INTRODUCTION

A sudden urge to urinate that is difficult to suppress describes what is likely to be an overactive bladder. Incontinence, the involuntary loss of urine, may also be a signal.

Also called an irritable bladder, it tends to affect men 65 and older. Women are affected earlier, the rate beginning to climb when they reach their mid-40’s.

If you have overactive bladder you may feel embarrassed, isolate yourself, or limit your work and social life. But treatments are available to alleviate your symptoms and help manage the impact on your daily life.

SIGNS AND SYMPTOMS

Symptoms of overactive bladder may include:

•    A strong, sudden urge to urinate.
•    Urge incontinence, the unintended loss of urine immediately after an urgent need to urinate.
•    Frequent urination, usually eight or more times in 24 hours.
•    Awakening two or more times at night to urinate (nocturia).

Overactive bladder without urge incontinence – often called overactive bladder, dry – affects two-thirds of people with the disorder. When symptoms include urge incontinence, it’s called overactive bladder, wet.

CAUSES

Filling and emptying your bladder is a complex business involving nerve signals and muscle activity. A problem anywhere in this system can contribute to overactive bladder and urge incontinence.

Now, your bladder expands like a balloon to accommodate urine flow. When about half its capacity is reached, nerve signals alert your brain and you sense that your bladder is “full.” By the time it’s three-quarters full you feel the need to urinate. When you urinate nerve signals co-ordinate the relaxation of the pelvic floor muscles and those around the bladder-neck and upper portion of the urethra (sphincter). The bladder muscles contract, forcing urine out.

INVOLUNTARY BLADDER CONTRACTIONS

Overactive bladder symptoms occur mostly because the bladder muscle involuntarily contract when it’s still filling and only about half full. This contraction creates the urgent need to urinate. The urinary sphincter (upper portion of the urethra) may remain constricted and prevent the bladder from emptying. If not, a person experiences urge incontinence.

CAUSAL OR CONTRIBUTING FACTORS

Neurological disorders, such as Parkinson’s disease or strokes, are often associated with overactive bladder. Other contributing factors include:

•    Urinary tract infection.
•    Inflammation of tissues near the urinary tract.
•    Abnormalities in the bladder, such as tumors.
•    Diabetes, which can cause excess urine production.
•    Factors that obstruct bladder outflow (enlarged prostate, constipation, bladder stones, or previous operations to treat other forms of incontinence).
•    Excess consumption of caffeine or alcohol. Take note.
•    Medications that cause a rapid increase in urine production.

RISK FACTORS

Growing older is an increased risk factor for developing overactive bladder. Older age increases your susceptibility to diseases and disorders that can contribute to bladder function problems, such as enlarged prostate, inflammation of vaginal tissues, and diabetes.

Although common among older adults, overactive bladder and urge incontinence shouldn’t be considered a normal part of aging.

COMPLICATIONS

Urge incontinence detracts from one’s overall quality of life, but frequent urination and nocturia can also be detrimental to your well-being. Those with significant disruption from an overactive-bladder are more susceptible to:

•    Depression
•    Low self-esteem
•    Anxiety
•    Fatigue
•    Poor attention or concentration

Some people may also have a disorder called mixed incontinence. This is usually the presence of both urge incontinence and stress incontinence. Stress incontinence is the loss of urine when you exert pressure on your bladder, like when you cough or laugh.

TREATMENT

Behavioral interventions include:

The amount and timing of fluid consumption during the day especially alcohol and caffeinated beverages, are important. Doctor will make recommendations.
Eating more fiber, to avoid constipation.
Double voiding. Urinate, wait a few minutes, and then try again to empty your bladder completely.
Bladder training. Use of a strategy to train yourself to delay urinating when you feel the urge, may be helpful. Begin with small delays, like 10 minutes, and gradually work your way up to urinating every 2 to 4 hours.
Scheduled toilet trip. This is a strategy to urinate at the same time every day – every two to four hours as recommended – rather than when the urge is there.
Pelvic floor muscle exercises. Exercises called Kegels strengthen your pelvic floor muscles and urinary sphincter muscle that are critical for holding urine even if your bladder muscles involuntarily contract.
Absorbent pads. These can avoid embarrassing incidents if you do have incontinence.

MEDICATIONS

Medications called anticholinergics are effective and many are available. They are called antispasmodics.

Surgery is reserved for severe cases, who don’t respond to other treatments. The goal: improve the bladder’s storing ability and reduce pressure in the bladder.

There is:
•    Sacral nerve stimulator
•    Augmentation cystoplasty

Perhaps we can expand on these another time when there is more space. Or contact your surgeon, although I’m sorry to say that neither of these are available in Dominica.

See you next week. Stay dry.