Overactive Bladder
Introduction
Overactive bladder is a problem with bladder function resulting in a sudden urge to urinate that is difficult to suppress. It may also cause incontinence, the involuntary loss of urine.
Overactive bladder, sometimes called an irritable bladder, affects about one in six men and women in the United States. Most men with overactive bladder are 65 and older. But women tend to be affected earlier — the prevalence rate begins to climb among women when they reach their mid-40s.
If you have overactive bladder, you may feel embarrassed, isolate yourself or limit your work and social life. A combination of treatments may greatly alleviate symptoms of overactive bladder and help you manage their impact on your daily life.
Signs and symptoms
Overactive bladder symptoms may mean you:
- Feel a strong, sudden urge to urinate
- Experience urge incontinence, the unintended loss of urine immediately following an urgent need to urinate
- Urinate frequently, usually eight or more times in 24 hours
- Awaken two or more times in the night to urinate (nocturia)
You may be able to get to the toilet in time when you sense an urge to urinate and not suffer any leakage. Nonetheless, frequent and nighttime urination, as well as the need to suddenly "drop everything," can significantly disrupt your life.
Overactive bladder without urge incontinence — often called overactive bladder, dry — affects about two-thirds of the people with the disorder. When symptoms include urge incontinence, it's often referred to as overactive bladder, wet.
Causes
Filling and emptying your bladder is a complex interplay of nerve signals and muscle activity. A problem anywhere throughout this system can contribute to overactive bladder and urge incontinence.
Normal bladder function
Your kidneys produce urine, which travels down a pair of long tubes from your kidneys to your bladder. Urine drains from your bladder through an opening at the bottom (neck) and flows out a short tube called the urethra (u-RE-thruh). In women, the urethral opening is located just above the vagina. In men, the urethral opening is at the tip of the penis.
Your bladder expands like a balloon to accommodate the flow of urine. When it's reached about half its capacity, nerve signals alert your brain, and you sense that your bladder is "full." By the time it's three-quarters full, you feel the need to urinate (void). When you urinate, nerve signals coordinate the relaxation of the pelvic floor muscles and the muscles surrounding the neck of the bladder and upper portion of the urethra (urinary sphincter muscles). The muscles of the bladder contract, forcing urine out.
Involuntary bladder contractions
The symptoms of overactive bladder occur in most cases because the muscles of the bladder involuntarily contract when it's still filling and only about half full. This contraction creates the urgent need to urinate. The urinary sphincter may remain constricted and prevent the bladder from emptying. If not, then a person experiences urge incontinence.
Causal or contributing factors
In many cases doctors can't exactly identify overactive bladder causes. Neurological disorders, such as Parkinson's disease or strokes, are often associated with overactive bladder.
Several factors may cause or contribute to symptoms similar to those of overactive bladder and your doctor will try to rule out these during an evaluation, because these require other specialized treatments. These include:
- Urinary tract infection
- Inflammation of tissues near the urinary tract
- Abnormalities in the bladder, such as tumors
- Factors that obstruct bladder outflow (enlarged prostate, constipation, bladder stones, or previous operations to treat other forms of incontinence)
- Diabetes, which can cause excess urine production
- Excess consumption of caffeine or alcohol
- Medications that cause a rapid increase in urine production
Complications
As might be expected, urge incontinence detracts from your overall quality of life, but frequent urination and nocturia can also be detrimental to your well-being. People with significant disruption from an overactive bladder are more susceptible to:
- Depression
- Low self-esteem
- Anxiety
- Fatigue
- Poor attention or concentration
Treatment
Your doctor is likely to recommend a combination of overactive bladder treatment strategies to alleviate your symptoms.
Behavioral interventions
Behavioral interventions can help you manage overactive bladder. If you experience urge incontinence, these interventions alone aren't likely to result in complete dryness, but they will reduce the number of incontinence episodes. The interventions your doctor will recommend may cover the following areas:
- Fluid consumption. Your doctor may recommend the amount and timing of fluid consumption during the day. You should also determine whether dietary irritants, particularly caffeinated and alcoholic beverages, cause or worsen your symptoms.
- Fiber intake. Eat a diet rich in fiber, or take fiber supplements if instructed by your doctor, to avoid constipation.
- Bladder training. Your doctor may recommend a strategy to train yourself to delay voiding when you feel an urge to urinate. You'll begin with very small delays, such as 10 minutes, and gradually work your way up to urinating every two to four hours.
- Double voiding. If you have problems with residual urine, your doctor may recommend double voiding. After urinating, you wait a few minutes and then try again to empty your bladder completely.
- Scheduled toilet trips. Your doctor may recommend a schedule for toileting so that you urinate at the same time every day — every two to four hours as recommended — rather than when you feel the urge to urinate.
- Pelvic floor muscle exercises. Exercises called Kegels strengthen your pelvic floor muscles and urinary sphincter — muscles that are critical for holding urine even if your bladder muscles involuntarily contract. Kegels are then used to suppress the bladder's involuntary contractions. Your doctor or a physical therapist can help you learn how to do these exercises correctly.
- Absorbent pads. You can wear absorbent pads or undergarments to protect your clothing and avoid embarrassing incidents if you do experience incontinence.
Clinical trial evidence shows that medications called anticholinergics (antispasmodics) are the most effective for alleviating symptoms of overactive bladder and reducing episodes of urge incontinence. These drugs include tolterodine (Detrol), oxybutynin (Ditropan), an oxybutynin skin patch (Oxytrol), trospium (Sanctura) and solifenacin (Vesicare).
The most common side effect of these drugs is dry mouth, but drinking water to alleviate thirst can exacerbate symptoms of overactive bladder. Your doctor may recommend that you suck on a piece of sugar-free candy or chew sugar-free gum to alleviate dry mouth. Extended-release forms of oxybutynin (Ditropan XL) and tolterodine (Detrol LA), the oxybutynin skin patch (Oxytrol), trospium (Sanctura) and solifenacin (Vesicare) tend to result in fewer side effects.
Surgery
Surgery to treat overactive bladder is reserved for people with severe cases who don't respond to other treatments. The goal is to improve the bladder's storing ability and reduce pressure in the bladder. Surgical interventions include:
- Sacral nerve stimulator. In this procedure a small device, which resembles a pacemaker, is placed under the skin of your abdomen and is connected to a small wire placed near the sacral nerves near your tailbone. The sacral nerves are a primary link between the spinal cord and nerves in the bladder's tissues. Modulation of these nerve impulses can improve overactive bladder symptoms.
- Augmentation cystoplasty. This reconstructive procedure, intended to increase the capacity of your bladder, uses pieces of your bowel to replace a portion of your bladder. If you undergo this procedure, you may need to use a catheter to empty your bladder.
As most causes of overactive bladder are unknown, prevention strategies are somewhat limited. Healthy lifestyle choices that may reduce your risk of overactive bladder include a regular exercise routine, a high-fiber diet, and limited consumption of caffeine and alcohol.
Informations obtained from National Institute of Health.