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What You Need to Know about Overactive Bladder

Bladder-control problems can be frustrating due to the disruption of daily living. According to statistics, more than 33 million Americans are affected by some type of bladder-control problem. Overactive bladder is the instance of frequent contractions of the detrusor muscle that controls the bladder. This muscle contracts even when the bladder is not full, creating an overwhelming urge to urinate. Although bladder-control problems like overactive bladder are very common, many people hesitate to talk about them. We want you to. There is help for overactive bladder, but you have to talk to your urologist to get it.

Symptoms of Overactive Bladder

The most common symptom of overactive bladder is a frequent need to urinate. Not just any need, though, a sudden and uncontrollable need to urinate. This may lead to urge incontinence, the accidental leakage of urine. People with overactive bladder also tend to have to get up at least once at night to urinate (nocturia).

Why does this happen?

Overactive bladder may stem from an infection that irritates the bladder lining or from an enlarged prostate. Another potential factor in overactive bladder is an abnormality in the nerves that control the bladder. The condition may also be caused by a stroke, neurological disease, or side effects from medication. Sometimes, doctors cannot discern an exact cause for the frequent and urgent need to urinate. Some of the questions that are asked to help diagnose overactive bladder include:

  • How often do you urinate?
  • Do you experience discomfort or pain when urinating?
  • Do you ever leak urine before you can reach the bathroom? How severely and how often?
  • How long has this sense of urgency been happening?
  • Have you recently been ill or had surgery?
  • Are you taking medications? If so, what?

A doctor will also perform tests to help make an accurate diagnosis. This may include:

  • Urinalysis from a urine sample
  • Bladder stress test
  • Urodynamic testing
  • Cystoscopy, a minimally invasive procedure to observe the inner lining of the bladder for cysts

Treating Overactive Bladder

When possible, overactive bladder is remedied with behavior modification and medication. Behavior modification may include Kegel exercises to strengthen the pelvic floor, biofeedback therapy, and adjusting dietary habits. In some cases, sacral nerve stimulation may be advisable.

UT Urology in Chattanooga develops customized OAB treatments for optimal improvement. To learn more, schedule a visit with us at (423) 778-5910.

How to Train Your Bladder

When we think about overactive bladder (OAB) treatments, many of us inevitably focus on the many medications that we can use to treat the symptoms of urinary urgency, frequency or urgency incontinence. Or perhaps we might even think of more advanced therapies such as botulinum toxin, sacral neuromodulation or percutaneous tibial neuromodulation. However, patients and health providers should be careful not to dismiss everyday changes that can be made without ever going to the pharmacy or visiting the doctor’s office. In fact, because behavioral changes can be so important, the current American Urological Association guidelines on OAB urge providers to offer these as first-line therapies. Even better, behavioral treatments are as effective as medications with few if any side effects. For those people who may eventually require medications or more advanced therapy, multiple studies confirm that these treatments are made more effective if combined with behavioral treatments.

bladder health | Chattanooga TNBehavioral treatments for OAB include fluid reduction, diet changes, weight loss, and pelvic floor exercises. Bladder training (BT) is another means of behavior therapy for OAB that can be effective in a properly motivated or dedicated person. BT begins with education about overactive bladder often accomplished with brochures, websites or videos. Completing a record for several days of how often one voids (and whether there is an urgency to void) helps to identify a time interval of typical urination. The goal becomes to gradually increase that interval, usually by 30 minutes every 1-2 weeks. There are numerous distraction techniques (pelvic contractions, relaxation techniques) that can be used to ignore any urinary urgency that comes in between the interval.

How effective is bladder training? Trials comparing BT to the most common medications used to treat OAB show that it is as effective as medications with fewer side effects. Perhaps more encouraging, other therapies including medications, are more effective if you add bladder training. So, not only can behavioral therapies be used to treat OAB on their own, but they should be continued even if you move on to other therapies.

