Overactive Bladder - Severe Overactive Bladder
Your bladder holds and collects the urine that arrives from the kidneys. When a certain level of urine has accumulated in the bladder, your bladder sends signals to your brain so you know that it is time to urinate. Urination is a voluntary action. When you are ready, the bladder walls (detrusor muscle) contract and the pelvic floor muscles relax. A valve-like muscle on the bladder (urinary sphincter) opens and allows urine to empty from the bladder. Urine is carried from the bladder to the outside of your body through a tube called the urethra. The female urethra is short and ends above the vaginal opening. The male urethra is longer and ends at the tip of the penis . When you have finished urinating, the urinary sphincter closes to hold urine in the bladder.
There are several underlying conditions that appear to be associated with overactive bladder. Conditions that affect the urinary tract may contribute to overactive bladder, for example urinary tract infections, inflammation, structural abnormalities, an enlarged prostate in men, bladder cancer, and bladder stones. Neurological conditions including Parkinson’s disease, stroke, and multiple sclerosis can contribute to overactive bladder. People with diabetes or those who consume excess alcohol or caffeine may develop overactive bladder.
Researchers suspect a chemical (serotonin 5-hydroxtryptamine) imbalance in the brain that disturbs the nerve signal process may be linked to overactive bladder. The chemical is associated with depression, anxiety, attention deficit disorder, irritable bowel syndrome, and pain. Further, people with both fibromyalgia and a bladder condition known as interstitial cystitis experience higher incidences of overactive bladder and irritable bowel syndrome.
The main symptom of overactive bladder is the very sudden urgent need to urinate. You may urinate frequently, more than eight times during the day and more than two times at night (nocturia). Following the urgent feeling, you may have the unintended loss of urine (urge incontinence), known as “overactive bladder, wet”. About two thirds of people with overactive bladder do not experience urge incontinence, which is termed “overactive bladder, dry”.
Common tests include blood tests and urine tests. Your doctor may ask you to keep a record of how much you drink and urinate and episodes of incontinence over several days. The information can help your doctor diagnose factors that may contribute to your symptoms.
Specialized tests may also be conducted. A uroflowmeter is used to measure the amount of urine and speed of your voiding. A post void residual (PVR) measurement helps to find out if you have a problem with emptying your bladder. After you have urinated, your doctor will use a catheter or ultrasound to assess how much urine is left in your bladder. A catheter is a soft thin tube that is carefully inserted into your urethra to your bladder to remove remaining urine for measurement. An ultrasound is a painless imaging test that uses sound waves to create a picture of the bladder and remaining urine. With either test, a large amount of remaining urine indicates a blockage in the urinary tract or a bladder problem.
Urodynamic testing is another test to learn more about bladder function. Urodynamic testing evaluates the muscle strength in the bladder walls and sphincter. For this procedure, a catheter is inserted into the bladder and then the bladder is filled with water via the catheter. A pressure monitor records the pressure within the full bladder. Pressure in a healthy bladder increases slightly while filling.
Bladder pressure can also be measured with cystometry. For this procedure a catheter is inserted into the bladder and the bladder is filled with water. A small pressure monitor is inserted through the anus and into the rectum. The device measures pressure changes in the bladder and surrounding areas while the bladder is filled to various capacities.
Video urodynamic testing is frequently performed at the same time as cystometry. Video urodynamic testing uses X-rays or ultrasound to show what the bladder looks like while it is filling and emptying. A special dye may be used to enhance the images.
Your doctor may use a cystoscope to view the inside of your lower urinary tract. A cystoscope is a thin tube with a viewing instrument. It is carefully inserted through your urethra. The bladder is expanded with air or water to open the bladder folds and provide a better view. The procedure (cystoscopy) allows your doctor to check for problems inside of the bladder and urethra. Narrow instruments can be inserted through the cystoscope to allow your doctor to remove tissue if necessary.
In some cases, electromyography is used to assess the way that nerves conduct signals to the bladder muscles or sphincter. The evaluation involves placing sensors on the skin, in the bladder, or in the rectum. The sensors transmit a record of how coordinated specific nerve signals are with each other.
Prescription medications (anticholinergics) are used to relax the bladder wall muscles to prevent episodes of overactive bladder. Medications can help treat urge incontinence as well. Prescription medications are usually an effective treatment for most people.
Your doctor may recommend behavioral changes, such as limiting fluids, avoiding alcohol and caffeine, losing weight, and quitting smoking. It can be helpful to go to the bathroom more often or do so on a regular schedule. Bladder training involves holding urination for increasing minutes after feeling the urge to go to the bathroom to help lengthen the time between urinating. Another strategy, double voiding, is to wait for a few minutes after you have urinated, and then try again. Additionally, there are a variety of disposable or washable protective pads and briefs on the market today that can be worn to protect clothing.
It is common for people with incontinence to learn Kegel exercises to help strengthen the muscles that control urination. You may be referred to a physical therapist that specializes in pelvic floor strengthening.
Surgery may be recommended for people with severe overactive bladder that fail to have symptom relief with other types of treatment. Sacral nerve stimulation is used to help regulate the nerve signals between the bladder tissues and spinal cord. It involves surgically placing a small device under the skin in the abdomen. Wires from the device are placed near the nerves.
Another surgical option, augmentation cystoplasty, is used to enlarge a bladder that is too small or has very high pressure. This is a major surgery that uses sections of your bowel to reconstruct the bladder. Following augmentation cystoplasty, you may need to use a catheter to empty your bladder.
Neurolysis is a surgery to cut the nerves that supply the bladder. This prevents nerve signals from reaching the muscles in the bladder that cause it to contract. Neurolysis is rarely used, but may be an option for people with severe overactive bladder.
Am I at Risk
Overactive bladder is most frequently experienced in men over the age of 65 and women in their mid-40s. It is fairly common in the United States, affecting about one in six people.
Risk factors for overactive bladder:
___ Certain neurological disorders
___ Enlarged prostate in men
___ Bladder cancer
___ Urinary tract infection
___ Urinary tract inflammation
___ Bladder stones
___ Bladder tumors
___ Excess caffeine or alcohol consumption
___ Certain medications
If you experience urine incontinence with overactive bladder, you may be at risk for skin infections or sores (ulcers). Additionally, chronic urine incontinence increases the risk for repeated urinary tract infections. Ask your doctor to recommend preventive measures that are appropriate for you.