Overactive Bladder

What Is An Overactive Bladder?

An OVERACTIVE BLADDER is a problem with bladder-storage function that causes a sudden urge to urinate. The urge may be difficult to stop, and overactive bladder may lead to the involuntary loss of urine (incontinence).

If you have an overactive bladder, you may feel embarrassed, isolate yourself, or limit your work and social life. The good news is that a brief evaluation can determine whether there is a specific cause for your overactive bladder symptoms.

Management of overactive bladder often begins with behavioral strategies, such as fluid schedules, timed voiding and bladder-holding techniques using your pelvic floor. If these initial efforts do not help enough with your overactive bladder symptoms, second line and third line treatments are available.

With an overactive bladder, you may:

• Feel a sudden urge to urinate that's difficult to control
• Experience urge incontinence — the involuntary loss of urine immediately following an urgent need to urinate
• Urinate frequently, usually eight or more times in 24 hours
• Awaken two or more times in the night to urinate (nocturia)

Although you may be able to get to the toilet in time when you sense an urge to urinate, unexpected frequent urination and nighttime urination can disrupt your life.

Overactive bladder occurs because the muscles of the bladder start to contract involuntarily even when the volume of urine in your bladder is low. This involuntary contraction creates the urgent need to urinate.

Several conditions may contribute to signs and symptoms of overactive bladder, including:

• Neurological disorders, such as Parkinson's disease, strokes and multiple sclerosis
• High urine production as might occur with high fluid intake, poor kidney function or diabetes
• Medications that cause a rapid increase in urine production or require that you take them with lots of fluids
• Acute urinary tract infections that can cause symptoms similar to an overactive bladder
• Abnormalities in the bladder, such as tumors or bladder stones
• Factors that obstruct bladder outflow — enlarged prostate, constipation or previous operations to treat other forms of incontinence
• Excess consumption of caffeine or alcohol
• Declining cognitive function due to aging, which may make it more difficult for your bladder to understand the signals it receives from your brain
• Difficulty walking, which can lead to bladder urgency if you're unable to get to the bathroom quickly
• Incomplete bladder emptying, which may lead to symptoms of overactive bladder, as you have little urine storage space left
• Constipation

THE PROCEDURE

Surgery to treat Overactive Bladder is reserved for people with severe symptoms who do not respond to other treatments. The goal is to improve the bladder's storing ability and reduce pressure in the bladder. However, these procedures will not help relieve bladder pain.  Interventions include:

• SURGERY TO INCREASE BLADDER CAPACITY

This procedure uses pieces of your bowel to replace a portion of your bladder. This reconstructive surgery is used only in cases of severe urge incontinence that doesn't respond to any other, more conservative treatment measures. If you have this surgery, you may need to use a catheter intermittently for the rest of your life to empty your bladder.

• BLADDER REMOVAL

This procedure is used as a last resort and involves removing the bladder and surgically constructing a replacement or an opening in the body (stoma) to attach a bag on the skin to collect urine.