Overactive Bladder is a condition in which there is a very strong and uncontrollable urge to urinate, even when the bladder is not full. One of the direct consequences of this condition is what is called urge incontinence, wherein urine tends to leak in case the person does not urinate immediately. These two conditions together can have a disruptive effect on one’s professional, personal and social lives. Such patients start avoiding social gatherings, and feel embarrassed at the workplace. It affects their sleep and sex-life. Over time, the person shows symptoms of depression and/or anxiety. If left untreated, the condition can worsen with time.
Overactive Bladder (OAB) is quite common. In the US alone, 33 million American women receive treatment for this condition every year. Men are equally prone to the condition but do not seek treatment as often as women do, which worsens their condition. This is unfortunate considering that the condition can be treated successfully. That is why this article is being written so that people are aware of the condition and seek treatment in time.
Causes
Many patients suffering from OAB dismiss the condition as a natural outcome of ageing or old-age. However, this is not true. There are clear pathological reasons for the condition.
As we all know, the kidneys filter wastes, toxins and excess fluid from the body, in the form of urine. Urine is sent from the kidneys to the bladder via the ureters. The bladder drains the urine out of the body through a thin pipe called the urethra located in the penis in men and above the vagina in women. A ring of muscles called the sphincter surround the urethra. When the bladder is not full, its relaxed, while the sphincter is tense. This ensures the urethra is closed and whatever urine is there in the bladder does not void (empty out). When the bladder is full, the brain signals the bladder to tense and push the urine out. Simultaneously, the sphincter is signaled to relax and allow the urine to drain out through the urethra. This cycle repeats 6 to 8 times a day, in normal, healthy adults.
In people with OAB, the signaling between the brain and the urinary system is affected. As a result, the brain sends a signal to the bladder and sphincter even when the bladder is not full. There are various causes and risk factors for such an eventuality.
- Neurological disorders which cause nerve damage. This causes the signaling between the brain and urinary-system to get disrupted. Such disorders include stroke, multiple sclerosis, Parkinson’s disease, a herniated disc, radiation treatment for cancer and surgery for the back or pelvis.
- Uncontrolled Diabetes
- Urinary tract infection: In this, the bladder nerves get irritated which causes the bladder to contract involuntarily, which causes symptoms similar to OAB
- Hormonal changes during menopause in women. Estrogen deficiency after menopause can cause urge incontinence and over time – OAB.
- Obstructions to urine flow, or abnormalities in the bladder: This includes bladder stones, tumor, enlarged prostate, constipation or an earlier surgery to treat other forms of urinary incontinence
- Medications that cause a surge in urine production, or medicines that must be consumed with lots of fluids. These dull the nerve signals from the brain, triggering OAB.
- Excess consumption of caffeine or alcohol can also dull the nerve signals from the brain, triggering OAB in the long run
- Declining cognitive function due to dementia or Alzheimer’s. In this case, it becomes difficult for the bladder to understand signals received from the brain
- Any condition that causes difficulty in walking, such as Osteoarthritis. The person is not able to get to the bathroom quickly, so as a defense mechanism, the body may develop OAB.
- Indifference to voiding completely can leave some urine in the bladder, which triggers OAB over time.
- Weak pelvic muscles: In women, pregnancy and childbirth can cause pelvic muscles (the muscles and tissues that support organs in the lower abdomen) to stretch and weaken. As a result, the bladder sags, or is displaced, triggering OAB eventually.
- Injury: An accident or a nasty fall can cause trauma to the pelvic muscles or the urinary system, triggering OAB for some people.
- Obesity: Excess weight puts excess pressure on the bladder, leading to urge incontinence.
Symptoms
- Urinary urgency: A strong and sudden urge to urinate that’s difficult to control.
- Urgency incontinence: The person experiences unintentional loss of urine immediately after the strong urge. (This is not the same as stress incontinence caused when the person laughs, coughs or sneezes hard, or is emotionally disturbed.)
- Increased frequency: The person urinates more than eight times in 24 hours
- Nocturia: The person wakes up more than two times in the night to urinate
- Behavioral changes: As a result of all the above, the person is moody, withdrawn, anxious or depressed, quite often.
Treatment
There are various treatment options, including medication, exercise therapy, lifestyle changes, other therapies, and surgery in rare cases when the other options don’t work out. A qualified urologist, nephrologist, or gynecologist in the case of women, can evaluate the person carefully and recommend the right treatment.
Medication
- Anti-cholinergics: They control the muscle spasms in the bladder, and include Alfuzosin, Solifenacin, Oxybutynin, oxybutynin XL , oxybutynin TDDS and Oxybutinin Gel, Silodosin, Terazosin, Darifenacin , Fesoterodine , Tolterodine, Doxazosin, Tamsulosin and Trospium.
