.5 times), depression (2 times), and anxiety (1.9 times).1 In addition, researchers now understand that both male and female IBS patients have an increased risk of a variety of urinary problems.
Urinary problems that both men and women with IBS experience include overactive bladder syndrome (OAB) and interstitial cystitis.
Overactive bladder syndrome
Patients with OAB experience symptoms such as urgency, increased frequency of urination, the need to urinate frequently at night, and incontinence. OAB is a diagnosis of exclusion – it is diagnosed when there is not another explanation of these symptoms. In a large Japanese study, researchers looked at how commonly IBS and OAB are found in the same patient. They found that the prevalence of OAB in IBS patients is similar in men and women.2 In patients with OAB, they found that 32 percent of men and 35 percent of women also had IBS.2
In patients who experience urinary urgency associated with OAB, this may be due to dysfunction in the muscles of the pelvic floor. In pelvic floor dysfunction, the muscles that control the bladder and colon aren't working properly.
Interstitial cystitis is also known as painful bladder syndrome. Patients with interstitial cystitis report frequent urination, chronic bladder discomfort, and pain.
Urinary problems in men and women
Men with IBS are at increased risk for chronic prostatitis, which is characterized by pain in the lower pelvic region. Symptoms include urinary pain, pain upon urination, urgency, increased frequency, and incontinence.
While current clinical studies don't support an increased risk of urinary tract infection (UTI) in women with IBS, the increased risk of other urinary problems is well established. One study found that women with IBS are at increased risk (3 fold or more) for several symptoms that are common in UTI, including urinary frequency, urinary urgency, and painful or difficult urination.3 A second study examined over 2000 racially diverse women and found that IBS patients had slightly more urinary urgency and greater lifestyle impacts from that urgency.4
Connection between IBS and urinary problems
The short answer is that researchers aren't sure. Theories include dysfunction of the muscles and nerves that control both the colon and the urinary tract, central nervous system function, and problems with the regulation of serotonin receptors.2
If you experience urinary symptoms, be sure your physician(s) is aware of all of your symptoms so they can do the appropriate follow-up and make behavioral recommendations, and prescribe drugs as needed.
Overactive bladder treatment
First-line treatment of OAB includes behavior modifications that could include pelvic floor muscle exercises, maintaining a bathroom schedule, and bladder training. Kegel exercises strengthen the muscles of the pelvic floor and can lead to improved control of the urinary sphincter, the muscle that must relax in order to urinate. If you can contract your pelvic floor muscles, training your bladder to cope with small delays in going to the bathroom may help with the urgency problem.
Anticholinergic drugs can treat both IBS and overactive bladder. Acetylcholine is a neurotransmitter that plays an important role in neuronal transmission to smooth muscles that control both the intestines and urinary tract. One drug in this class (Oxytrol) is available over the counter for women. In some cases, a tricyclic antidepressant may be prescribed to relax the bladder muscles. Finally, in patients who are not successful with behavioral and oral medications, Botox may be used to help relax the bladder muscle.5
Interstitial cystitis treatment
Physical therapy can help relieve pelvic pain associated with interstitial cystitis.
Nerve stimulation, such as with a transcutaneous electrical nerve stimulation (TENS) unit, or with a sacral nerve stimulation device may help with muscular control and pain management.
Oral medications include antihistamines, nonsteroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants, and Elmiron. It is not known how Elmiron works and it can take a few months before it is effective.6
Chronic prostatitis treatment
Many treatments for chronic prostatitis are oral medications. In men who had a UTI before chronic prostatitis, antibiotics can be used. Other therapies include anticholinergic drugs and alpha-blockers. Alpha-blockers are drugs that block adrenergic receptors and result in relaxation of smooth muscle.7
Which time of day is worse for your IBS symptoms?