Overactive Bladder- Causes,Diagnosis and Treatment
Overactive bladder refers to a set of symptoms which include urgency, frequency, and the feeling of incomplete voiding. Incontinence can occur in the form of urge incontinence.
Patients with urge incontinence have a severe sensation to void and usually are not able to make it to a bathroom.
Bladder instability is another term which is used to describe an overactive bladder.
Causes of Overactive Bladder
1. Idiopathic ( cause unknown )
Most causes of overactive bladder are considered to be of no known cause.
It is important that your physician rule out any of the following causes of overactive bladder which are treatable.
2. Age – Related
Increasing age can cause bladder instability.
Atrophic vaginitis, which occurs at menopause is a very common cause of bladder instability in post-menopausal women.
3. Infectious causes
Bladder infections are very common causes of overactive bladder.
Diseases of the brain, spinal cord and nerves suppling the bladder can cause what is called a neurogenic bladder.
Distinguishing overactive bladder from neurogenic bladder can be difficult.
5. Foreign bodies
Stones within the bladder can cause bladder instability.
They are usually diagnosed by a pelvic ultrasound or by cystoscopy.
6. Bladder cancer
Bladder cancer can present as an overactive bladder.
Usually there are findings on a patient’s urinalysis with bladder cancer.
If cancer is suspected a cystoscopy is usually performed.
7. Bladder outlet obstruction
Obstruction of the bladder which is long term, especially in men with BPH (benign prostatic hyperplasia) can result in an overactive bladder.
8. Pelvic floor dysfunction
9. Urethral Syndrome
Urethral syndrome is considered to be an early form of interstitial cystitis.
10. Urethral Stenosis
Urethral stenosis is a condition in which there is scarring of the urethra resulting in a narrow opening of the urethra.
The diagnosis of overactive bladder includes a complete patient history and physical exam.
Once your physician suspects overactive bladder, the following are several investigations which can be performed:
The urinalysis rules out any infection, inflammation or blood in the urine.
2. Urine Cytology
Urine cytology refers to examination of the epithelial cells of the bladder which are shed during each void.
Urine cytology is helpful in diagnosing bladder cancer.
Cystoscopy is a test in which a urologist evaluates the inside of the bladder by a small teloscopic instrument which is placed into the urethra and up into the bladder.
This is usually performed which local anasthetic in a jelly form which is placed into the urethra prior to comencing the procedure.
Urodynamics is a test that determines the function of the bladder.
Urodynamics is performed by placing a small ” catheter ” onto the bladder.
The bladder is then filled with water with the patient awake.
Information is then obtained about bladder capacity and bladder emptying which is very helpful in diagnosing bladder problems.
Appropriate treatment can then be initiated.
The basis of treatment of overactive bladder includes reducing irritation within the bladder and modifying the sensory nerves suppyling the bladder to allow the bladder to store urine for a longer period of time.
1. Diet Modification
Diet modification is the first line therapy for treatment of overactive bladder.
It is well known that acidic and spicy foods aggrevate the bladder.
Caffeine and alcohol also aggrevate the bladder.
Tobacco use can be irritating to the bladder.
Anticholinergic agents are the primary form of medical management for the treatment of overactive bladder.
Anticholineric medications work by blocking the sensory nerves supplying the lining of the bladder.
The following are anticholinergic medications used in the treatment of overactive bladder:
a) Ditropan (oxybutinin )
Ditropan is a very potent anticholinergic medication used in the treatment of overactive bladder.
The usual dose of ditropan is up to 5mg three times per day.
The main side effects of ditropan includes a dry mouth and constipation. Side effects can occur in up to 30%, therefore ditropan is not very tolerated.
b) Ditropan XL
Ditropan XL is a new anticholinergic medication and it is currently available in Canada.
Ditropan XL is taken once per day and has very few side effects compared to more traditional anticholinergic medications.
c) Detrol (tolterodine)
Detrol is a new anticholinergic medication which is taken two times per day.
The side effects of detrol are much less than other traditional anticholinergic medications.
Surgery usually does not have a role in overactive bladder.
1. Urethral Dilation
Cystoscopy and dilation of the urethra has been advocated for treatment of urethral syndrome which can manefest itself as an overactive bladder.
Dilation of the urethra is only approximately 50% effective for urethral syndrome.
2. Bladder Augmentation
Bladder augmentation is a procedure in which the volume of the bladder is increased by surgical operation