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Overactive bladder

Definition


Disease: Overactive bladder Overactive bladder
Category: Genito-urinary diseases

Disease Definition:

The problem with bladder function that causes a sudden urge to urinate is called overactive bladder.
Overactive bladder could lead to the involuntary loss of urine (incontinence) because the urge could be hard to suppress.
A person might feel embarrassed, isolate themselves, or limit their work and social life in the case of having overactive bladder. Fortunately, the affected person can receive treatments that might greatly alleviate symptoms of overactive bladder and help them control their impact on their daily life after a brief evaluation to determine the cause of overactive bladder.

 

Work Group:


Symptoms, Causes

Symptoms:

Signs and symptoms of overactive bladder might indicate that the affected person:

 

  • Urinates frequently, often eight or more times in 24 hours
  • Feels a strong, abrupt urge to urinate
  • Awakens two or more times in the night to urinate, a condition called nocturia
  • Experiences urge incontinence, which is the involuntary loss of urine immediately after an urgent need to urinate.

 

It can be real disruptive sensing an urge to urinate, having to urinate frequently and even at night, and having to drop everything and run to the toilet.

 

It is essential that a person talks to his/her doctor about overactive bladder, particularly if the person experiences urge incontinence or if other symptoms of overactive bladder disrupt their work schedule, social interactions and everyday activities, despite the fact that discussing these private matters with a doctor could be difficult.

 

A person shouldn’t only wear absorbent undergarments or pads and go on avoiding evaluation. Treatments are available; and seeing a doctor is very important, for an overactive bladder and urge incontinence might occur as the result of a cancerous tumor or some other serious underlying problem.  
 

Causes:

Filling and emptying the bladder is a complex interplay of kidney function, nerve signals and muscle activity. Overactive bladder and urge incontinence could be contributed to in case a problem occurs anywhere throughout this system.

 

NORMAL FUNCTION AND INVOLUNTARY CONTRACTIONS OF THE BLADDER:

The kidneys produce urine that travels down a pair of long tubes form the kidneys to the bladder. Urine drains from the bladder through an opening at the bottom (neck) and flows out a short tube known as the urethra. In men, the urethral opening is at the tip of the penis; while in women, it is located just above the vagina.

 

To accommodate the flow of urine, the bladder enlarges like a balloon. Nerve signals alert the brain when the bladder reaches about half its capacity, and the person senses that their bladder is “full”. A person feels the need to urinate (void) by the time the bladder is three-quarters full. Nerve signals coordinate the relaxation of the pelvic floor muscles and the muscles surrounding the neck of the bladder and upper part of the urethra (urinary sphincter muscles) when a person urinates. The muscles of the bladder contract, forcing urine out.

 

When the muscles of the bladder contract involuntarily, symptoms of overactive bladder occur. The urgent need to urinate is created by this contraction.
The symptoms of overactive bladder take place mostly, because the muscles of the bladder involuntarily contract. This contraction creates the urgent need to urinate. The urinary sphincter might stay constricted and prevent the bladder from leaking. A person will experience urge incontinence in case the strength of the sphincter is overwhelmed by the contraction.

 

FACTORS THAT MAY CAUSE OR CONTRIBUTE TO OVERACTIVE BLADDER:

Usually, the exact cause of overactive bladder can’t be identified. Overactive bladder is often associated with multiple sclerosis, strokes and neurological disorders such as Parkinson’s disease.

 

Symptoms that are similar to those of overactive bladder may be caused or contributed to by many factors, and the doctor will try ruling them out during an evaluation, because these symptoms require other specialized treatments. These factors may be:

 

  • Inflammation of tissues near the urinary tract
  • Medications resulting in a rapid increase in urine production or require that the patient take them with lots of fluids
  • Acute urinary tract infections that could contribute to symptoms very much like an overactive bladder
  • High urine production as might occur with high fluid intake, diabetes or poor kidney function.
  • Abnormalities in the bladder, such as bladder stones or tumors
  • Consumption of large amounts of caffeine or alcohol
  • Factors that obstruct bladder outflow, extended prostate, constipation or previous procedures to treat other types of incontinence.

 

Someone’s risk of developing overactive bladder is increased with age, which also increases the risk of diseases and disorders that lead to problems with bladder function, such as diabetes and an enlarged prostate. This condition and urge incontinence shouldn’t be considered a normal part of aging even though it is common among older adults.
 

Complications

Complications:

A person’s overall quality of life could be affected by urge incontinence, nocturia and frequent urination. Additionally, emotional distress and depression is more likely to develop in people suffering from significant disruption due to an overactive bladder.

 

Additionally, when both urge incontinence and stress incontinence occur together, it means that the person has a disorder called mixed incontinence. The loss of urine that occurs with exerting physical stressors or pressure on the bladder is the condition called stress incontinence.
 

