Overactive Bladder

WHAT YOU SHOULD KNOW

Causes

The bladder is emptied by a large muscle called the detrusor. Prompted by a signal from the spinal cord, the detrusor ordinarily contracts and squeezes urine out of the bladder only when the bladder is full. In people with overactive bladder, however, the detrusor gets out of control, forcing urine out of the bladder even when the time and place aren't appropriate. These unwanted contractions are often the fault of a disorder in the nervous system, such as spinal cord injury, a brain or spinal cord tumor, a ruptured vertebral disk, stroke, diabetes, multiple sclerosis, or dementia. In some cases, no cause can be found.

Signs/Symptoms

The hallmark of an overactive bladder is urgency---a sudden, strong need to urinate. Most sufferers find they also need to urinate frequently---more than eight times in a 24-hour period, and often two or more times during the night. In 4 out of 5 cases, these symptoms result in episodes of incontinence.

The same pattern of symptoms can result from an enlarged prostate, which is not a bladder problem and needs a completely different form of treatment. For this reason, a medical diagnosis is a crucial first step towards a cure.

Care

Your medical history, a physical exam, and the results of urinalysis and blood tests are often enough to establish a diagnosis. If more information is needed, the doctor may conduct a series of specialized tests to measure bladder activity and the strength of associated muscles.

Treatment for an overactive bladder typically starts with medications that reduce the frequency and intensity of bladder contractions. Among these drugs are Bentyl, Detrol, Ditropan, Levsin, Tofranil, and Urispas.

Your doctor may also suggest a program called bladder retraining. Often used in conjunction with drug therapy, this program is designed to teach you how to inhibit feelings of urgency, postpone urination, and urinate according to a timetable instead of responding to an urgent need. As you adjust to your timetable, you'll be instructed to gradually increase the interval between bathroom visits in 15-minute steps until you're urinating every 2 to 4 hours.

It's also helpful to strengthen the muscles that control the outlet from the bladder. In a training program called Kegel exercises, you're required to squeeze and relax the muscles for a set number of repetitions each day. Alternatively, you can try treatments that involve electrical stimulation of the muscles with a low-voltage device. This form of treatment takes about 20 minutes every 1 to 4 days.

If all else fails, surgery is sometimes recommended to divert the urine to an external opening or to enlarge the bladder with a segment of the intestine. This type of treatment is usually reserved for cases of spinal damage or urinary blockage.

WHAT YOU SHOULD DO

• Eliminate or decrease foods or beverages that may worsen overactive bladder symptoms. These products include tea, coffee, alcohol, chocolate, caffeinated soft drinks, tomato-based products, spicy and acidic foods and drinks, and artificial sweeteners.
• Take your medicine exactly as prescribed. If you feel it is not helping or you begin experiencing side effects such as dry mouth, dry eyes, headache, constipation, or indigestion, call your doctor, but do not quit taking the medicine on your own. Often the doctor can reduce the side effects with a change in dosage, or treat the side effects sufficiently to allow you to continue.
• Ask your doctor about any over-the-counter medications you are taking. Some nonprescription drugs, such as pain relievers, antihistamines, and cold remedies, can make bladder problems worse.
• Maintain bowel regularity. Constipation places added pressure on your bladder and can worsen your symptoms. Eat plenty of fiber-rich foods, including beans, pasta, oatmeal, bran cereal, whole wheat bread, and fresh fruits and vegetables. Regular exercise also helps to maintain bowel regularity.
• Maintain a healthy weight. Too many pounds can put added pressure on your bladder, causing leakage when you laugh or cough. If you are having trouble losing weight, talk with your doctor or a nutritionist about devising a weight-loss program.
• Work closely with your doctor on your bladder retraining. Stick with your schedule and be patient. It can take between 6 to 8 weeks to see results from bladder retraining.

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