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Overactive Bladder

You may have a condition called overactive bladder syndrome.

Overactive bladder syndrome is when you feel a sudden urge to urinate that is difficult to control.

Some of the symptoms that you might experience include:

  • Urgency

Sensation to pass urine that is difficult to control

  • Leaking of urine (Incontinence)

Involuntary leak of urine following an urgent need to pass urine

This usually happens when you can’t find a toilet in time

  • Frequency

Having the need to pass urine more than 8 times in 24hours

  • Waking up at night to pass urine (Nocturia)

Having to wake up from sleep to pass urine

Is this common?

Overactive bladder syndrome has a 30% overall incidence and it is more common among women. Fifty percent of males more than 70 years old and it is associated with prostate enlargement.

Why is this happening?

There have been more than 1 theory to explain the underlying cause to this condition.

Overactive bladder occurs when the muscles of the bladder start to contract involuntarily.

This involuntary contraction of the bladder results in the sensation of need to pass urine urgently. This can happen when the amount of urine in the bladder is low so you will notice only a small amount of urine is being passed out despite the urgency sensation.

Although most of the time the causes of overactive bladder is unknown (idiopathic), some underlying conditions can contribute to it. Neurological conditions such as post stroke, Parkinson’s disease, diabetes mellitus or abnormalities in the bladder such as bladder stones, urinary tract infections, enlarged prostates can contribute to overactive bladder symptoms.

Excessive consumption of caffeine containing fluids such as coffee, tea or alcohol can cause this as well.

Although aging is a risk factor of developing OAB, it shouldn’t be considered as normal part of aging.

What should I expect at my first visit to a Urologist?

Your Urologist will first take a history, perform physical examination and do a series of tests to rule out any organic causes to your urinary symptoms. These may include:

  • Internal examination for women
  • Midstream urine analysis
  • Urine Culture and Sensitivity analysis of the bacteria involved
  • Bedside ultrasound examination of the kidneys and bladder
  • Uroflowmetry and post void residual urine

Once the diagnosis has been established, the Urologist will do some specialised investigations such as filling up a bladder diary to determine the type and severity of the urinary incontinence before discussing treatment options with you.

Specialised test such as urodynamic studies is very important especially when conservative management has failed or when a surgical treatment is being offered.

What is Urodynamic study? Does it cause pain?

Urodynamic study is a test to assess the function of the bladder and urethra in an objective way. The Urologist will be able to assess the pressure changes in the detrusor muscle and the behaviour of the bladder when fluid (normal saline with/without contrast) is being infused into the bladder.

It is not painful. Small transducers are being inserted into the bladder and rectum in order to measure the pressures of the bladder and abdomen respectively. It may cause some discomfort but not pain.

What is a bladder diary?

Bladder diary is a tool used by the Urologist to better understand your urinary symptoms.

It is a simple form that requires you to track down how much fluid that you are taking, the frequency of you going to the toilet in the day and night, the volume of urine that you pass each time and the frequency of urinary leaks.

Your Urologist will understand your daily habits and urinary symptoms better with the diary and customized your treatment regime.

It is best done over 3 consecutive days for accuracy.

Example of a bladder diary:

 

What are the treatment options?

Lifestyle modifications and bladder training

If the symptoms are not severe, the Urologist will usually recommend this as the initial treatment.

The treatment is individualized according to your voiding diary. This includes bladder training and toileting habits, dietary changes such as cutting down fluids at certain time of the day, reducing intake of caffeinated drinks such as coffee and tea, pelvic floor muscle training (PFMT), and biofeedback.

Bladder training have been shown to be effective in controlling urgency. Techniques such as delaying urination and deep breathing exercises when you feel urgent and slowly increasing the interval will help you to better control the bladder.

Medications

The main medical treatment given would be a class of medication called anticholinergics (Oxybutynin, Tolterodine, Solifenacin). These medication blocks the nerve fibers that are responsible for involuntary contractions of the muscles of the bladder.

Newer mediation such as Mirabegron to induce the relaxation of the bladder is an option as well.

However, these medications may cause side effects due to blockage of the receptors in other parts of the nervous system. The most commonly seen adverse effects include dry mouth, dry eyes and constipation.

Nerve stimulation

This is similar to the concept of acupuncture. A tiny needle is inserted on the surface of your skin around the ankle. This is coupled with electrical stimulation to send signals through the posterior tibial nerve. This helps to rehabilitate the bladder. The initial treatment starts with a once weekly session lasting for 3 months.

It is an outpatient procedure. The needle only cause mild discomfort at the insertion site, it should not cause pain.

Surgical

Intravesical injection of Botulinum toxin

For patients who have failed conservative treatment, Botulinum toxin or Botox® can be injected into the bladder wall through a cystoscope.

The botulinum toxins inhibit release of acetylcholine which is a type of neurotransmitter from the muscle. This relaxes the bladder and prevents involuntary contractions of the bladder.

As the botulinum toxins get degraded, this procedure requires repeated injections every 6 to 12 months.

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