Overactive Bladder
Introduction
The bladder is an organ that stores urine before it passes out of the body. An overactive bladder is a condition characterized by an urgency to urinate and difficulty controlling urination. It occurs due to poor control of the bladder muscles and sphincter muscles at the base of the bladder.
Causes
The act of urination is controlled by nerve impulses triggered by a full urinary bladder. The nerves signal the relaxation of the sphincter muscles at the base of the bladder while the muscles of the bladder wall contract. This mechanism helps push the urine out. If you have an overactive bladder, the muscles of the bladder wall contract abnormally causing an urge to urinate even if your bladder is not full.
Conditions such as stroke, diabetes, acute urinary tract infections, bladder stones, an enlarged prostate gland, and constipation, can lead to an overactive bladder.
Other factors include taking certain medications, consumption of alcohol and caffeine, and a decline in cognitive function due to aging.
Signs and Symptoms
An overactive bladder may cause you to experience some incontinence or involuntary leakage of urine and the need to urinate more frequently. Some even wake up two or more times at night to urinate, a condition called nocturia. Lack of urinary control can lead to a lot of emotional distress and embarrassment, especially when it occurs during social interactions and work schedules.
Diagnosis
When you visit your doctor with complaints of urgency and incontinence, your medical history will be reviewed and a physical examination is performed including a focused neurological exam. A urine sample is obtained for testing. A bladder ultrasound may be performed to assess the amount of residual urine in the bladder and note any abnormalities. Your doctor may order special tests called urodynamic tests that evaluate how well your bladder empties, the pressure within and around your bladder, and the speed and volume of urine being voided from the bladder.
Treatment
To help you manage an overactive bladder, your doctor may recommend a conservative approach using behavioral interventions such as:
- Kegel exercises which strengthen the bladder sphincter and pelvic floor muscles
- Maintaining a healthy weight
- Controlling fluid intake
- Voiding at regular intervals
- Delayed voiding to train the bladder
- Wearing absorbent pads
- Intermittent use of a catheter to help empty the bladder completely
Other treatments include certain medications, estrogen therapy, direct injection of Botox and stimulation of the nerves that signal the bladder.
For severe cases of overactive bladder that do not respond to conservative treatments your surgeon may recommend a procedure called bladder augmentation, which increases the capacity of the bladder, or a surgery to remove the bladder entirely. If the bladder is removed, an opening called a urostomy may be created in the abdominal wall, through which urine is eliminated from the body and collected in a bag.
Summary
An overactive bladder occurs when the neurological mechanism controlling bladder evacuation is impaired. This causes urinary urgency and incontinence that can affect your sleep and quality of life. An overactive bladder can often be managed by various behavioral techniques. For those with a severe condition, surgery can improve quality of life.