It should be remembered that bladder training can be difficult. It requires time and attention that some people are not able to devote. The number of patients remaining adherent to bladder training tends to be low in many of these studies. We certainly could use better tools to make this therapy more successful. Yet, for the determined patient who wants a successful therapy without the cost or side effects of medication, BT can be a wonderful therapy.

Colin M. Goudelocke, M.D.

Normal Bacteria in the Bladder?

I suspect that if you ask most people (including most health providers) whether it is normal to have bacteria in the bladder, you would hear an emphatic “NO!”. The conventional wisdom has long been that the bladder is a sterile environment. But for many years there has been mounting evidence that this simply is not true. A recent review article written by Thomas-White et al provides an excellent history and summary of our developing understanding of normal and beneficial bacteria found in the bladder. These authors also detail their own research which is helping to lead to a radical new understanding of what constitutes a healthy bladder.

bacteria in the bladder | Chattanooga TNThis enlightening paper begins by pointing out that our misunderstanding of urine as sterile dates back to the 19th century when we were just beginning to grasp the nature of bacteria. This idea of a sterile bladder delayed one of the most important advancements in our treatment of patients with neurologic injuries of the bladder: self-catheterization. Prior to the 1960’s, patients with urinary retention were not told to self-catheterize out of fear that it would lead to infections. Unfortunately, the opposite is true and infections are actually prevented by catheterization in these patients.

Most importantly, the authors detail their ground-breaking new work that is advancing our understanding that not only are healthy bladders full of bacteria but that some of these bacteria may be very beneficial for bladder health. Their research identifying bacteria that are clearly alive and present in the bladder suggests that patients with overactive bladder (OAB) may lack an abundance of certain Lactobacillus species. These are the same types of bacteria thought to be protective of infection in the intestine and vagina. It may be that these types of bacteria are also protective against developing urinary tract infections.

For decades we have been guided by an overly simple understanding of the bladder and urine that today seems just plain wrong. This may even influence our current over-use of antibiotics, particularly as it relates to bladder bacteria.  Perhaps our abundant use of antibiotics may predispose some patients to recurrent urinary tract infections by killing beneficial and protective bacteria in the vagina and bladder. It is wonderful to see such cutting-edge scientific study that may one day revolutionize the way we approach our bladder health.

Colin M. Goudelocke, M.D.

Sleep Apnea and Frequent Night Urination

Many people blame their frequent visits to the bathroom every night on an overactive bladder (OAB) or, for men, an enlarged prostate. While these may be frequent causes of nocturia (waking up to urinate more than one time per night), an often overlooked cause is obstructive sleep apnea. If you wonder how sleep apnea could cause you get up multiple times at night to urinate, a recent study by Miyauchi et al  confirms both the relationship between nocturia and sleep apnea as well as the improvement seen with treatment.
Sleep Apnea and Frequent Night Urination | Chattanooga TNWe begin by noting that many patients who get up frequently at night do so because they make too much urine at night. The bladder is simply filling up more quickly than it should. Normally for young people, no more than 20% of your daily urine production should come while you are asleep. In older patients, less than 33% is more normal. Patients who exceed this are said to have nocturnal polyuria, meaning they make too much urine at night. This is easily diagnosed by having patients keep a diary for several nights to measure how much urine they make during the night compared to the day.

While there are several causes of nocturnal polyuria, an often overlooked one is obstructive sleep apnea. Blockage of your airway in sleep apnea results in a lot of negative pressure in the chest as you try to breathe (try closing your throat and taking a breath).  This causes more blood to return to the heart. When this part of the heart expands from the extra blood, it releases a hormone (atrial natriuretic peptide) that makes you make more urine. It’s as if the body thinks there is too much blood volume (maybe you drank a lot of fluid) and tries to get rid of the excess fluid. So, patients with obstructive sleep apnea make too much urine at night.

The encouraging news is that treatment of the sleep apnea such as with a mask providing continuous airway pressure (CPAP) not only treats the sleep apnea but also will reduce the urine production and the nocturia. So next time you find yourself getting up that 3rd or 4th time at night, consider having an evaluation of whether you are making too much urine at night. If so, a test for sleep apnea may be in order.

