Bladder Control
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Bladder Control
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Overview In people with an overactive bladder (OAB), the layered, smooth muscle that surrounds the bladder (detrusor muscle) contracts spastically, sometimes without a known cause, which results in sustained, high bladder pressure and the urgent need to urinate (called urgency). Normally, the detrusor muscle contracts and relaxes in response to the volume of urine in the bladder and the initiation of urination. People with OAB often experience urgency at inconvenient and unpredictable times and sometimes lose control before reaching a toilet. Thus, overactive bladder interferes with work, daily routine, intimacy and sexual function; causes embarrassment; and can diminish self-esteem and quality of life. What is Urination Urination (micturition) involves processes within the urinary tract and the brain. The slight need to urinate is sensed when urine volume reaches about one-half of the bladder's capacity. The brain suppresses this need until a person initiates urination. Once urination has been initiated, the nervous system signals the detrusor muscle to contract into a funnel shape and expel urine. Pressure in the bladder increases and the detrusor muscle remains contracted until the bladder empties. Once empty, pressure falls and the bladder relaxes and resumes its normal shape. Incidence and Prevalence of OAB Overactive bladder affects men and women equally. Approximately 13 million people in the United States suffer from OAB and other forms of incontinence. Causes of Overactive Bladder A malfunctioning detrusor muscle causes overactive bladder. Identifiable underlying causes include the following:
Other conditions can produce symptoms similar to those experienced with overactive bladder, the most common of which is urinary tract infection (UTI) in women. Signs and Symptoms for OAB Three symptoms are associated with an overactive bladder:
Physical examination A physical examination includes a neurologic status evaluation and examination of the abdomen, rectum, genitals, and pelvis. The cough stress test, in which the patient coughs forcefully while the physician observes the urethra, allows observation of urine loss. Instantaneous leakage with coughing indicates a diagnosis of stress incontinence. Leakage that is delayed or persistent after the cough indicates urge incontinence. The physical examination also helps the doctor identify medical conditions that may be the cause of overactive bladder. For instance, poor reflexes or sensory responses may indicate a neurological disorder. Urinalysis Examination of the urine may identify medical conditions associated with overactive bladder, such as the following:
Specialized Testing If overactive bladder persists after diagnosis and treatment, additional testing may be needed. Urologists perform urodynamic, endoscopic, and imaging tests to obtain a more extensive evaluation of the lower urinary tract to determine a new treatment plan. Postvoid residual volume (PRV) This procedure requires catheterization or pelvic ultrasound. The patient voids just before the PRV is measured. Urodynamic Testing Cystometry may be used to measure the anatomic and functional status of the bladder and urethra. The cystometer is an instrument that measures the pressure and capacity of the bladder; thus evaluating the function of the detrusor muscle. Endoscopic Tests Cystoscopy may be performed when urodynamic testing fails to duplicate symptoms, when the patient experiences new symptoms (e.g., cystitis, pain), or when urinalysis reveals a disease process (e.g., menaturia, pyuria). Cystoscopy identifies the presence of bladder lesions (e.g., cysts) and foreign bodies. Imaging Tests X-rays and ultrasound may be used to evaluate anatomic conditions associated with overactive bladder. Imaging of the lower urinary tract before, during, and after voiding is helpful in examining the anatomy of the urinary bladder and urethra Treatment for OAB Treatment may include one or more of the following:
Bladder Training with Timed Voiding This treatment is used for urge and overflow incontinence. The patient keeps a voiding diary of all episodes of urination and leaking. In bladder training, biofeedback and Kegel exercise help the patient resist the sensation of urgency, postpone urination, and urinate according to the timetable. Medication Drugs such as oxybutynin chloride (Ditropan XL®) and tolterodine (Detrusitol®, Detrol LA®) are taken orally, once a day, for overactive bladder. Newer drugs indicated for OAB include trospium chloride (Sanctura™), derifenacin (Enablex®), and solifenacin (Vesicare®). Women who are pregnant should not take these medications without consulting a doctor. Side effects, including dry mouth, constipation, headache, blurred vision, hypertension, drowsiness, and urinary retention occur in approximately 50% of those who use the drugs. People with glaucoma or certain types of kidney, liver, stomach, and urinary problems are advised not to take Ditropan XL. Although there is no evidence that Ditropan XL causes birth defects, pregnant women should not take it without consulting a doctor. Oxybutynin Transdermal System The oxybutynin transdermal system (Oxytrol™) is a thin, flexible, clear patch that is applied to the skin of the abdomen or hip, twice weekly, to treat overactive bladder. Patients who have urinary or gastric retention, uncontrolled narrow-angle glaucoma, and those with hypersensitivity to oxybutynin should not use the oxybutynin transdermal system. Side effects are usually mild and include adverse reactions at the site of application, dry mouth, and constipation. Sacral Nerve Stimulation InterStim® therapy is a reversible treatment for people with urge incontinence caused by overactive bladder who do not respond to behavioral treatments or medication. Prior to implantation, the effectiveness of the therapy is tested on an outpatient basis with an external InterStim device. Possible adverse effects include the following:
Surgery Surgical augmentation of the bladder is reserved for people who do not benefit from bladder retraining or medication. Those who cannot take medication due to medical conditions or intolerance may find incontinence management devices helpful. Elimination and Challenge Diet Bladder control problems that are not the result of neurological damage, poor muscle tone, or hormone deficiencies may result from irritability within the bladder or urethral tissues caused by chronic inflammation and/or food sensitivities. An elimination and challenge diet can help determine a food sensitivity. Symptoms that can occur on a food challenge include the following:
Symptoms associated with food challenges may not be the same symptoms experienced before the elimination process. For example, before the elimination and challenge diet began, a patient's symptom was chronic sinus pain, but a stomachache occurred during the challenge. This does not mean that the food group being challenged was not causing the sinus pain. It is just that the body and immune system react differently when the offending agent is removed and then reintroduced.
Herbal Support Soothing urinary tract tonics may help heal the bladder and related nervous irritation. Also drink 2 - 3 quarts of water daily. Herbs to use as tea:
Anti-inflammatory Support
Homeopathic Support A trained homeopathic practitioner is needed to diagnose and prescribe a deep acting, constitutional remedy. For acute, symptomatic relief, the following remedies may relieve some of the symptoms associated with incontinence.
Standard dosage for acute symptom relief is 12c to 30c, 3 to 5 pellets taken 3 times a day until symptoms resolve. If you have chosen the right remedy, you should experience improvement shortly after the first or second dose. Warning: Most homeopathic remedies are delivered in a small pellet form that has a lactose sugar base. If you are lactose intolerant, be advised that a homeopathic liquid may be a better choice. The above opinionated views and information serves to educated and informed consumer . The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. .It should not replaced professional advise and consultation. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions
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