Overactive Bladder

In the Overactive Bladder, the urge to urinate may be so pressing that it is hard to control. Moreover, holding can be difficult until the incontinence (urge incontinence). This symptom frequently occurs day and night, so the quality of life is heavily affected.

Even if the overactive bladder is not life-threatening, its symptoms are often bothersome.

Overactive bladder symptoms become more frequent with increasing age.

Between 10 and 20% of people suffer from it at some stage.

If you have an Overactive Bladder, you may feel stressed and sleepy (if you cannot sleep properly during the night); reduce drinking water for fear of having an inappropriate urinary urge (because you are in a meeting or a place without restrooms). Your daily activities could be so affected to limit your work and social life.

In many cases, accurate evaluation and a correct diagnosis solve the problem and restore a good quality of life.

Simple behavioural strategies (dietary changes) and exercises (timed bladder voiding and bladder-holding techniques using the pelvic floor muscles) might alleviate this discomfort. We can consider other treatments if these initial efforts don’t help enough with symptoms.

Symptoms

Overactive bladder typically causes:

• a sudden need to urinate and to have trouble postponing it (urgency) even with involuntary loss of urine (urge incontinence);
• need to urinate frequently (frequent urination);
• need to wake up at night to urinate (nocturia).

These symptoms usually impact the quality of life. Patients with OAB often need to plan their toilet stops before leaving the house, which may affect social activities. Also, the need to urinate at night may impact daily activities. Episodes of urgency resulting in urine leakage are embarrassing and may lower self-esteem.

Causes

The cause of Overactive Bladder syndrome is not well understood and is still under investigation.

This bladder dysfunction causes:

• the sudden, spontaneous contractions of the bladder muscle even when the volume of urine in the bladder is low (bladder instability);
• the abnormal sensitivity to the feeling of bladder filling (bladder sensitivity);
• The bladder fills up more quickly because of low bladder capacity.

These three mechanisms that cause OAB can occur in the following diseases:

General diseases:

• Diabetes;
• Neurology disorders (stroke and multiple sclerosis);
• Hormonal changes during menopause;
• Psychologic distress;

Bladder diseases:

• Factors that obstruct bladder outflow (prostate enlargement, urethral strictures);
• Incomplete bladder emptying (little urine storage space left);
• Tumours or bladder stones;
• Urinary tract infections.

Other factors:

• Medications that cause increased production of urine;
• Excess consumption of caffeine or alcohol;
• the declining cognitive function and abnormality in the nervous reflexes between the brain and bladder.

Treatment

 Self-management can be the first step of treatment. The following self-management measures may help (under medical advice):

• To “hold it” longer when feeling the urge to urinate. It will train the bladder to increase the time between urinations;
• Pelvic muscles can weaken with age. Different exercises can help enhance muscle strength and suppress the urge to urinate. A physiotherapist can help to do these exercises in the right way;
• Lifestyle changes:
  • Discuss with the doctor how much to drink;
  • Drink less before and during long trips;
  • Drink less in the evening to avoid getting up at night;
  • Reduce alcohol and caffeine;
  • Certain foods can have an irritative action on the bladder and worsen OAB symptoms. It is better to reduce artificial sweeteners, spicy foods, citrus fruits and juices, caffeine and soft drinks;
  • Maintain a healthy weight.

You do not have to see these symptoms as a normal part of ageing or an untreatable problem. If you have bothersome symptoms, you must go to your doctor and discuss your situation.

Seek help and let your family know about your situation. It might make you feel more comfortable if your partner, relatives, or friends are aware of your problem.

Medical treatment

We have some medications to treat an overactive bladder that can decrease bladder contractility and capacity. As a result, urination is less frequent and urgent. However, the treatment is chronic, and if it is discontinued, symptoms will appear again.

Botulinum

Multiple injections of botulinum toxin in the bladder may help decrease bladder contractility. We make these injections during a cystoscopy, generally under sedation. However, the effect is temporary and may last up to 6-8 months.

Sacral nerve stimulation