Colin M. Goudelocke, M.D.

What Do You Mean, OAB?

Thanks in no small part to the marketing efforts of companies that produce treatments for overactive bladder (OAB), the term “OAB” has become relatively well known among health providers and the general public alike. The fact that the term has become so common and well accepted has been a source of criticism by some who feel that it doesn’t adequately describe the symptom complex it is associated with it.

overactive bladder | Chattanooga TNBut where does the term even come from? A review of the history of the term “Overactive Bladder” by Cardona-Grau and Spettel is a fascinating exploration of how this term came to be commonly used. They point out the very interesting way in which the name OAB has been influenced by the syndrome it describes, but also how thinking about these symptoms as “overactive bladder” has influenced the way we approach and treat it.

The authors of this review note that the origin of the name overactive bladder is credited to Drs. Wein and Abrams, two giants in the field of urology, particularly bladder health. It reflects their understanding of how the symptoms of urinary urgency, frequency and sometimes incontinence are perceived by patients. It also was a term they were already using with their patients to make their condition more understandable. It took away the stigma that was attached to previous terms such as “unstable bladder” that may have made patients feel that their mental stability was being questioned.

But the term also has had an influence on the way we think about and study OAB. Prior to the introduction and later acceptance of a standard definition for OAB that is based on symptoms reported by a patient, previous definitions relied on the findings of an invasive test called urodynamics. In contrast, the definition of OAB can be applied without the need for expensive and invasive testing. It can be used by specialists and general practioners alike. I like to point out that patients are generally able to self-identify all of the symptoms we associate with OAB (even if they can’t always rule out other causes of those symptoms). The change to using the term overactive bladder largely coincided with the development of recommendations that the initial evaluation of OAB should not involve advanced testing, with a history and physical exam largely sufficing.

And while it is often noted by critics that the term OAB has been used effectively for marketing purposes by the pharmaceutical industry, the term was not invented by marketers or for marketing. Rather, it has served as a useful starting point for an understanding, by both patients and physicians, that can lead to a better and more thorough understanding of just what is this thing we call “OAB”.

Colin M. Goudelocke, M.D.

Does caffeine REALLY cause overactive bladder?

If you are a coffee drinker and you suffer from symptoms of overactive bladder (OAB) such as frequent urination or urgent urination, it is a very safe bet that someone (very often your health care provider) has told you to cut out the caffeine. Caffeine can serve as both a stimulant, an irritant, and a diuretic so it should follow that it must lead to overactive bladder, right? That has been the conventional wisdom for years, though we should always be careful to check that our wisdom is really based on facts.

Does caffeine REALLY cause overactive bladder? | Chattanooga TNA recent review article by Palma and Staak provides an overview of the most recent studies about the effects of caffeine on the bladder. When taken together, these studies demonstrate that drinking more than 2 cups of coffee per day (>200mg caffeine) is associated with worsening symptoms of overactive bladder. The effect does depend on the dose and more than 4 cups of coffee per day may result in developing symptoms of OAB even in patients with no symptoms before.

One bit of good news is that the small amount of caffeine found in decaffeinated coffee does not appear to have a negative effect on OAB symptoms.

In this case, the conventional wisdom, dispensed for years by friends, family and even your health care provider appears to be spot on. You may want to skip that extra cup of coffee tomorrow if you have a long meeting in the morning.

Colin M. Goudelocke, M.D.

How OAB Affects You

In a digital world that provides endless distraction, we tend to focus on those things that directly affect us or those we care about. We are drawn to the local news, the posts of our friends, or just tomorrow’s weather forecast. Judged by this standard, for most of us, Overactive Bladder (OAB) doesn’t always seem to have that personal impact. But whether we realize it or not, almost all of us know someone well who suffers with OAB (or we suffer ourselves).  And the impact of these symptoms – financial, social, personal – is immense.

