Overactive Bladder

Symptoms:

• Urgency and urge incontinence: Sudden and intense sensation to pass urine which cannot be tolerated and may cause leakage
• Frequency: Going to toilet more than 7 times per day
• Nocturia: going to toilet more than once at night
• Coital incontinence at the time of orgasm

How does a normal bladder work?

The bladder is like a balloon. Normally, the bladder muscle is relaxed while the bladder gradually fills up. Urine is kept inside the bladder by a valve-like mechanism. The valve stays close until you feel the need to empty and have reached a toilet. The valve mechanism is assisted by the pelvic floor muscles below the bladder which contract when you cough or sneeze. As the bladder fills up, you start to be aware that you need to pass urine but are able to hold on. Once you have decided to empty your bladder your brain signals the muscles of the bladder to squeeze and empty out the urine. At the same time the valve and pelvic floor muscle relaxes to allow the ease of urine flow. The bladder usually needs to be empty out less than 7 times a day and once at night.

Causes of overactive bladder

• Urinary tract infection
• Conditions affecting the nervous system such as Multiple sclerosis
• Previous operation for stress incontinence causing obstruction
• The amount and type of caffeinated drinks and fizzy drinks
• Idiopathic causes ( unknown causes)
• Age

Investigation for overactive bladder

• Urinalysis to exclude urinary tract infection
• Measuring residual urine via ultrasound machine or small catheter
• Urodynamics : assessing the activity of the bladder muscle as it is filled with fluid

What are the treatments for over active bladder ?

Changing general life style :

• Reducing Caffeine intake, alcohol, fruit juices and fizzy drinks
• Aim to drink 1.5 to 2 litter of water
• Switch to herbal tea and decaffeinated drinks

Bladder retraining and physiotherapy :

It aims to help you to strengthen your pelvic floor muscle to hold more urine by going to toilet less. It involves gradually increasing the time between visits to the toilet. Start by delaying going to the toilet by 15 minutes until you reach 2 to 3 hours between the voids.

Magnetic chair :

Non-invasive and successful way of treating the overactive bladder. It involves 20 minutes sitting on a special chair twice a week for five weeks, then weekly for 10 weeks and fortnightly thereafter. Women with hip replacements or a pacemaker cannot use this treatment.

Medication :

They are anticholinergic drugs such as ditropan, vesicare or oxytrol which can cause side effects such as: dry mouth, dry eyes and constipation.
Topical oestrogen such as vagifem may help.
Hiprex and cranberry tablets to prevent urinary tract infections will decrease bladder irritability.

Botulinum toxin :

Botox injection into the bladder muscle wall. This treatment decreases the abnormal contractions of the bladder. However, it may also reduce the normal contractions so that your bladder is not able to empty fully. It can causes also leakage as a side effect.

Sacral nerve stimulation

This involves directly stimulating the nerves that controls your bladder function.