Overactive bladder syndrome

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at August 28, 2016
StartDiseasesOveractive bladder syndrome

Overactive bladder syndrome (OBS) or simply overactive bladder is a condition in which a person feels the need to urinate much more often than is normal. It can also be characterized by a sudden urge to urinate which cannot be controlled. This can lead to the inability to control urination, which is known as urinary incontinence.

Contents

Definition & Facts

According to experts, more than 33 million Americans suffer from an overactive bladder. This amounts to about 30% of men and 40% of women. The number of those experiencing overactive bladder, however, may actually be much higher. Many cases may go undiagnosed because the patient is ashamed or embarrassed to admit they are experiencing incontinence issues or they simply may not realize they are suffering from a medical condition for which help is available.

Symptoms & Complaints

The primary symptom of overactive bladder syndrome is frequent urination. While an average adult urinates four to seven times in a 24-hour period, people suffering from OBS have reported going as often as once per hour, as well as waking up two to three times per night to visit the bathroom (nocturia).

There is also a strong, sudden urge to urinate. Individuals find it difficult to hold their urine and this leads to frequent bouts of incontinence. Unlike other urinary tract disorders, there is no physical pain associated with OBS.

It can, however, be extremely challenging emotionally. Bouts of incontinence can become embarrassing and the need for constant access to bathroom facilities can cause people to limit activities such as travel.

Causes

In the urinary system, the kidneys produce urine which then drains into the urinary bladder. As the bladder fills, nerve signals are sent to the brain which let the body know the bladder is getting full.

People with a normally functioning urinary tract system can put off urinating for some time. When they are ready to urinate, the brain sends a signal to the bladder muscles which contract to force the urine out of the bladder through the urethra, the tube that carries urine from the body.

In people with overactive bladder syndrome, the muscles of the bladder begin to contract involuntarily. This can occur even if there is only a small amount of urine in the bladder.

OBS can be caused by misfiring of the nerves between the brain and the bladder which causes the brain to signal the bladder to empty even when it isn’t full. It can also be due to bladder muscles being overactive. In many cases, the specific cause of overactive bladder syndrome isn’t known in which it is said to be idiopathic.

Overactive bladder syndrome may be caused by certain medications, high urine production associated with poor kidney function or diabetes mellitus, and neurological disorders such as Parkinson’s disease and multiple sclerosis. There is a higher risk for OBS in postmenopausal women as well as men who have had prostate problems.

Diagnosis & Tests

Diagnosis of overactive bladder syndrome will begin with a complete medical history and physical examination. The exam will focus on the abdomen, pelvis, and genitals. In men, this exam will also include checking the prostate because an enlarged prostate (benign prostatic hyperplasia) often produces many of the same symptoms as OBS and must be ruled out.

The doctor may ask the patient to keep a bladder diary to document how often he or she urinates in a 24-hour period as well as any bouts of incontinence. Clinical urine tests will be ordered in which a urine sample will be collected and checked for infection and the presence of blood in the urine (hematuria).

The doctor will then likely refer the patient to a specialist. There are several types of diagnostic testing the specialist may perform. Urodynamic testing may be used to see how the lower urinary tract stores and releases urine. The doctor may also choose to insert a small tube called a catheter through the urethra and into the bladder in order to drain and measure the remaining urine.

In a test called a cystoscopy, the doctor will insert a thin tube into the bladder. A lens on the end allows the doctor to examine the urethra and the lining of the bladder. This test is a type of endoscopy.

Treatment & Therapy

There are several medications available which help to relax the bladder and relieve symptoms of OBS. The doctor may also recommend the patient make some behavior modifications such as losing weight, limiting fluid consumption, and practicing exercises (such as Kegel exercises) to strengthen the muscles of the pelvic floor. Some doctors will suggest bladder training or scheduled urination as a means of regulating the number of times per day a patient uses the bathroom.

For more serious cases, there are more invasive methods of treatment available. An injection of Botox directly into the bladder tissues will partially paralyze the muscles, however, it has only been approved for use in patients with neurological diseases.

Sacral nerve stimulation can help to regulate the nerve signals to the bladder. If no other method of treatment works, surgery may be considered. A procedure exists which allows doctors to use a piece of the patient’s bowels to replace portions of the bladder.

As a last resort, the bladder may be removed completely (cystectomy). In this case, either a new bladder would be fashioned from portions of the patient’s gastrointestinal tract or a bag to collect the urine would be attached to the patient using a stoma, or opening, in the abdominal wall.

Prevention & Prophylaxis

There has not been much study on the prevention of overactive bladder syndrome; however, doctors do recommend some basic lifestyle choices that may reduce the risk. These include maintaining a healthy weight, getting regular exercise, quitting smoking, and limiting intake of caffeine and alcohol.

Keeping the pelvic muscles strengthened is also helpful. This can be accomplished by practicing Kegel exercises daily. To do these, one should first empty the bladder of urine, contract the bladder muscles and hold for ten seconds, then release. Doctors suggest working up to performing ninety Kegel contractions per day.

For older men, regular prostate cancer screenings are vital. Any enlargement of the prostate should be monitored and its symptoms addressed.