Treatments:

To relieve the symptoms of overactive bladder, a combination of treatments may be recommended, such as:

 

BEHAVIORAL INTERVENTIONS:

Overactive bladder could be controlled by behavioral interventions. When experiencing urge incontinence, these interventions will probably decrease the number of incontinence episodes, but they aren’t likely to cause complete dryness by themselves. The interventions recommended might cover the following areas:

Fiber intake: 

Because constipation is usually associated with bladder problems, eating a diet rich in fiber or taking fiber supplements with the doctor’s ok may help with overactive bladder.

Fluid consumption: 

The quantity and timing of fluid consumption might be determined by the doctor. It might be wise to avoid caffeinated and alcoholic beverages in case they worsen the symptoms.

Double voiding: 

In some cases, people have problems emptying their bladder. This is diagnosed by significant elevations of residual urine volumes and might be helped by double voiding. The affected person could wait a few minutes after urinating and try again to empty the bladder completely.

Bladder training: 

Sometimes, a strategy to train oneself to delay voiding when feeling an urge to urinate could be recommended. The person will start with very small delays, such as 10 minutes and gradually work their way up to urinating every 3 to 5 hours.

Pelvic floor muscle exercises: 

The exercises that strengthen the pelvic floor muscles and urinary sphincter; muscles that are critical for holding urine even when bladder muscles involuntarily contract, are called Kegel exercises. When the person feels the urge, these strengthened muscles contract so that he/she can successfully suppress the involuntary contractions of the bladder. The patient may learn how to perform these exercises from their doctor or physical therapist. A study suggests that it may take up to eight weeks before a person notices changes in their symptoms.

Scheduled toilet trips: 

Rather than urinating when feeling the urge, the doctor will recommend the patient to go to the toilet on schedule in order to urinate at the same time every day, for instance every two to three hours.

Absorbent pads:

To avoid embarrassment and to protect clothing, a person who suffers from incontinence can wear absorbent pads or undergarments.

Intermittent catheterization: 

A very safe and comfortable process. A catheter may be passed periodically in order to empty the bladder completely. It doesn’t make the bladder lazy; on the contrary, it simply helps the bladder do what it can’t do on its own. The doctor will see whether this is a suitable solution for the person or not.

Maintaining a healthy weight: 

Because excess weight is associated with more urge incontinence, losing weight if the affected person is overweight may help with the symptoms. Additionally, stress urinary incontinence is more likely to develop in overweight people.

 

MEDICATIONS:

Symptoms of overactive bladder could be relieved and episodes of urge incontinence reduced by taking medications that relax the bladder. These medications are often used in combination with behavioral interventions; they include trospium, an oxybutynin skin patch, darifenacin, tolterodine, solifenacin and trospium. Dry eyes and dry mouth are included within the common side effects, but symptoms of overactive bladder may be exacerbated due to drinking water to alleviate thirst. Fewer side effects are caused by the extended-release forms of these medications and the skin patch.

 

To keep the eyes moist, the person could use eyedrops and to alleviate dry mouth, he/she could suck on a piece of sugar-free candy or chew sugar-free gum. Chronically dry mouth could be managed by some over-the-counter preparations. 

 

BOTULINUM TOXIN:

This drug is a protein from the bacteria that results in botulism illness. Yet, in small doses directly injected into tissues, this protein paralyzes those muscles; research has proved that severe cases of urge incontinence could benefit from this toxin. However, it’s not approved by the Food and Drug Administration for this purpose, and the effects are only temporary, lasting only about six months. Worsening bladder emptying, particularly in older adults is one of the risks of botulinum toxin.

 

SURGERY:

For people with severe cases of overactive bladder who don’t respond to other treatments, surgery may be an option. It aims at improving the storing ability of the bladder and decreasing pressure in the bladder. Surgical interventions include:

Augmentation cystoplasty: 

Trying to increase the capacity of the bladder, pieces of the bowel are used in this major surgical operation to replace a part of the bladder. The patient may need to use a catheter intermittently for the rest of his/her life to empty the bladder after this procedure. This surgery is reserved only for people who suffer from severe overactive bladder that hasn’t improved in spite of other treatments, because it is a major surgical procedure that has a potential for serious side effects.

Sacral nerve stimulation: 

Between the spinal cord and nerves in the bladder’s tissues, the sacral nerves are a primary link. Symptoms of overactive bladder could be improved by modulation of these nerve impulses. A thin wire is placed in this operation near the sacral nerves as they pass near the tailbone. Later on a device is used to deliver electrical impulses to the bladder, similar to what a pacemaker does for the heart. The wire is finally connected to a small battery device that’s placed under the skin in case it succeeds at decreasing symptoms.
 

Prognosis:

Not available

Expert's opinion

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