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Overactive bladder is a common problem that can cause you to have a sudden urgent desire to pass urine during the day and at night, and can sometimes cause you to leak some urine before you reach the toilet.
Urgency and urge incontinence: Sudden and intense sensation to pass urine which cannot be put up with and may cause leaking
Frequency: Going to toilet more than 7 times
Nocturia: going to toilet more than once at night
Coital incontinence at the time of orgasm
How does a normal bladder work?
The bladder is like a balloon. Normally, the bladder muscle is relaxed while the bladder gradually fills up. Urine is kept inside the bladder by a valve-like mechanism. The valve stays close until you feel the need to empty and you have reached a toilet. The valve mechanism is assisted by the pelvic floor muscles below the bladder which contract when you cough or sneeze as your bladder fills up, you start to be aware that you need to pass urine but are able to hold on. Once you have decided to empty your bladder your brain signals the muscles of the bladder to squeeze and empty out the urine. At the same time the valve and pelvic floor muscle relaxes to allow the ease of urine flow. The bladder usually needs to be emptied out less than 7 times a day and once at night.
Causes of overactive bladder
Urinary tract infection
Conditions affecting the nervous system such as MS
Previous operation for stress incontinence causing obstruction
The amount and type of caffeinated drinks and fizzy drinks
Idiopathic causes ( unknown causes)
Investigation for overactive bladder
Urinalysis to exclude urinary tract infection
Measuring residual urine via ultrasound machine or small catheter
Urodynamics : assessing the activity of the bladder muscle as it is filled with fluid
What are the treatments for over active bladder?
Changing general life style:
Reducing Caffeine intake, alcohol, fruit juices and fizzy drinks
Aim to drink 1.5 to 2 litter of water.
Switch to herbal tea and decaffeinated drinks
Bladder retraining and physiotherapy:
It aims to help you to strengthen your pelvic floor muscle to hold more urine by going to the toilet less. It involves gradually increasing the time between visits to the toilet. Start by trying to delay going to the toilet by 15 minutes until you reach 2 to 3 hours between the voids.
These are anticholinergic drugs such as Ditropan, Vesicare, Detrol LA, or oxytrol which can cause side effects such as: dry mouth, dry eyes and constipation.
A new class of drug, Myrbetriq may have fewer side effects.
Botox injection into the bladder muscle wall. This treatment decreases the abnormal contractions of the bladder. However, it may also reduce the normal contractions so that your bladder is not able to empty fully. It can also cause overflow leakage as a side effect. Generally only offered by urologists.
Sacral nerve stimulation
This involves directly stimulating the nerves that controls your bladder function.
Dr. Jose L. Goncalves
Obstetrics and Gynecology, Pelvic and Reconstructive Surgery