Overactive Bladder
Although this condition can result from a variety of different medical issues, overactive bladders (OAB) can really put a damper on one’s social life and daily routine. After age 60, the odds of developing an overactive bladder is 20 to 30 percent.
Essentially, this refers to a condition where individuals have frequent sudden urges to urinate and/or experience the constant leakage of urine.
40 percent of people experience wet OAB, meaning there is leakage accompanied with a frequent urge to urinate. The remaining percentage (60%) of people only have the urge to urinate frequently, but no leakage.
An overactive bladder can be expressed in several, yet very different symptoms. One of the most common forms of incontinence is a result of stress, or pressure being applied during actions like coughing, laughing, sneezing or lifting something heavy.
Others may have what’s known as urge incontinence, where sudden urges to urinate seem to occur without warning. Many find this very disruptive to their sleeping schedules as the sensations persist throughout the night.
Overflow incontinence is a third form, whereby individuals experience a frequent or nearly constant draining of urine as a result of a bladder that cannot empty completely.
Any of these forms of incontinence can occur simultaneously and to varying severities. Unfortunately, this condition can also make it difficult to lead a regular schedule, instead, forcing you to plan around trips to the bathroom - and that’s less than ideal for most people.
Given that there are several types of overactive bladders, the causes are not always obvious. In general, old age can cause urinary incontinence as bladder muscles weaken naturally. Even constipation can cause an overactive bladder since the nerves controlling the rectum are shared with the urinary tract.
It could also be as simple as recognizing foods or beverages in your diet that may be affecting your ability to retain urine. Alcohol, caffeine, carbonated drinks, and even spicy foods or certain medications are known to act as diuretics, so this is a good place to start.
However, an overactive bladder may also be caused by other more serious underlying health conditions.
Common, more severe causes include urinary tract infections, an enlarged prostate in men, diabetic neuropathy, or obstructions like urinary stones or masses of tissue.
Women are much more likely to experience stress incontinence, especially after menopause and due to normal aspects of the female anatomy.
Neurological disorders such as multiple sclerosis, Parkinson’s disease, a stroke, or spinal and brain injuries can also cause an overactive bladder. Prostate cancer and its treatments may also result in urinary incontinence.
Like the start of most medical diagnoses, doctors will ask you about your medical history, current habits and lifestyle, as well as any medications you’re currently taking. It’s best to come prepared with a list of this information and to answer openly and honestly.
Doctors will likely start with a urinalysis to check for signs of infection, traces of blood, and other abnormalities. This is usually accompanied by a post-void residual measurement during which you’ll be asked to urinate completely so the remaining urine can be measured.
Advanced testing will include urodynamic testing to understand your bladder strength and sphincter health. Depending on the severity of your incontinence, ultrasounds and other imaging techniques like a cystogram (bladder x-ray) may be used to detect physical abnormalities.
There are many ways to treat an overactive bladder, each of which relates to the type of incontinence a diagnosis reveals.
If it’s a matter of weak bladder muscles, training your bladder to hold urine for longer periods of time can be achieved by delaying your trip to the bathroom in increasing intervals of 10 minutes. The idea is that eventually, you’ll work all the way to a healthy 2-4 hours. Doctors may also recommend Kegel exercises which involve the repetitive contraction of one’s pelvic floor muscles.
Electrical stimulation is another option whereby electrodes are temporarily situated inside your rectum or vagina to emulate neural impulses normally used to control the bladder. More advanced versions of this involve devices implanted to stimulate one’s sacral nerve directly.
Medications for incontinence can include:
Anticholinergics - Used to sedate overactive bladders and diminish the urge to urinate.
Mirabegron - Treats incontinence by relaxing the bladder muscles release urine at the appropriate times and volume.
Alpha Blockers - Commonly used by men to reduce urge or overflow incontinence symptoms by relaxing the bladder neck muscles and those surrounding the prostate.
Topical Estrogen - Can rejuvenate tissues in the urethra / vagina and reduce some symptoms of incontinence.
Botulinum Toxin Type A (Botox) - Usually prescribed as a later option in dealing with bladder incontinence and works to properly stiffen the appropriate muscle groups.
For the most advanced cases, surgery may be required to mechanically support or keep closed the urethra along with the bladder neck. Women may benefit from prolapse surgery which incorporates one’s own tissues and synthetic meshes.
This condition shouldn’t get in the way of life. Whether it’s a minor nuisance or a serious health condition, an overactive bladder is nothing to put off treating. It’s increasing common in the elderly population, so don’t be embarrassed to talk to your doctor about what steps are right for you.