Overactive Bladder

Overactive bladder is a type of urinary incontinence. It is a condition in which the bladder develops problem in storing the urine normally which causes sudden urge for urination. Very often it leads to urinary incontinence (involuntary passage of urine). This condition does not occur due to aging phenomenon and can occur in person of any age group. Medications are given for strengthening the pelvic muscle of the bladder.

It is difficult in engage in social life for people with overactive bladder. But you can also take treatment to reduce the symptoms so that you can manage the activities of daily life. It is believed that one out of every 11 adults in the USA are having overactive bladder and this figure increases if they are aged.

Symptoms :

• Sudden urge to pass urine

• Difficulty in controlling and retaining urine

• There will be involuntary loss of urine

• Frequent urgent need for urinating is seen

• The affected person will have urge incontinence (not able to control passing urine)

• Frequent urination is observed. Most of the affected people will have 8 or more times of urination in 24 hours time

• Nocturia exists in many people with overactive bladder. (Nocturia is waking up at night 2-4 times for urinating)

• Many times they will be wetting their trousers even they can find a toilet nearby

Causes :

The muscles of the bladder develop spasms involuntarily resulting in sudden urge to urinate. The bladder and many other organs are controlled by nerves and muscles and any interruption in the contraction of the muscle may result in overactive bladder. Detrusor is the important muscle of the bladder and this muscle is controlled by certain nerves.

A chain of interaction is involved in the bladder function involving nervous system, kidney function and muscle activity. Any problem in this system can cause overactive bladder. When the bladder gets filled in with 300 cc of urine or more the nervous system will trigger the detrusor muscles to pass urine. The sphincter muscles of the bladder are capable of holding the urine for long time until the entire bladder (up to 600 cc) gets filled up.

If the detrusor muscles of the bladder contractors involuntarily without getting signal from the nerves it would lead to overactive bladder feeling an urge to urinate immediately. Thus inappropriate contraction of this muscle is the major cause of this problem. Any injury or trauma to the spinal cord, and diseases like Parkinson’s syndrome, dementia, multiple sclerosis and stroke can affect the nervous system causing overactive bladder. People with chronic diabetes can develop this condition due to diabetic neuropathy. Any infection in the urinary tract or formation of stones in the bladder can also affect the normal function of detrusor muscle causing overactive bladder.

Who are at risk?

People who are aged (above 70 years), people who have developed nervous system complications like stroke, brain injury, spinal cord injury or Parkinson’s disease, people with chronic diabetes and people who have undergone surgery for prostate enlargement are likely to develop overactive bladder.

Overactive bladder is a common problem in older adults but it can occur on any age if the person has any of the above complications. Quality of life can be severely disrupted due to overactive bladder and this can eventually lead to depression, anxiety and even sleep disturbance.

Diagnoses :

Your doctor will look for the major symptom of sudden urge to urinate and increased frequency of passing urine. He may order for pelvic examination (in women) and prostate examination (for men) for eliminating other issues. Urine analysis is done for checking the presence of any infection. Ultrasound method is used for measuring the volume of urine in the bladder after the person has urinated. This method will give right information about the urinary incontinence.

If necessary, your doctor will refer the case to neurologist for studying the function of nervous system to identify any abnormal reflex. Cystometry is the test done for measuring bladder pressure. Your doctor will insert a thin tube to fill the bladder with water. He would gently insert another catheter for measuring the pressure developed inside the bladder. In this method, the involuntary muscle contractions can be verified.

Treatment :

Depending on the intensity of the problem, treatment method varies from one person to another. Usually combination of treatment approach like medications, behavioral modifications and bladder injections are recommended for many patients with overactive bladder.

Medications :

Drugs are given for relaxing the bladder muscles so that you can manage sudden urge for urinating. Drugs like Detrol, Ditropan XL, Oxytrol, Gelnique, Trospium, Solifenacin, Enablex and Myrbetrig are prescribed for reducing the activity of detrusor muscle. However these drugs can produce some side effects. Antidepressant medications like Tofranil or Sinequan are given for treating overactive bladder.

Bladder injection is given for paralyzing the muscle partially. Botox injection in minute doses is injected directly into the tissues of your bladder. It is highly effective for managing urge incontinence. Sacral nerve stimulation is yet another technique used for reducing the symptoms of overactive bladder. A thin wire is inserted into the sacral nerves near the area of tailbone. Electrical impulses are sent through the wire by a device kept outside which will automatically prevent involuntary contractions of the muscles.

Surgery :

Surgery is done if none of the other treatment methods are effective. During the surgical process the bladder capacity is increased to hold more volumes of fluids. But you need to rely on catheter for the rest of your life if you opt for surgery. Bladder is completely removed in very severe cases and a small opening is made at the end of the stoma to attach a bag on your skin for collecting urine.

Lifestyle Changes :

Modifying certain behavior is the first choice for reducing the symptoms of overactive bladder. After consulting your doctor you can learn pelvic floor exercises for preventing and managing involuntary sphincter muscle contraction. You should not expect quick results after you start doing pelvic floor exercises. You have to do it daily for 7-8 weeks for getting some changes in managing the symptoms of overactive bladder. Your therapist can help you out from this problem easily by spending few minutes daily.

In case you are obese, you need to learn weight loss program and dieting regularly. This would gradually bring down urinary incontinence. People with overactive bladder should not consume fluids/water as they wish. It is necessary to consult the doctor to know the right volume of fluids and right timing. Reduce taking coffee or tea or quit this habit for getting better. You can manage incontinence by practicing double voiding. You can wait for few minutes after urinating and try again to empty the bladder completely.

Your doctor would prepare a chart for following schedule for urinating. By simply following this schedule your body will accustom to fixed timings for toileting gradually so that you can avoid sudden urge for urinating. For some people catheter training is given for emptying the bladder periodically. But you have to learn how to use a catheter and follow hygienic habits to avoid any infection. Alternatively many people use absorbent pads or thick pads for avoiding embarrassment caused by sudden leakage of urine. In case you are going out to party or any social event you need not get tensed if you use these pads.

Alternative Approaches :

It is believed that acupuncture therapy and biofeedback technology are effective in reducing the symptoms of overactive bladder. Follow the self care techniques and practice pelvic exercises regularly to avoid urge incontinence.

Prevention :

You cannot prevent getting overactive bladder if you are aged adult. But you can reduce the risk of developing this problem by involving in regular physical activity and limiting the consumption of coffee and alcohol.

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