- Beta-3 adrenergics and anti-muscarinics: These help the bladder muscles relax and prevent them from contracting even when the bladder is not full. These include Mirabegron.
Exercise therapy
- Kegel exercises: These exercise help strengthen the pelvic floor muscles and urinary sphincter, which help prevent the bladder muscles from contracting involuntarily. These will be taught by a physiotherapist and how well or how regularly the person performs these exercises will decide the outcome.
- Quick flicks: In this, the person must quickly squeeze and then relax the pelvic floor muscles, over and over again, whenever the urge to go arises. Mentally, the person must stay relaxed and focused on the exercise without being stressed in any way.
- Biofeedback: This is a program that helps the person understand how the bladder works. It uses computer graphs and sounds to monitor the movement of the muscles in the bladder. This will give an idea on how strong are the person’s pelvic muscles so that the right treatment can be selected.
Lifestyle changes
- Keeping a diary: The person must maintain a diary on how much fluid was consumed in a day, how many times the person urinated, number of instances of urinary leakage and whether the person had coughed, sneezed or laughed at the time of leakage.
- Monitoring the diet: Some foods and beverages worsen bladder symptoms, so they should be avoided. These include tea, coffee, alcohol, caffeinated soft-drinks, chocolate products, tomatoes and tomato products, citrus fruits or their juices, spicy foods or drinks, acidic food or drinks and anything that contains artificial sweeteners.
- Stay hydrated: Even as the person follows the above step, it’s important not to get dehydrated. Dehydration causes the urine to concentrate, which irritates the lining of the bladder. This can become a trigger for OAB. Drink plain water only, at room temperature, in quantities that ensure your urine is pale-yellow or straw-colored every time.
- Maintaining bowel regularity: Since constipation is a trigger for OAB, it’s important to clear your bowels regularly. Consume a diet rich in fiber, drink more hot water than cold water or water at room temperature. And ensure you use the bathroom at specific periods of time in the day. This will discipline you and ensure your bowels move regularly.
- Maintaining weight: Since obesity is a trigger for OAB, the person should watch his/her eating habits and weight all the time. He/she must exercise for 30-40 minutes a day, at-least 5 days a week to instill a discipline which will help lose weight.
- Quit Smoking: Tobacco smoking is known to irritate the bladder muscles, so quitting is an important step in overcoming OAB and preventing many other ailments.
- Bladder retraining: A doctor or physiotherapist will train the person in various aspects of voiding, controlling the urge and maintaining a bathroom schedule.
- Controlling the urge: This can be undertaken even if the above bladder retraining is not done. Here, the therapist will teach various methods to control the urge.
- Absorbent pads: Absorbent pads and adult diapers can overcome the embarrassment that comes from urinary leakage and help the person de-stress which is an important aspect of treating OAB.
Other therapies
- Neuromodulation therapy (NMT): In this, electrical pulses are sent to the nerves that come from the brain to the bladder (sacral nerve). These help correct any disruption of signals in this route.
- Percutaneous Tibial Nerve Stimulation (PTNS): The nerves that come from the brain to the bladder (sacral nerve) and from the brain to the legs (tibial nerve) meet at the spine. So, in this procedure, an electrode is placed near the ankle and electrical impulses given to the tibial nerve which will travel all the way to the spine and hence the sacral nerve. This helps correct any abnormality in it.
- Sacral Neuromodulation (SNM): In this, the sacral nerve is given electrical pulses using a temporary or permanent pacemaker. In case of a temporary pacemaker, its worn on the body and an electrical wire implanted under the skin sends signals to the sacral nerve. In case this is not working, a permanent pacemaker will be fitted inside the body.
- Botox treatment: Botox, the drug used in cosmetic treatments, is injected into the bladder muscles to help them relax. There are side-effects of this but the doctors will help overcome them.
- Intermittent catheterization: If voiding is not happening properly, a catheter inserted into the body can help void periodically.
Surgery
- Augmentation Cystoplasty: In this process, the bladder is enlarged so that it can hold more urine. This reduces the need to go often.
- Urinary diversion: In this, the flow or urine is diverted from the regular path, either temporarily or permanently.
- Bladder removal: In this, the bladder is removed (as in the case of advanced cancer). Then a new bladder is constructed and implanted inside the body. Or, an opening (stoma) is made on the body and a bag attached to it externally to hold the urine.
Outlook
If you or any of your dear ones are showing the symptoms of Overactive Bladder, do not ignore them as a natural signs of ageing. Or do not panic. Consult a urologist at a reputed hospital, immediately. He/she will diagnose the condition precisely and choose the best course of treatment for quick recovery and rehabilitation.
Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals
NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.
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