What is it?
It is a problem with the function of bladder storage , which causes a sudden urge to urinate. The urge is difficult to stop, and overactive bladder can lead to involuntary loss of urine (incontinence).
The treatment of overactive bladder often begins with behavioral strategies, such as fluid schedules, timed voiding, and bladder retention techniques using the pelvic floor.
- Urgent and sudden urination sensation, difficult to control.
- Involuntary loss of urine.
- Urinate frequently, usually eight or more times in 24 hours.
- Wake up two or more times at night to urinate (nocturia)
Causes of overactive bladder
The normal function of the bladder
The kidneys produce urine, which drains into the bladder. When urinating, the urine passes from the bladder through an opening in the lower part and flows through a tube called the urethra. In women, the urethral opening is just above the vagina. In men, it is at the tip of the penis.
As the bladder fills, the nerve signals sent to the brain eventually trigger the urge to urinate. When urinating, nerve signals normalize the relaxation of the muscles of the pelvic floor and the urethra (urinary sphincter muscles). The muscles of the bladder contract, pushing urine.
Involuntary contractions of the bladder
Overactive bladder is due to the fact that the muscles of the bladder begin to contract involuntarily even when the volume of urine in the bladder is low. This involuntary contraction creates the urgent need to urinate.
Several conditions may favor the symptoms of overactive bladder:
- Neurological disorders such as: cerebrovascular accidents and Parkinson’s multiple sclerosis.
- Kidney failure or diabetes
- Acute urinary tract infections that can cause symptoms similar to an overactive bladder
- Abnormalities in the bladder, such as tumors or bladder stones
- Obstruction of the flow of the bladder, caused by: enlargement of the prostate, constipation or operations.
- Excessive consumption of caffeine or alcohol
- Decreased cognitive function due to aging.
- Dificulty to walk.
- Incomplete emptying of bladder.
- Medical history.
- Physical examination in the abdomen and genitals.
- Urine sample to check for infection, blood traces or other abnormalities.
- Neurological exam to identify sensory problems or abnormal reflexes.
The doctor may order a simple urodynamic test to evaluate the function of the bladder and its ability to empty constantly and completely. These tests usually require a referral to a specialist.
The tests include:
Measurement of urine left in the bladder . This test is important if the bladder does not empty completely when urinating or if urinary incontinence is experienced. The remaining urine (residual urine after evacuation) can cause symptoms identical to an overactive bladder. To measure residual urine after urinating, the doctor may perform an ultrasound of the bladder or pass a thin tube (catheter) from the urethra to the bladder to drain the urine and measure the rest.
Measure the flow rate of urine . To measure the volume and velocity of the emptying of the bladder, a urine sample is needed in a uroflowmeter. This device transcribes the data in a graph, about the changes in the flow velocity.
Test of bladder pressures . Cystometry measures the pressure in the bladder and in the surrounding area during bladder filling. During this test, the doctor uses a thin tube (catheter) to gradually fill the bladder with warm water. Another catheter with a pressure measurement sensor is placed in the rectum or, if female, in the vagina.
This procedure can identify if you have involuntary muscle contractions or a rigid bladder that is not able to store urine at low pressure.
Overactive bladder treatment
They are the first option to help manage overactive bladder. They are often effective, and have no side effects. Behavioral interventions may include:
Exercises of the pelvic floor muscles . Some exercises, such as Kegel’s, strengthen the muscles of the pelvic floor and the urinary sphincter. These strengthened muscles can help stop having involuntary contractions of the bladder. It may take up to six to eight weeks before an improvement is noticed.
Healthy weight . Losing weight can relieve symptoms.
Double urination . To help empty your bladder more completely, wait a few minutes after urinating, and then try again to empty your bladder completely.
Scheduled trips to the toilet or bathroom . The establishment of a calendar to go to the bathroom – for example, every two to four hours – leads to urinating every day, at the same time, in a certain place.
Intermittent catheterization . Using a catheter periodically to completely empty the bladder helps the bladder do what it can not do on its own.
Absorbent pads . The use of absorbent patches can protect clothing and help avoid embarrassing incidents, so you will not have to limit the normal performance of activities. Absorbent garments come in a variety of sizes and absorbency levels.
Bladder training . It consists of training to delay urination when you feel like urinating. It starts with small delays, for example, 30 minutes, and gradually forms the habit of urinating every three or four hours. Bladder training is possible only if you contract the pelvic floor muscles.
Medications may be useful to relieve symptoms of overactive bladder and reduce episodes of incontinence:
Among them we have the following and that the doctor can prescribe:
- Tolterodina (Detrol)
- (Ditropan XL)
- Oxybutynin as a skin patch (Oxytrol)
- Oxibutinina gel (Gelnique)
- Trospio (Sanctura)
- Solifenacin (Vesicare)
- Darifenacina (Enablex)
- Mirabegron (Myrbetriq)
- Fesoterodina (Toviaz)
The most common side effects are : dry eyes and dry mouth, but drinking water to quench thirst can aggravate the symptoms of overactive bladder. Constipation – another potential side effect – can aggravate bladder symptoms. Drugs such as the skin patch or gel may cause fewer side effects.
The treatment of the side effects of a medication that is having an effect is more important than the suspension of the medication. For example, the doctor may recommend consuming a sugar-free candy or chewing gum without sugar to relieve dry mouth, as well as, use eye drops and keep eyes moist.
Stimulation of the nerve
The regulation of nerve impulses can improve the symptoms of overactive bladder. The procedure uses a thin thread that is placed near the sacral nerves (which carry signals to the bladder) where they pass near the tailbone.
This surgical procedure is often done with a trial of a temporary wire or as an advanced procedure in which the permanent electrode is implanted and a longer test is performed before the surgical placement of the pulse generator with batteries. Then, the doctor uses a device connected to the wire to create electrical impulses in the bladder, similar to what a pacemaker does for the heart.
Surgery to treat overactive bladder is reserved for people with severe symptoms who do not respond to other treatments. The objective is to optimize the storage capacity and reduce the pressure in the bladder. However, these procedures do not help relieve bladder pain. The interventions include:
Surgery to increase the capacity of the bladder . Uses parts of the patient’s bowel to replace a portion of his bladder. This surgery is used only in cases of severe urgency incontinence that does not respond to any other treatment. If this type of surgery is performed, it may be necessary to use a catheter intermittently to empty the bladder.
The elimination of the bladder . This procedure is used as a last resort and involves removing the bladder and surgically constructing a replacement or opening in the body, called a stoma, to attach a bag to the skin to collect urine.
In short, the bladder has the capacity to maintain up to 500 ml of urine, and usually it is when you reach approximately half to feel the sensation of urinating.
The bladder sends a signal to the brain that in an approximate time, it is necessary to empty the bladder, in this way the human being becomes alert, and when it finds a suitable place the bladder tells the brain that it can already urinate.
However, when you have an overactive bladder, it does not work this way. It is a pathology that continuously gives the feeling that the bladder is full so you must go to the bathroom many times, causing incontinence, dribbling and embarrassment for people who suffer from it.