What is it?
It is a problem with the function of bladder storage, which causes a sudden urge to urinate. The notion is difficult to stop, and an overactive bladder can lead to involuntary loss of urine (incontinence).
The treatment of an 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 powers of the bladder contract, pushing urine.
Involuntary contractions of the bladder
An overactive bladder is because 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 can cause symptoms similar to an overactive bladder
- Abnormalities in the bladder, such as tumors or bladder stones
- Obstruction of the bladder flow caused by: enlargement of the prostate, constipation, or operations.
- Excessive consumption of caffeine or alcohol
- Decreased cognitive function due to aging.
- Difficulty in walking.
- Incomplete emptying of the bladder.
- Medical history.
- Physical examination of 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 bladder’s function and ability to empty wholly and constantly. These tests usually require a referral to a specialist.
The tests include:
Measurement of urine left in the bladder. This test is essential if the bladder does not empty when urinating or if urinary incontinence is experienced. The remaining (residual urine after evacuation) can cause symptoms identical to an overactive bladder. To measure residual urine after urinating, the doctor may perform an ultrasound 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. A urine sample is needed in a uroflowmeter to measure the volume and velocity of the bladder emptying. 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 the surrounding area during bladder filling. The doctor gradually uses a thin tube (catheter) to fill the bladder with warm water during this test. 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 cannot store urine at low pressure.
Overactive bladder treatment
They are the first option to help manage an overactive bladder. They are often practical and have no side effects. Behavioral interventions may include:
Exercises of the pelvic floor muscles. Some activities, such as Kegel’s, strengthen the powers of the pelvic floor and the urinary sphincter. These strengthened muscles can help stop having involuntary contractions of the bladder. It may take 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 try again to empty your bladder.
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 particular place.
Intermittent catheterization. Using a catheter periodically to 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 average 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 slight 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 helpful to relieve symptoms of overactive bladder and reduce episodes of incontinence:
Among them, we have the following that the doctor can prescribe:
- Tolterodine (Detrol)
- (Ditropan XL)
- Oxybutynin as a skin patch (Oxytrol)
- Oxibutinina gel (Gelnique)
- Trospio (Sanctura)
- Solifenacin (Vesicare)
- Darifenacin (Enablex)
- Mirabegron (Myrbetriq)
- Fesoterodine (Toviaz)
The most common side effects are dry eyes and dry mouth, but drinking water to quench thirst can aggravate the symptoms of an 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 has an impact is more important than the suspension of the drug. For example, the doctor may recommend consuming a sugar-free candy or chewing gum without sugar to relieve dry mouth and use eye drops and keep eyes moist.
Stimulation of the nerve
The regulation of nerve impulses can improve the symptoms of an overactive bladder. The procedure uses a thin thread 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. A more extended 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 do 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. It 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 can maintain up to 500 ml of urine, and usually, it is when you reach approximately half that 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.