Overactive Bladder

Overactive bladder is diagnosed and treated by the Urology Division of Premier Medical Group. Overactive bladder (OAB) is characterized by the urgent and frequent need to urinate and being regularly wakened two or more times in the night by the need to urinate (nocturia). OAB may sometimes result in urinary in-continence, when the extreme urge to urinate can’t be controlled long enough to get to a toilet. This type of incontinence is called urge incontinence.

In people with an overactive bladder, the layered, smooth muscle that surrounds the bladder (detrusor muscle) contracts spasmodically, which results in sustained, high bladder pressure and the urgent need to urinate (called urgency). Normally, the detrusor muscle contracts and relaxes in response to the volume of urine in the bladder and the initiation of urination.

People with OAB often experience urgency at inconvenient and unpredictable times and sometimes lose control before reaching a toilet. Thus, overactive bladder interferes with work, daily routine, intimacy and sexual function; causes embarrassment; and can diminish self-esteem and quality of life. Overactive bladder is very common in older adults. Both men and women can have it, but it’s more common in women. Dr. Daniel Katz specializes in overactive bladder. He sees patients in our Poughkeepsie office.

Overactive bladder can cause other problems too. Hurrying to the bathroom can lead to falls and broken bones, especially in women who have gone through menopause. That’s because older women are more likely to have brittle bones that break easily. In both men and women, overactive bladder can cause sleeping problems, depression, and urinary tract infections.

What causes overactive bladder?

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Involuntary contractions (spasms) of the bladder muscle cause the associated symptoms of OAB. In many cases, there is no identifiable cause for these contractions. But there are a number of factors that have been found to contribute to OAB. These include: bladder infection, abdominal or pelvic trauma, bladder stones, bladder cancer or prostate cancer, or another medical problem.

Some brain problems, such as Parkinson’s disease or a stroke, can also lead to overactive bladder. Some medications can cause symptoms that mimic overactive bladder. Talk with your doctor about the medicines you’re taking to find out if they could be affecting your bladder, but don’t stop taking your medicine without the doctor’s OK. You may want to speak with Dr. Daniel Katz who specializes in OAB, and sees patients in our Poughkeepsie office.

What are the symptoms of overactive bladder?

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The most common symptoms of OAB are:

  • Urinating more than eight times in a 24 hour period
  • Sudden and strong urges to urinate even if you have just gone to the bathroom
  • Taking trips to the bathroom only to urinate just a little bit each time
  • Leaking urine when you have the urge to urinate
  • Getting up two or more times a night to go to the bathroom
  • Uncontrollable urges to urinate that sometimes result in wetting accidents

How is overactive bladder diagnosed?

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While overactive bladder is more common as we age, it is not a normal part of aging and can affect anyone at any age. A complete medical history, including a voiding diary; a physical examination; and possibly one or more diagnostic procedures help the physician determine an appropriate treatment plan for overactive bladder.

Other tests may be ordered if your doctor thinks your symptoms could be caused by other problems, such as diabetes or prostate disease.

Medical History

The medical history includes information about bowel habits, patterns of urination and leakage (when, how often, how severe), and whether there is pain, discomfort, or straining when voiding. The patient’s history of illnesses, pelvic surgeries, pregnancies, and medications currently used also supply the physician with information relevant to making a diagnosis. In the elderly, a mental status evaluation and assessment of social and environmental factors may be performed.

Physical Examination

A physical examination includes a neurologic status evaluation and examination of the abdomen, rectum, genitals, and pelvis. The cough stress test, in which the patient coughs forcefully while the physician observes the urethra, allows observation of urine loss. Instantaneous leakage with coughing indicates a diagnosis of stress incontinence. Leakage that is delayed or persistent after the cough indicates urge incontinence.

The physical examination also helps the physician identify medical conditions that may be the cause of overactive bladder. For instance, poor reflexes or sensory responses may indicate a neurological disorder.

Urinalysis

Examination of the urine may identify medical conditions associated with overactive bladder, such as the following:

  • Bacteriuria-presence of bacteria in urine; indicates infection
  • Glycosuria-excess glucose in urine; may indicate diabetes
  • Hematuria-blood in urine; may indicate kidney disease, stone disease or bladder cancer
  • Proteinuria-excess protein in urine; may indicate kidney disease, cardiac disease, blood disease
  • Pyuria-presence of pus in urine; indicates infection or inflammation

Cystometrogram

This simultaneously measures intra-abdominal, total bladder, and true detrusor (bladder muscle) pressures. This allows involuntary detrusor contractions to be distinguished from increased intra-abdominal pressure. The voiding cystometrogram detects outlet obstruction in patients who are able to void.

Uroflowmetry

Identifies abnormal voiding patterns. In a simple uroflowmetry, typically a stop watch is used to measure the amount of time a patient needs to urinate into a calibrated vessel. The doctor then assesses the ratio. In a complex uroflowmetry, electronic equipment is used to record the volume of urine and elapsed time. The physician then assesses the ratio.

Bladder Stress Test

To see whether you’re leaking urine, your doctor might do a bladder stress test, which consists of filling your bladder with fluid and then asking you to cough.

Cystoscopy

If your urinalysis reveals blood in your urine, if you have frequent urinary tract infections or if your doctor is contemplating surgery for you,a cystoscopy might be scheduled. In this procedure a thin, lighted instrument called a cystoscope is used to evaluate the lining of the urethra, bladder, and prostate (in men). The cystoscope is inserted into your urethra and slowly advanced into the bladder, allowing the doctor to look at areas of your bladder and urethra that usually do not show up well on X-rays. Tiny surgical instruments can be inserted through the cystoscope that allows the doctor to remove samples of tissue (biopsy) or samples of urine. Small bladder stones and some small growths can be removed during cystoscopy. This may eliminate the need for more extensive surgery.

