Overactive Bladder

 

YOUR BODY'S DESIGN FOR URINARY CONTROL

URINARY CONTROLBladder control problems are medical conditions that prevent you from being able to control when you urinate. If you live with a bladder control problem you are not alone. Over 30 million Americans, both men and women, suffer from the involuntary loss of urinary control. While there may be many different causes and degrees of severity, one thing is certain: bladder control problems are not normal in adults of any age. Most problems can be treated successfully at any age. More than ten billion dollars are spent each year on this condition and, of this, one billion is spent on adult diapers. Overactive Bladder and Urinary Incontinence can lead to embarrassment, prevent those affected from participating in life's activities as they would like, and leads to social isolation. The information below covers overactive bladder and urinary incontinence. To better understand incontinence it helps to know a bit about the urinary tract (urinary system) particularly the parts that store and release urine.

WHAT IS YOUR BLADDER AND HOW DOES IT WORK?

Three sets of muscles control urine. One set is the bladder muscle itself. The second set is sphincter muscles that open and close the urethra and the third set is the pelvic floor muscles. They support the uterus, rectum and the bladder. The bladder is the muscle that sits just under your pubic bone and is connected to the kidneys. The two tubes (ureters) bring urine made by the kidneys down to the bladder. The bladder has two main jobs:

1) To store urine.
2) To empty the urine out that it has stored or "to void" at a socially acceptable time.

When the bladder is trying to store urine its job is to relax. The bladder is helped out with its storage function by two muscles, the internal sphincter and the external sphincter. These sphincters are muscles too and their job is to squeeze down tight to prevent loss of urine during storage. Pelvic floor muscles under the bladder also help keep the urethra closed. Urine stays inside the bladder when the sphincter and the pelvic floor muscles are tight. When the bladder is trying to empty urine its job is to contract while the sphincters relax, allowing urine to pass through. Bladder control means you urinate only when you intend. For good bladder control, all parts of your system must work together. The pelvic muscles must hold up the bladder and the urethra. The sphincter muscles must open and shut the urethra and the nerves must control the muscles of the bladder and the pelvic floor.

HOW DOES YOUR BLADDER KNOW WHAT TO DO?

The slight need to urinate is sensed when urine volume reaches about one half of the bladder's capacity. When your bladder is full, nerves in your bladder signal the brain that it is full and you get the urge to go to the bathroom. Your brain sends signals through nerves in your spinal cord that tell the large bladder muscle called the detrusor (layered smooth muscle that surround the bladder) when to relax and when to contract. Once stimulated, the detrusor contracts into a funnel shape ready to expel the urine. The brain also helps to co-ordinate the bladder, the sphincters and pelvic floor muscles so that they are working together to relax and to let the urine through. So, conditions that affect brain function and spinal cord function often affect a person's ability to control urination.

OVERACTIVE BLADDER

OVERACTIVE BLADDEROveractive bladder is when the bladder is not as relaxed as it should be. Instead it contracts very frequently. In people with an overactive bladder the detrusor muscle contracts spastically, sometimes without a known cause. Almost 20 million Americans are affected by overactive bladder. Some men with the symptoms of overactive bladder have an enlarged prostate rather than overactive bladder. However, it's also possible to have both an enlarged prostate and an overactive bladder. Overactive bladder is not normal at any age and is most often treatable no matter what the cause.

Overactive bladder symptoms:

Frequency - an urge to urinate more than 8 times a day with the need to urinate often occurring soon after the bladder has just been emptied
Urgency - a sudden and strong urge to urinate giving little or no chance to postpone urination.
Wetting accidents (incontinence) - an involuntary loss of urine
Nocturia - awakening to urinate 2 or more times a night. It can be a major problem in all ages, although the prevalence is increased in the elderly.

More than half of the 20 million people experience affected by overactive bladder only the symptoms of urgency and frequency. Overactive bladder affects men and women of all ages, but surprisingly most people with this condition are under the age of 65.

WHAT CAUSES AN OVERACTIVE BLADDER?

