Overactive Bladder

Definition

Overactive bladder is the leakage of large amounts of urine at unexpected times, including during sleep.

Description

People who lose urine for no apparent reason while suddenly feeling the need or urge to urinate may have overactive bladder. The condition effects 17 million Americans. The most common cause of overactive bladder is inappropriate bladder contractions. Medical professionals describe such a bladder as "unstable," "spastic," or "overactive." A doctor might call the condition "reflex incontinence" if it results from overactive nerves controlling the bladder. Having an overactive bladder can mean that the bladder empties during sleep, after drinking a small amount of water, or when touching water or hearing it running (as when someone else is taking a shower or washing dishes). Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to muscles themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke, brain tumors, and injury—including injury that occurs during surgery—all can harm bladder nerves or muscles.

Causes and symptoms

People with overactive bladder lose urine as soon as they feel a strong need to go to the bathroom. People with overactive bladder may leak urine:

• When they can not get to the bathroom quickly enough
• When they drink even a small amount of liquid, or when they hear or touch running water

People with overactive bladder may also go to the bathroom very often; for example, every two hours during the day and night. They may even wet the bed.

Diagnosis

To diagnose the problem, a doctor will first ask about symptoms and medical history. Other obvious factors that can help define the problem include straining and discomfort, use of drugs, recent surgery, and illness. If the patient's medical history does not define the problem, it will at least suggest which tests are needed. The doctor will physically examine the patient for signs of medical conditions causing the overactive bladder, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause. Overactive bladder is often treated by general or family practicioners but the patient may be referred to a urologist, who specializes in the urinary tract, or a urogynecologist, who focuses on urological problems in women.

Common tests used to diagnose overactive bladder include:

• Blood tests to examine blood for levels of various chemicals
• Cystoscopy to look for abnormalities in the bladder and lower urinary tract. It works by inserting a small tube into the bladder that has a telescope for the doctor to look through
• Post-void residual (PVR) measurement to see how much urine is left in the bladder after urinating by placing a small soft tube into the bladder or by using ultrasound (sound waves)
• Urinalysis to examine urine for signs of infection, blood, or other abnormalities
• Urodynamic testing to examine bladder and urethral sphincter function (may involve inserting a small tube into the bladder; x rays also can be used to see the bladder)

Treatment

Medications can reduce many types of leakage. Some drugs inhibit contractions of an overactive bladder. Others, such as solifenacin succinate (Vesicare), relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing leakage. Among the drugs used are oxybutynin (Ditropan XL), 5-30 mg daily; solifenacin (Vesicare), 5-10 mg a day; darifenacin (Enablex), 3.75-15 mg daily; and tolterodine (Detrol), 2-4 mg daily. A one-month supply of these drugs costs $90-125. Some medications, especially hormones such as estrogen, are believed to cause muscles involved in urination to function normally. Some of these medications can produce harmful side effects if used for long periods. In particular, estrogen therapy has been associated with an increased risk for cancers of the breast and the lining of the uterus. Patients should talk to their doctor about the risks and benefits of long-term use of medications.

Alternative treatment

Adjusting dietary habits and avoiding acidic and spicy foods, alcohol, caffeine, and other bladder irritants can help to prevent urinary leaking. Eat recommended amounts of whole grains, fruits, and vegetables to avoid constipation. Bladder training, used to treat urge incontinence, can also be a useful treatment tool. The technique involves placing a patient on a toileting schedule. The time interval between urination is then gradually increased until an acceptable time period between bathroom breaks is consistently achieved.

Biofeedback techniques can teach overactive bladder patients to control the urge to urinate. Biofeedback uses sensors to monitor temperature and muscle contractions in the vagina to help overactive bladder patients learn to increase their control over the pelvic muscles.

An infusion, or tea, of horsetail (Equisetum arvense), agrimony (Agrimonia eupatoria), and sweet sumach (Rhus aromatica) may be prescribed by an herbalist or naturopath to an overactive bladder. These herbs are natural astringents, and encourage toning of the digestive and urinary tracts. Other herbs, such as urtica, or stinging nettle (Urtica urens), plantain (Plantago major), ormaize (Zea mays) may be helpful. Homeopathic remedies may include pulsatilla and causticum. Chinese herbalists might recommend golden lock tea, a mixture of several herbs that helps the body retain fluids.

Prognosis

With proper treatment, the prognosis for controlling the disorder is very good. There is no cure for overactive bladder.

Prevention

There are no known preventative measures for overactive bladder.

Resources

BOOKS

Ellsworth, Pamela. 100 Q & A About Overactive Bladder and Urinary Incontinence. Boston: Jones and Bartlett Publishers, 2005.

Newman, Diane K., and Alan J. Wein. Overcoming Overactive Bladder: Your Complete Self-Care Guide. Oakland, CA: New Harbinger Publications, 2004.

PERIODICALS

Perry, Patrick. "On Tour With Debbie Reynolds: The Feisty and Fit Actress Speaks Out About an All-Too-Common Problem—Overactive Bladder." Saturday Evening Post (January-February 2003): 26-27.

Radley, Stephen, and Maggi Saunders. "Sex and the Overactive Bladder: Stephen Radley and Maggi Saunders Discuss the Treatment of Patients With an Overactive Bladder in Primary Care." Primary Health Care (October 2004): 13-14.

Weiss, Barry D. "Selecting Medications for the Treatment of Urinary Incontinence." American Family Physician (January 15, 2005): 315.

Zepf, Bill. "Diagnosis and Management of Overactive Bladder." American Family Physician (October 1, 2004): 1386.

ORGANIZATIONS

National Bladder Foundation. P.O. Box 1095, Ridgefield, CT 06877. (877) 252-3337. [email protected]. http://www.bladder.org.

KEY TERMS

Alzheimer's disease— A degenerative disorder that affects the brain and causes dementia, especially late in life.

Biofeedback— The use of monitoring devices that display information about the operation of a bodily function, for example, heart rate or blood pressure, that is not normally consciously controlled.

Cystoscopy— The use of a narrow tubular instrument that is passed through the urethra to examine the interior of the urethra and the urinary bladder.

Estrogen— Any of several steroid hormones, produced mainly in the ovaries, that stimulate estrus and the development of female secondary sexual characteristics.

Multiple sclerosis— A serious progressive disease of the central nervous system.

Parkinson's disease— An incurable nervous disorder marked by the symptoms of trembling hands, lifeless face, monotone voice, and a slow, shuffling walk.

Sphincter— A circular band of muscle that surrounds an opening or passage in the body and narrows or closes the opening by contracting.

Urethal— Referring to the tube in humans that carries urine from the bladder out of the body.

Urogynecologist— A physician that deals with women's health, especially with the health of women's reproductive organs and urinary tract.

Urologist— A physician who deals with the study and treatment of disorders of the urinary tract in women and the urogenital system in men.