OVERACTIVE BLADDER INFORMATION

Overview

Overactive 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. 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.

The most important thing is to be prepared for your visit. Bring a list of all the medication you are currently taking and a list of the dates and outcomes of any bladder related test or surgical procedures you may have had. To make an appointment, please contact our office at (281) 335-4095.

Evaluation tools to determine if you have an overactive bladder

Doctor Robinson will ask you questions about your health history including any medications you may be taking. He may also perform a physical exam. In some cases he 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 catheterization or bladder scan which is a non-evasive, non-radioactive proceedure.

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, Doctor Robinson 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, 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.

Bladder Training:

Bladder training has also been used as a method to reduce frequency by using bladder training techniques. Methods vary, but patients decide to void at designated times and use relaxation techniques and distractions to keep to the schedule. Gradually, patients try to lengthen the time between scheduled voids.

Surgery:

Surgery is typically performed only when other treatments fail to provide relief. Many approaches and techniques are used, each of which has its own advantages and complications that should be discussed with a Urologist. Many doctors are reluctant to operate because the outcome is uncertain and some people still have symptoms after the surgery. Below is a list of surgeries that can be considered:

1. Sacral Nerve Stimulation with The InterStim® device
2. Fulguration and resection of ulcers
3. Augmentation of the bladder
4. Bladder removal or Cystectomy

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