An overactive bladder occurs when a large muscle in the bladder known as the detrusor is too active. This muscle squeezes or contracts more often than normal and at inconvenient times. Instead of staying at rest as the urine fills the bladder, the detrusor contracts while the bladder is filling up with urine. This causes the person to feel a sudden and sometime overwhelming urge to urinate even when the bladder isn't full.

An overactive bladder can be caused by:

  • irritability of the bladder without an identifiable cause
  • brain injury
  • damage to the spinal cord
  • infection of the bladder
  • an enlarged prostate
  • a stone
  • a bladder outlet (sphincter) that doesn't open properly during urination
  • cancer
  • abdominal or pelvic trauma or surgery resulting in nerve damage.

DO I HAVE AN OVERACTIVE BLADDER?

Answer these questions with a yes or no.

1. Do you urinate more than 8 times in a 24-hour period?
2. Do you frequently get up 2 or more times during the night to go to the bathroom?
3. Do you have uncontrollable urges to urinate that sometimes result in wetting accidents?
4. Do you frequently limit your fluid intake when you are away from home so that you won't have to worry about finding a bathroom?
5. When you are in a new place, do you make sure you know where the bathroom is?
6. Do you avoid places if you think there won't be a bathroom nearby?
7. Do you frequently have strong, sudden urges to urinate?
8. Do you go to the bathroom so often that it interferes with the things you want to do?
9. Do you use pads or liners to protect your clothes from wetting?

If you answered yes to one or more of these questions you may have overactive bladder.

WHAT CAN I DO BEFORE I SEE THE DOCTOR?

The first step is to locate a health care provider, such as a urologist, who is interested in and well informed about treating incontinence. If you are thinking about seeking treatment for overactive bladder, you can help your doctor by providing detailed information about your symptoms. You may want to call the office for an appointment. Three days before your appointment complete the Voiding Diary (click here to download). The dairy is very simple and easy to complete. It tracks how often you go to the bathroom. If you are unable to print from your computer, ask the staff at Urology Team to mail you a diary. The most important thing is to be prepared for your visit. Bring a list of all the medication you are currently taking, a list of the dates and outcomes of any bladder related test or surgical procedures you may have had, and your completed a voiding diary.

EVALUATION TOOLS TO DETERMINE IF YOU HAVE OVERACTIVE BLADDER

Your doctor will ask you questions about your health history including any medications you may be taking. The doctor may also perform a physical exam. In some cases the doctor will need to conduct tests which may include:

  • Urinalysis: a urine sample is taken and analyzed to determine if you have a urinary tract infection, blood or other abnormality in your urine.

  • Post void residual measurement: This test is performed to see whether any urine remains after you have attempted to empty your bladder completely. Measurements may be made by catherization or bladder scan which is a non-invasive, non-radioactive procedure.

  • Ultrasound: This technique also can be used to determine the size and shape of the kidneys, bladder and prostate.

  • Cystoscopy: a thin telescope like instrument is passed into the bladder through the urethra. This allows the doctor to see the inside of the bladder to check for problems.

  • Urodynamic testing: involves testing of the sphincters and bladder to see if they are functioning normally.

TREATMENT OF OVERACTIVE BLADDER

If you are diagnosed with overactive bladder, your doctor will make recommendations about how to best manage your condition. A number of treatment choices are available.

Treatment may include:

  • Medications: Medications are usually tried first. Antimuscarinics, anticholinergics, and low dose tricyclics may be prescribed to decrease the frequency and intensity of bladder contractions, and to relax the smooth muscle of the bladder. This reduces the symptoms of overactive bladder, including frequency, nocturia, urgency and urge incontinence.
  • Bladder retraining and behavior modification

  • Sacral nerve stimulation or InterStim® Therapy is used with patients that have urge incontinence caused by overactive bladder who do not respond to behavioral treatments or medications.

WHAT SHOULD I DO IF I HAVE AN OVERACTIVE BLADDER?

The symptoms of overactive bladder can be very disruptive and can impact many aspects of your life. Making the decision to see your doctor about the symptoms is very important. When you visit the doctor it is important to provide as much information as possible about your symptoms. If you think you have an overactive bladder you should contact a Urologist. The Urologist may be able to find and treat the cause of the problem as well as to treat the symptoms.