OVERACTIVE BLADDER
What is overactive bladder?
Overactive bladder (OAB) is a condition when the bladder squeezes too often or without warning. The symptoms include: frequent urination, the sudden and urgent need to urinate and may be linked with episodes of urine leakage or loss of control of urination, which is called urinary incontinence. Overactive bladder is common, especially as women age, but many do not talk to their health care providers because they are embarrassed or they think it is a normal part of getting older. Some studies show up to 20% of women over 40 have an overactive bladder. OAB can have a large impact on your life and can cause disruptions in work, leisure and social activities.
What are the symptoms of an overactive bladder?
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Urinate over 8 times in 24 hours
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Urinate over 2 times at night
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Sudden need to urinate that is unstoppable or hard to control
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Having your urine leak out with the urge to urinate or not being able to hold your urine (urge incontinence)
How does the urinary system work?
Urine is made in the kidneys, and travels to the bladder through two tubes called ureters, one from each kidney. The bladder is the organ that stores urine before it leaves the body through the urethra. The bladder is a muscle: it can get larger like a balloon to store urine, and can get smaller in size by shrinking down to push the urine out of the body. The urethra is normally closed to keep urine stored in the bladder. When the bladder gets full and you feel the urge to urinate, the bladder muscle squeezes, the pelvic muscles relax, and the urethra opens to let the urine leave the bladder.
What causes overactive bladder?
We don’t really know why people get an overactive bladder. It can happen because the bladder muscles squeeze too often and at the wrong times (like when the bladder is not full). This may cause you to feel the need to urinate.
Most of the time we cannot find the cause.
Overactive Bladder can be linked to many conditions like:
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Infection
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Menopause
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Poor bladder habits (such as not urinating very often; and delaying urinating)
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Neurological disease (like Multiple Sclerosis)
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Drinking caffeine and alcohol
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Tumors or bladder stones
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Blockages to urine flow like a vaginal bulge (pelvic organ prolapse), or, scarring from surgeries (less common),
Overactive bladder can be affected by:
• Urinary tract infections (UTIs)
• Medications that cause more urine production
• Diabetes and other diseases that affect the kidneys
• Trouble walking to reach the bathroom on time
What are some problems that can happen because of overactive bladder?
Overactive bladder can be very disruptive. It can cause:
• Stress
• Depression
• Interruptions in your sleep
How do you test for an overactive bladder?
Your doctor will ask you questions about your overactive bladder, and may ask you to keep a bladder diary for several days to learn more about your bladder habits.
Your doctor might do an examination of your vagina and bladder. Your doctor might also do a neurologic examination (an assessment of nerve responses and reflexes related to the bladder) to look for causes of your bladder symptoms.
You might need to give urine sample to check for signs of a urinary tract infection, which has the same symptoms as overactive bladder and can be easily treated with antibiotics.
Depending on what your doctor thinks is causing your symptoms, special tests might be done. These tests are:
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Post-void residual: this measures the amount of urine left in your bladder after you urinate. It can be done with an ultrasound or a catheter (a thin plastic tube placed in the urethra brie y to empty the bladder)
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Urine flow rate: this measures how fast you urinate and the ow of your urine.
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Urodynamic study: this is a bladder function test to see how your bladder behaves when it is storing urine and how it empties urine
I have overactive bladder. What treatments are there?
There are many treatments that can help overactive bladder.
Lifestyle changes
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Keep a healthy weight
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Limit the amount of fluids that you drink.
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Train your bladder by scheduling urination and empty your bladder twice in a row (double voiding) to be sure it is empty
Hormone replacement
If you are menopausal, low dose vaginal estrogen may help. Your doctor will let you know if you can have this treatment.
Pelvic floor physiotherapy
A pelvic floor physiotherapist can test the strength of your pelvic oor muscles and nd which muscles need to have strengthening and relaxing training. Almost everyone can be trained to strengthen the pelvic oor and help make overactive bladder symptoms better. One such exercise is called Kegel exercises.
Medications
Medications can be used to relax the bladder muscle and lessen the urge to urinate. Ask your doctor about these medications.
Bladder injections
If your OAB symptoms do not respond to medications, Botox® can be used to help relax the bladder muscle and prevent muscle contraction (this lessens the urge to urinate).
Tibial Nerve Stimulation
Bladder function is controlled by a group of nerves (sacral nerve plexus) located at the base of your spine. Tibial nerve stimulation uses an electrical pulse placed on the inner side of the ankle to send a mild electrical current up to the sacral nerves to help control bladder function. This type of treatment requires several out-patient visits.
Sacral nerve Stimulation
This works on the same principle as tibial nerve stimulation but is more involved as this means a small electrical stimulator is implanted under your skin much like the way a heart pacemaker might be implanted (this is sometimes referred to as a ‘bladder pacemaker’).
Surgery
Surgery is the last option that will be tried if nothing else works. Your doctor will talk to you about whether this is a treatment option you should think about.
There are treatments for an overactive bladder. Please talk to your doctor about which one is best for you.
Sunnybrook Health Sciences Centre
2075 Bayview Avenue Toronto, ON M4N 3M5
Telephone: 416.480.6100
PR xxxxx (Feb 2017)
