Medical Centric

OVERACTIVE BLADDER (OAB)

Men's Health, Women's Health / By

OVERACTIVE BLADDER (OAB)

 Overactive bladder describes a frequent feeling of a sudden urge to urinate.

  • The frequent need to urinate may occur during the day, at night, or both
  • The urge may be difficult to stop, and this may trigger involuntary loss of urine (urinary incontinence)
  • More than 40% of people with overactive bladder have urinary incontinence
  • Managing symptoms can be difficult because an overactive bladder may be unpredictable. This can cause some people with the condition to feel embarrassed, limit their work and social life, and isolate themselves, affecting the quality of life
  • Overactive bladder is not life-threatening, but most people with the condition have complications, such as emotional distress or depression, issues with sexuality, anxiety, or interrupted sleep cycles

CAUSES

Normally, the kidneys produce urine, which drains into the bladder through a narrow tube called the ureter. The bladder slowly fills up with the urine. The urine is then expelled from the body through another narrow tube called the urethra.

As the bladder fills, nerve signals sent to the brain triggers the need to urinate. Nerve signals coordinate the relaxation of the pelvic floor muscles and the muscles of the urethra during urination. The muscles of the bladder contract, pushing urine out.

In overactive bladder, a problem with the nerves and muscles of the bladder causes the bladder muscles to contract involuntarily, creating an urgent need to urinate even when the bladder isn’t full.

Overactive bladder can be caused by common abnormalities of the nervous system, including:

  • Spinal cord injury
  • Strokes
  • Dementia
  • Multiple sclerosis
  • Diabetic neuropathy
  • Parkinson’s disease
  • Back problems such as disc hernia, degenerative disc disease

Other causes include:

  • Urinary tract infection
  • Abnormalities in the bladder, such as bladder stones or tumor
  • Excess consumption of caffeine or alcohol
  • Using medications that increase urine production
  • Failure to completely empty the bladder
  • Factors that obstruct bladder outflow – enlarged prostate or previous operation

In some cases, no apparent cause can be determined (idiopathic overactive bladder)

SYMPTOMS

  • an urgent and uncontrolled need to urinate
  • frequent urination. A person will urinate more than 8 times in a day
  • awaken two or more times in the night to urinate (nocturia)
  • frequent involuntary loss of urine

DIAGNOSIS AND TREATMENT

Diagnosis is made on the presence of symptoms and by ruling out other possible conditions that may cause similar symptoms. This is usually based on medical history, physical exam (focusing on the abdomen and genitals), urine sample to test for infection, traces of blood and other abnormalities, and focused neurological exam that may identify abnormal reflexes and sensory problems.

Bladder ultrasound measurement to measure residual urine after urination may also provide additional information.

Cystometry may be used to identify whether you have involuntary muscle contractions or a stiff bladder that is unable to store urine.

TREATMENT

Treatment options may include:

Behavioral interventions, including

  • Pelvic floor exercises
  • Bladder training
  • Maintaining a healthy weight. Excess weight can put pressure on the bladder
  • limiting the intake of caffeine and alcohol

Medications, including:

  • Tolterodine (Detrol)
  • Oxybutynin (Ditropan
  • Trospium (Sanctura)
  • Solifenacin (Vesicare)

Bladder injections with botulinum toxin (BOTOX) to reduce muscle spasm

Nerve stimulation to change the electrical signal of the nerves that carry impulses to the bladder

Surgery for people with severe symptoms, including:

  • Surgery to increase bladder capacity
  • Bladder removal. The bladder is removed and a replacement bladder is surgically constructed