What is Overactive Bladder?
An Overactive Bladder is a pathological condition of the Genitourinary System in which the affected individual has an increased and sudden urge to urinate. This urge to urinate is to an extent that it becomes very hard for the individual to hold urine until he or she can reach the restroom and often leads to urinary incontinence. Overactive Bladder is actually caused due to a dysfunctional bladder which contracts abnormally leading to the sudden urge to urinate.
An individual suffering from an Overactive Bladder may force himself or herself into isolation for fear of being embarrassed in a social environment and may severely impact their work and personal life to a significant degree. Fortunately, once an Overactive Bladder is diagnosed then there are quite a number of treatments and lifestyle modifications that can be done which may allow the affected individual a significant degree of relief from the symptoms of an Overactive Bladder.
What Causes Overactive Bladder?
Normally, the kidneys filter the fluids that we take in and the waste products that are left are drained into the bladder in the form of urine. During the process of urination, the urine passes from the bladder through the urethra and all the waste products are eliminated from the body. When the bladder becomes full of urine, there are signals sent to the brain through neurotransmitters which triggers the urge to urinate. During urination, again the neurotransmitters come into play resulting in relaxation of the pelvic floor muscles and the muscles of the urethra and the muscles of the bladder tighten up pushing the urine out. In cases of an Overactive Bladder, the bladder muscles start to contract involuntarily even if the bladder is not full resulting in the individual having an urgent need to urinate. There are also certain conditions which may contribute to development of an Overactive Bladder. These conditions are:
- Neurological disorders like Parkinson’s disease, stroke, or multiple sclerosis
- Excessive intake of fluids, kidney dysfunction or diabetes mellitus
- Intake of certain medications which cause an excessive increase in the production of urine.
- Urinary tract infections
- Medical conditions like bladder tumor or stones, prostatitis, enlarged prostate
- Excess consumption of alcohol
- Natural process of aging
- Incomplete bladder emptying.
What are the Symptoms of Overactive Bladder?
The main symptoms of Overactive Bladder are:
- A sudden urge to urinate which is extremely difficult to control which may cause urinary incontinence
- Involuntary loss of urine immediately after the urge to urinate
- Frequent urination up to 10 times in a day
- Getting up more than once to urinate at night, a condition called as nocturia.
How is Overactive Bladder Diagnosed?
Once an individual presents with the symptoms mentioned above to a physician then he or she will be referred to an urologist. The first step towards a diagnosis is to rule out any infection in the blood or urine that may be causing the symptoms. The urologist may also ask the patient whether he or she may be taking in certain medications that have the potential to cause an increased urge to urinate.
The urologist will also conducts tests to check whether the patient is emptying the bladder fully upon urination or is there any urinary retention. A comprehensive workup needs to be done in order to confirm the diagnosis of an Overactive Bladder. These tests include a comprehensive medical history and a detailed physical examination directed towards the abdomen and the genital areas.
Urinalysis may be done to rule out any infection causing the symptoms. A detailed neurological examination will also be performed to rule out any neurological disorders causing the symptomatology. Additionally the following tests will be done to confirm the diagnosis of Overactive Bladder.
A Urodynamic Test may be done to check the function of the bladder and whether it is emptying the urine completely or not. In case if the test is positive for urinary retention then the urine that is left over in the bladder may cause symptoms that are similar to an Overactive Bladder. An ultrasound of the bladder may also be done to check the functioning of the bladder.
The urologist will also check the flow of the urine and whether the urine stream is smooth or is it obstructed which may indicate towards some sort of obstruction within the pathway of the urine suggesting a stone or a tumor. A cytometry test which is a test which measures bladder pressure may also be done to see whether there are any involuntary contractions in the bladder. The results of these tests will confirm the diagnosis of an Overactive Bladder.
How is Overactive Bladder Treated?
The treatment of Overactive Bladder requires both medications and certain behavioral changes in order to relieve symptoms.
The treatment for Overactive Bladder begins with behavioral modifications. These modifications are quite effective and sometimes may be all that is needed to get rid of symptoms of an Overactive Bladder. Some of the behavioral modifications done for treatment of Overactive Bladder are:
Kegel Exercises: These exercises are aimed at strengthening the pelvic floor muscles and urinary sphincter such that abnormal involuntary contraction of the bladder is prevented. A physical therapist may be required to teach the patient on how to do the Kegel exercises correctly. If the patient does Kegel exercises regularly then he or she may note a change in symptoms within a span of four to six weeks.
Weight Maintainance: It is important for individuals suffering from Overactive Bladder to have an ideal body weight. In case if an individual is overweight then a consultation with a nutritionist is required who can formulate a dietary plan so as to lose weight in a healthy manner. Losing weight helps a lot in preventing urge incontinence from Overactive Bladder.
Fluid Consumption: It is recommended that an individual with an Overactive Bladder avoid taking in excessive amount of fluids as it may lead to frequent urination and fluids should only be taken at a certain amount
Timed Voids: It is important that the patient time his or her voids, meaning that he or she go to the restroom at regular intervals of time so as to prevent any chances of urinary urgency and incontinence.
Adult Diapers: In case if the patient works at a place where timed voids may be difficult then wearing adult diapers are quite helpful in preventing the clothing from getting soiled even if there is urinary incontinence at work.
Bladder Training: This is an important aspect of treatment of Overactive Bladder. In this the patient trains the bladder to delay voiding whenever there is an urge to urinate. The delay may be started at 30 minutes and can work its way up to an hour meaning that you can go to the restroom every three to four hours instead fo every 20 minutes or so. Bladder training is only possible if the patient has strong pelvic floor muscles and is able to tighten them up successfully whenever he or she feels an urge to urinate. Hence people with weak pelvic floor muscles may not find bladder training useful and this is where Kegel exercises come to the rescue. A combination of Kegel exercises and bladder training can be an extremely effective measure to relieve the symptoms of an Overactive Bladder.
Medications: There are also certain medications that can help relax the bladder and treat the symptoms of Overactive Bladder. Some of these medications are Detrol, Ditropan, Oxybutynin, Vesicare and the like.
Surgery: This is done for patients who do not respond to conservative treatments and have severe symptoms. The procedure done is to improve the bladder’s ability to store urine and also reduce any pressure in the bladder. There are basically two kinds of procedures done the first of which involves attaching a segment of the intestine to the patient’s bladder to increase the capacity of the bladder while in the second procedure which is also known as gastrocystoplasty a portion of the stomach is attached to the bladder to increase its capacity and prevent bladder incontinence arising out of overactive bladder.
Bladder Removal: This procedure is the last resort for treating an Overactive Bladder and is done by removing the bladder completely and replacing it with an opening to which a bag is attached which collects the urine. This is usually done in the most severe cases which do not respond to other conservative and surgical treatments for Overactive Bladder.