Overactive Bladder

The sudden urge to go to the bathroom multiple times in a short period, or involuntary urine leaks at unfortunate times, is not only irritating and uncomfortable but could be embarrassing too. This condition where the bladder squeezes urine out at a wrong time is known as an overactive bladder. 

Overactive bladder, or also called OAB, is challenging to control. One may feel the need to pee many times during day and night, and may also experience unintentional loss of urine (urgency incontinence) (1). 

The first sign of OAB is the sudden urge to urinate that cannot be ignored. Also, the frequency of visits to the bathroom to leak is usually eight (8) or more times within 24 hours. Notably, individuals having OAB might experience nocturia or waking up more than two (2) times at night to urinate (2). 

The cause may be unknown, or “idiopathic”. However, nerve or muscle problems, too much fluid intake, and drinking of caffeinated drinks such as coffee and tea could be factors for this disorder (3)

The bladder works in such a way that when it is filled up, the nerve sends signals to the brain that would trigger the need to urinate. These coordinated nerve signals would tell the muscles in the urethra and pelvic floor to either contract or relax. When the bladder muscles tighten, it will push out urine (4).

In most OAB cases, the bladder muscles start to contract involuntarily even when the bladder is not yet full. These involuntary tightening of the bladder muscle creates the urgency to urinate (5)

Having an overactive bladder could affect and disrupt a person’s social life. One might feel embarrassed and might limit work and social life. 

How does CBD work on the bladder? 

A leaky bladder is not something you have to worry about forever. Researches revealed that cannabis could theoretically act on the brain and bladder signaling pathways. 

The ECS or Endocannabinoid system is widely distributed in the urinary bladder. The cannabinoid receptors are present in the lower urinary tract as well as spinal and higher centers involved in lower urinary tract control (6).

The effect of cannabis on bladder activity is probably mediated through the mechanism that is dependent on the endocannabinoid receptors (7).

It is far from clear on how the mechanism of ECS and CBD affects one another. And the published data on the expression and functional sites of the cannabinoid receptors in the bladder are contradictory (8).

It is well established that the ECS binds to cannabinoid receptors CB1 and CB2. In the case of the urinary bladder, since CB1 is more present than CB2, the CB1 receptor binds to the ECS, resulting in the relaxation of the bladder during the filling up phase. (9)

The CB1 receptors are mainly found at the central and peripheral neuron terminals of the bladder, inhibiting neurotransmitter release (10).

In the study done by the University of Naples, Federico II, it showed that the contractions of the bladder were reduced in the bladders of both mice and humans (11).

Another study at University of Leicester indicated that cannabis could be used to treat overactive bladders. The patients with neurogenic hyperactivity of the detrusor muscle (the muscle responsible for draining the bladder) experienced relief from urinary incontinence after taking extract containing high levels of THC (12).

Despite the good results of THC, researchers are exploring more the use of CBDs as an alternative to the psychoactive effects of THC. CBD is the cannabis derivative that has more medicinal benefits and without the “high” after effect. 

Can CBD treat overactive bladder?

Medications used to treat overactive bladder are to calm the nerves. Cannabis can have a similar effect. 

One study used the THC/CBD oromucosal spray to treat patients with multiple sclerosis (MS) overactive bladder. The result showed to be effective in improving overactive bladder symptoms in MS patients. It demonstrates a favorable impact on detrusor muscle overactivity (13).

In a meta-analysis done in 2017 of scientific articles on human trials, there were three studies using THC or combination of THC and CBD on the efficacy of these compounds to the overactive bladder patients with MS (14). 

On the same meta-analysis, researchers used the capsule or oromucosal spray. It was conclusive that cannabis treatment had decreased the incontinence episode in all three studies significantly (15). 

Side-effects were noted, such as dizziness, headaches, vomiting, UTI, and dry mouth on patients that received treatment through a spray. However, there was no side-effect in tablet trials (16). 

Moreover, these side-effects were mild compared to other conventional treatments. It is not known though if synthetic drugs or natural plant extracts were used (17).  

With the spur of research on cannabis, it remains to be seen whether CBD will be as effective without having it combined with THC for OAB patients. 

Conclusion

Overactive Bladder is socially disruptive because it could disrupt a person’s activity. The sudden and frequent back and forth to the comfort room, and unfortunate urine leak because of loss in bladder control is not only irritating but embarrassing.

The cause of such bladder dysfunction is not well established, but it may be due to lifestyle and nerve disorders. 

Interestingly, ECS is widely distributed in the urinary system. And it is a known fact that cannabinoid receptors bind with the ECS. In this case, CB1 receptors are in the works.

Moreso, studies have shown that THC, CBD, or a combination of these two has significantly influenced the contraction and relaxation of the bladder.

However, researchers are exploring more the use of CBD for AOB treatment because of its medicinal use, rather than THC mainly because of psychoactive effects. 

Three studies show that the oromucosal spray has been effective in OAB patients with MS. There were notable side-effects, but it is mild compared to other treatments. 

There is no established standard dosage for CBD use for OAB. Thus, it is encouraged to best consult a doctor expert on cannabis before administering CBD to patients with OAB. 


  1. Mayo Clinic. (20 March, 2020). Overactive Bladder. Retrieved from: https://www.mayoclinic.org/diseases-conditions/overactive-bladder/symptoms-causes/syc-20355715
  2. ibid.
  3. MediLine Plus. Retrieved from: ttps://medlineplus.gov/overactivebladder.html
  4. Mayo Clinic. op. cit. 
  5. ibid.
  6. Bakali, E., & Tincello, D. G. (n.d.). PDF. Retrieved from: https://www.longdom.org/open-access/Cannabinoids-and-the-Urinary-Bladder-2161-0932.1000163.pdf
  7. Freeman, R. M., Adekanmi, O., Waterfield, M. R., Waterfield, A. E., Wright, D., & Zajicek, J. (2006, November). The effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicentre, randomised placebo-controlled trial (CAMS-LUTS). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16552618
  8. ibid. 
  9. Gratzke, C., Streng, T., Park, A., Christ, G., Stief, C. G., Hedlund, P., & Andersson, K.-E. (2009, April). Distribution and function of cannabinoid receptors 1 and 2 in the rat, monkey and human bladder. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19237169
  10. ibid.
  11. Ruggieri, Michael. (2011). Cannabinoids: Potential Targets for Bladder Dysfunction. Handbook of experimental pharmacology. 202. 425-51. 10.1007/978-3-642-16499-6_20. 
  12. Bakali, E. op. cit. 
  13. Maniscalco, G. T., Aponte, R., Bruzzese, D., Guarcello, G., Manzo, V., Napolitano, M., … Florio, C. (2018, January). THC/CBD oromucosal spray in patients with multiple sclerosis overactive bladder: a pilot prospective study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29052091
  14. Youssef, N. A., Schneider, M. P., Mordasini, L., Ineichen, B. V., Bachmann, L. M., Chartier‐Kastler, E., … Kessler, T. M. (2017, February 23). Cannabinoids for treating neurogenic lower urinary tract dysfunction in patients with multiple sclerosis: a systematic review and meta‐analysis. Retrieved from https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.1111/bju.13759
  15. ibid.
  16. ibid. 
  17. ibid.
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