Overactive Bladder

An overactive bladder is a condition that results from sudden, involuntary contraction of the muscle in the wall of the urinary bladder. The layered, smooth muscle that surrounds the bladder, the detrusor muscle, contracts spastically, sometimes without a known cause, which results in sustained, high bladder pressure and the urgent need to urinate. Normal urination involves processes within the urinary tract and the brain. When urine is produced in the kidneys, it is stored in the bladder for controlled discharge. The slight need to urinate is sensed when urine volume reaches about one-half of the bladder's capacity. The brain suppresses this need until a person initiates urination. Once urination has been initiated, the nervous system signals the detrusor muscle to contract into a funnel shape and expel urine. Pressure in the bladder increases and the detrusor muscle remains contracted until the bladder empties. Once empty, pressure falls and the bladder relaxes and resumes its normal shape. Overactive bladder is also referred to as urge incontinence and is a form of urinary incontinence, or loss of urine.

Overactive bladder is especially common in older adults; however, it should not be considered a normal part of aging. It affects an estimated 1 in 11 adults or approximately 17 million people in the United States, according to the U.S. Department of Health and Human Services. People with overactive bladder often experience urgency at inconvenient and unpredictable times and sometimes lose control before reaching a toilet. It is an embarrassing and frustrating problem which can interfere with one's work, daily routine, intimacy, sexual function and can eventually diminish self-esteem and have a significant impact on someone's quality of life with resulting anxiety, depression, reduced activity level with secondary weight gain, and social isolation. An additional symptom seen very often, especially in the elderly, is nocturia, awakening more than two times at night to void, which will often disrupt sleep. Overactive bladder has been shown to be an independent risk factor for both falls and fractures. The rush to the toilet when urinary urgency occurs likely disposes one to falls that would otherwise not occur. Other medical conditions or diseases such as urinary tract infection or bladder tumors can cause bladder irritation leading to overactive bladder.

Overactive bladder is a real medical condition that can be treated. Many women never report symptoms of overactive bladder because they incorrectly think that treatment is not available or effective or that the symptoms are normal consequences of aging or childbirth. Overactive bladder has been called the closet disorder since only one-third of regularly incontinent women discuss their problem with their doctor and two-thirds of patient's first seeking medical advice have had their symptoms for more than two years. Instead of seeking help, many people with overactive bladders adjust their habits and lifestyle to accommodate the management of symptoms and may adopt such coping mechanisms as restricting fluids and urinating to a timed schedule or at the first sensation of urgency. Car trips and vacations are limited. Shopping, visiting public places, entertaining or socializing are curtailed and in some cases stopped. Finding accessible public toilets, a behavior referred to as toilet mapping, becomes a source of major anxiety. Initially, increasing the frequency of bladder emptying, often referred to a defensive voiding, may reduce the number of incontinent episodes.

Effective treatment includes the combination of drug therapy with behavioral interventions.

Behavioral techniques, which improve bladder control by teaching persons to adopt new skills, are recommended first for treating overactive bladder. These include self-care practices or lifestyle changes, such as weight loss, smoking cessation, moderation in fluid intake and elimination of foods that contain bladder irritants such as caffeine and alcohol, bladder retraining and pelvic floor muscle exercises. These behavioral changes can be very effective and should be used in combination with drug therapy. Your doctor may ask you to keep a bladder diary; a record of your fluid intake, trips to the bathroom, episodes of urine leakage, and an estimate of the amount of leakage. By looking at this record, the doctor may see a pattern and suggest making it a point to use the bathroom at regular timed intervals, a habit called timed voiding. As you gain control, you can extend the time between scheduled trips to the bathroom. Behavioral treatment also includes Kegel exercises to strengthen the muscles that help hold in urine. This regular, daily exercising of pelvic muscles can improve and even prevent urinary incontinence and urgency. This is particularly helpful for younger women. Kegel exercises should be performed 30-80 times daily for at least 8 weeks.

Several types of medication are available for treating overactive bladder and are classified as antimuscarinic or anticholinergic drugs. Drugs used to treat overactive bladder affect the nerve and muscle function of the detrusor muscle causing it to relax, reducing the frequency and intensity of contractions of the bladder, preventing the unwanted leakage of urine. These drugs can also increase bladder capacity. They work by blocking the attachment of a neurotransmitter called acetylcholine to specific sites on the bladder muscle. The attachment of neurotransmitters to the receptors site, called cholinergic, sets in motion a sequence of changes that result in muscle contractions. Blocking this combination prevents the contraction. Drugs that relax muscles and prevent bladder spasms include Ditropan and Detrol. Ditropan XL and Detrol LA are long-acting drugs that can be taken once a day. These drugs have been shown to work in 6 to 7 out of 10 persons. Persons should see an improvement in symptoms in 3 to 4 weeks. Tofranil relaxes bladder muscles and tightens urethral muscles. It may be used instead of or in combination with Ditropan XL or Detrol LA.

Many patients suffer unnecessarily from overactive bladder and the associated decline in quality of live. Antimuscarinic agents used alone or in combination with behavioral therapy are effective in reducing urinary urgency, urinary urge incontinence, frequency and nocturia.

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