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Overactive Bladder

The Bladder That Won't Behave or A Condition No One Talks About

Have you ever had the urge to urinate and feel that you can't hold the urge until you reach a toilet to empty your bladder? Do you occasionally lose control of your bladder soiling your clothing and embarrassing yourself? If you answered yes to one or both of these questions you may be one of the more than 17 million people in the United States who suffer from overactive bladder (OAB). Its symptoms include urinary frequency, urgency, and accidental loss of urine due to a sudden and unstoppable need to urinate. This condition is not normal at any age and most people can be helped with medication.

The symptoms experienced by people who have an overactive bladder include:

Frequency - often having to urinate more than 8 times over 24 hours (including waking up to urinate 2 or more times a night); the need to urinate may occur soon after the bladder has been emptied
Urgency - sudden, strong urges to urinate with little or no chance to postpone the urination
Wetting accidents (also called urge incontinence [in-KON-tuh-nents]) - involuntary loss of urine (a small or large amount) following a sudden, strong desire to urinate (urgency)

Most people with OAB experience only the symptoms of urgency and frequency (60%). The remaining 40% have wetting accidents (urge incontinence) in addition to urgency and, often, frequency.

If you have these symptoms, don't forget one important fact - OAB can be treated regardless of the cause!

Who has overactive bladder?

1 in 11 adults in the United States alone are estimated to have OAB.
OAB affects men and women of all ages - most people with this condition are under age 65.
At least 16% of the US population over age 40 report having chronic (ongoing) and troublesome symptoms of an OAB.

What causes overactive bladder?

Overactive bladder occurs when a large muscle in the bladder known as the detrusor (deh-TRUE-sir) is too active. This muscle squeezes or contracts more often than normal and at inappropriate times. Instead of staying at rest as urine fills the bladder, the detrusor contracts while the bladder is filling with urine. This causes a person to feel a sudden and sometimes overwhelming urge to urinate even when the bladder isn't full.

The reason why the bladder muscle contracts inappropriately is not always known. For some people it may be due to a problem with the nerve signals that run from the brain to the bladder. Sometimes minor nerve damage is caused by surgery or childbearing. Some men with the symptoms of OAB have an enlarged prostate gland.

The diagnosis and treatment of OAB may be made by primary care physicians, geriatricians, gerontologists, urologists, gynecologists, pediatricians, neurologists, physiotherapists, continence nurses, and nurse practitioners.

A primary care provider can diagnose OAB by taking a complete medical history and a physical exam. One commonly conducted test is a urinalysis (a urine test to determine whether the symptoms are caused by OAB, or another problem, such as a urinary tract infection or bladder stones). If the urinalysis is normal, a primary care provider may decide to treat the patient or refer him or her to a specialist for further examination.

What is the treatment for overactive bladder?

Overactive bladder can usually be simply and effectively treated. Treatment should first begin with the easiest, least expensive therapies, which often means bladder retraining and medication. Kegel (named after the inventor, Dr. Kegel) exercises, which contract pelvic muscles and help with stress incontinence, have been used effectively in women with OAB right after childbirth. Bladder retraining programs, or "bladder drills," often used in conjunction with medication, have also provided good results for patients. These programs are based on gradually increasing the time between visits to the bathroom.

Estrogen replacement therapies, which may strengthen the detrusor muscle, may help menopausal women whose muscles have become weakened from estrogen depletion.

If your doctor diagnoses your condition as OAB, he or she may prescribe a drug that is designed specifically for OAB. It is an easy-to-take pill that reduces the frequency and intensity of bladder contractions. The two most commonly used are Detrol (Pharmacia-UpJohn) and Ditropan XL (Alza). These drugs work by relaxing the detrusor muscle of the bladder and allows the bladder to hold more urine and decreases the unwanted contraction of the muscle that results in the urinary frequency and urgency.

Patients who are treated with one of these medications will usually report improvement in 7-10 days after starting the drug. Tolterodine should not be used by patients with urinary retention, gastric retention, or narrow-angle glaucoma.

Surgery, while effective in some cases, should only be used as a last resort for treating OAB. It is generally most effective in treating stress incontinence and does not usually help with OAB.

Bottom line:

Overactive bladder is a common condition that affects millions of American men and women. Help is available. Often suffers can avoid the embarrassment of the OAB with exercises and medications.

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Reprinted with permission from Neil Baum MD, neilbaum.com.

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