Urodynamic Testing

Cystometry may be used to measure the anatomic and functional status of the bladder and urethra. The cystometer is an instrument that measures the pressure and capacity of the bladder; thus evaluating the function of the detrusor muscle (the muscle surrounding the bladder).

Imaging Tests

X-rays, CAT scans and ultrasound may be used to evaluate anatomic conditions associated with overactive bladder. Imaging of the lower urinary tract before, during, and after voiding is helpful in examining the anatomy of the urinary bladder and urethra. A CAT scan is available in our Poughkeepsie office for the convenience of our patients.

How is overactive bladder treated?

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Bladder Training with Timed VoidingOAB Algorithm

This treatment is used for urge and overflow incontinence. The patient keeps a voiding diary of all episodes of urination and leaking, and the physician analyzes the chart and identifies the pattern of urination. The patient uses this timetable to plan when to empty the bladder to avoid accidental leakage. In bladder training, biofeedback and Kegel exercise help the patient resist the sensation of urgency, postpone urination, and urinate according to the timetable.

Bladder Training

The most common OAB treatment that doesn’t involve medication is bladder training. This helps change the way you use the bathroom. Instead of going whenever you feel the urge, you urinate at set times of the day, called scheduled voiding. You learn to control the urge to go by waiting – for a few minutes at first, then gradually increasing to an hour or more between bathroom visits.

Pelvic Floor Exercises

You can use a type of exercise called “Kegels” to strengthen the pelvic floor muscles that control urination. When doing Kegels, you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination. A special form of training called biofeedback can help you locate the right muscles to squeeze. It helps to start with just a few Kegel exercises at a time, and gradually work your way up to three sets of 10. Another method for strengthening pelvic floor muscles is electrical stimulation, which sends a small electrical pulse to the area via electrodes placed in the vagina or rectum. While this sounds unpleasant, there is no pain associated with this therapy.

Weighted Cones

Another technique that can strengthen the pelvis and bladder muscles is the use of weighted cones. The tampon-shaped cone is inserted into the vagina and held there by contracting your pelvic muscles. As your muscles strengthen, the weight of the cone is gradually increased. This helps improve your ability to hold urine until you get to a bathroom. While pelvic exercises often help, the mainstay of OAB treatment is the use of medications called anticholinergics.

Drugs for Overactive Bladder

With OAB an inappropriate signal from our nervous system causing the muscles in the bladder wall to contract and release urine at the wrong time. Medications called anticholinergics can combat this problem by blocking the nerve signals and reducing bladder muscle contractions. They relax the smooth muscle of the bladder, reducing detrusor muscle contraction and subsequent urgency, frequency and urge incontinence (wetting accidents).

Surgical Treatments for OAB

In some cases we will implant a small device similar to a pace maker under the skin. This therapy, called interstim, can often control symptoms when more conservative measures such as pelvic floor exercises and medications have failed or were not tolerated. The device is implanted in the back through a minimally invasive procedure. A wire from the device runs alongside the sacral nerve and delivers an electric signal to the nerve. This signal helps to control the bladder muscles and decrease the number of abnormal contractions.

Other, less common, surgical procedures for OAB include increasing the storage capacity of the bladder (hydrodistention), limiting nerve impulses to the control muscles (denervation), or diverting the flow of urine.

Elimination and Challenge Diet

Bladder control problems that are not the result of neurological damage, poor muscle tone, or hormone deficiencies may result from irritability within the bladder or urethral tissues caused by chronic inflammation and/or food sensitivities. An elimination and challenge diet can help determine a food sensitivity.

Until you get your overactive bladder under control, wearing absorbent pads can help hide any leakage that occurs.

Some other helpful tips for preventing urge incontinence include going to the bathroom on a regular basis, especially before physical activity, avoiding drinking caffeine or a lot of fluids before activities not drinking any fluids right before you go to bed, and avoiding lifting heavy objects.

Questions to Ask Your Doctor about Overactive Bladder

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  • Why do you suspect that I have OAB?
  • What are common overactive bladder symptoms?
  • What other conditions can cause symptoms similar to OAB?
  • Are there any complications associated with overactive bladder?
  • What are possible causes for bladder control problems?
  • What do you suspect is the underlying cause for my condition?
  • What does OAB diagnosis involve?
  • What is a voiding diary?
  • Might this tool be helpful in diagnosing bladder control problems or treating OAB? Why or why not?
  • What types of diagnostic tests might be performed?
  • What is urinalysis?
  • What do postvoid residual volume (PRV), urodynamic testing (e.g., cystometry, uroflowmetry), cystoscopy, and imaging tests (e.g., ultrasound, x-ray) involve?
  • Which of these diagnostic tests do you recommend?
  • Why do you recommend these tests?
  • What type(s) of overactive bladder treatments are available?
  • Which OAB treatment(s) do you recommend?
  • Why do you recommend these treatments?
  • What are the benefits, risks, and possible side effects of these OAB treatments?
  • What does bladder retraining with timed voiding involve?
  • Might this OAB treatment be helpful? Why or why not?
  • What types of medications are used to treat bladder control problems?

Relevant Articles About Overactive Bladder

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Reports from the medical journals