Overactive Bladder

Urinary Urgency and Frequency

The normal bladder stretches until it fills with enough urine to signal the nervous system that it is time to empty through urination. The muscle in the bladder wall contracts, pushing the urine out of the bladder. At the same time, the urinary sphincter muscle relaxes, allowing the urine to flow out of the bladder. If the bladder-wall muscle contracts too often, symptoms of overactive bladder can result.

Overactive bladder is a condition characterized by two urinary symptoms: urgency and frequency. Urgency means the sudden need to urinate; frequency is defined as having to urinate more than eight times in 24 hours. These symptoms can cause a number of problems for patients, including interrupted sleep, skin or urinary tract infections.

In many cases, the cause of overactive bladder cannot be determined. Some known causes of the condition are bladder inflammation or infection, bladder stones, and bladder cancer. In men, an enlarged prostate can cause overactive bladder.

There are several tests that can help identify the cause of overactive bladder symptoms. Medications used to relieve symptoms include those with anticholinergic and antispasmodic activity. Various exercises may be used to retrain the bladder muscles and the urinary sphincter so that they work together to relieve the symptoms. In overactive bladder patients with severe incontinence who cannot hold large amounts of urine, surgery to enlarge the bladder has been successful.

Diagnosis

Overactive blader is diagnosed by reviewing symptoms and performing a physical examination. Specific tests for determining bladder function include urinalysis, x-rays, ultrasound, and measurement of the amount of urine left in the bladder after urination. Other tests can determine how easily urine leaks from the bladder when the patient coughs or exercises. Cystoscopy provides a view of the inside of the bladder. Several of these tests may be performed in order to pinpoint the bladder problem and design a treatment plan

Treatments

Overactive bladder treatment depends upon the specific symptoms the patient is experiencing and the degree to which these symptoms affect activities of daily living. If an underlying cause (such as infection) is discovered, it will be treated first to determine whether bladder symptoms improve. Most often, overactive bladder does not have a discoverable cause.

Anticholinergic drugs (also known as muscarinic antagonists) are used to relax the bladder muscle and relieve abnormal contractions. These agents are available as long-acting oral medications or as patches applied to the skin and changed every 3 or 4 days. Common side effects include dry mouth, blurred vision, and constipation. Flavoxate, an antispasmodic drug approved to treat overactive bladder, works by relaxing spasms in the urinary tract. Certsain tricyclic antidepressants have been useful for overactive bladder because their effects are similar to those of anticholinergic drugs. Tricyclic antidepressants cause dry mouth, blurred vision, and dizziness, so they are best taken at bedtime.

One method of retraining the bladder to improve its function involves scheduling specific times to urinate while holding in the urine the rest of the time. Pelvic-floor exercises such as Kegels also help train the urinary sphincter muscle, which allows urine to flow normally. Greater control of the sphincter will help inhibit urine leakage.

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