OABA recent review article by Reynolds et al. is an eye-opening reminder not only of how prevalent OAB is but also what an out-sized impact it has on the lives of those who live with it.  The authors note that the development of a precise and easily-used definition of OAB based on patient symptoms rather than invasive testing has allowed a better sample of how common OAB really is in the United States. Though there is some variation among the larger studies looking at the prevalence of OAB, it seems likely that around 30% of women and 16% of men report symptoms of urinary frequency or urgency at least some of the time. Up to 11% of women report urinary incontinence associated with OAB. This means that about 37 million women in the United States have overactive bladder with 14 million of them experiencing urinary leakage. To put this in perspective, more people have OAB than diabetes, asthma, or arthritis.

The individual impact of OAB on daily life can be enormous. Much of this effect can be attributed to the embarrassment and distress that urinary leakage can cause. OAB isolates, forcing people to avoid friends, family and many of the activities that they may enjoy.  For someone who has to rush to the bathroom every 30 minutes, worshiping at church, seeing a movie with friends, or going to a basketball game is virtually impossible. The authors in this review note studies finding that over 1/3 of people with OAB report their daily activities curtailed by OAB symptoms and 12% even report staying at home because of their OAB. It is not surprising that many people with OAB gain weight when they are not able to exercise regularly due to their symptoms.

Even if you don’t personally have overactive bladder or know someone who does (though you almost certainly do), as a society we pay a heavy price for OAB. Overactive bladder costs each of us the equivalent of $426 per year in lost productivity and more than three times that in pads, medications and other treatments. The review by Dr. Reynolds and collegues cites a study estimating that by 2020 OAB may cost us over $82 billion. That is more then the US government spends on education each year.

For those who personally experience OAB, there is little question of its enormous impact on everyday life. But for the rest of us, there is no denying that overactive bladder should demand our attention.

Colin M. Goudelocke, M.D.

Dear Diary

The diagnosis of overactive bladder (OAB) depends on identifying urinary symptoms of frequency, urgency or urgency incontinence. Diagnosing OAB is not like checking for high blood pressure or diabetes. The symptoms that identify OAB are typically reported by patients rather than being directly observed by the health provider. It seems natural to question what would be the best way to identify and measure these symptoms.

overactive bladder | Chattanooga TNShort questionnaires of a dozen or so questions about urinary symptoms are often used to classify bladder symptoms as well as to measure their severity. These are attractive because they can be completed quickly and easily and do a very good job of characterizing OAB.

The bladder diary is a written log that may include information about how frequently urination happens, how much urine is produced with each void, how much liquid is consumed, whether any urine leakage occurs, and what was happening when leakage occurred. A recent review article by Dixon and Nakib expertly summarizes the important studies that show the usefulness of voiding diaries in bladder care.

The authors begin by pointing to several studies that demonstrate that voiding diaries are completed by the vast majority of patients asked to do so. Furthermore, most patients find these diaries easy to complete and they report that completing a diary was helpful to them. We often find that patients gain significant insight about how frequently they void and the relationship of their symptoms to behaviors such as how much they may be drinking. It is not unusual to see improvement from the first to the last day of a diary as the patient begins to modify her behavior in response what she sees in the diary.

Voiding diaries can be very useful for identifying specific problems. Patients who consume too much fluid will quickly be identified and can be given very specific recommendations as to how much to reduce intake. A voiding diary showing an excess of urine produced at night can give a clue to medical problems including sleep apnea or congestive heart failure. Finally, a voiding diary can be a very useful way to distinguish between stress incontinence and urgency incontinence.

In modern medicine, we frequently focus on complex, sophisticated and often expensive tests that often do provide useful information. But, when evaluating OAB, we would do well to remember a very simple study that costs just pennies in copy costs but can provide a wealth of information.

Colin M. Goudelocke, M.D.

5 Ways to Treat Your Overactive Bladder Naturally

Overactive bladder (OAB) is a very common health problem that is often a source of discomfort and embarrassment. Perhaps as a result of the stigma attached to incontinence, many patients are reluctant to bring up their issues of urinary frequency, urgency or urinary incontinence with their health provider. While it is our goal to make these conversations easier, it helps to have steps you can take on your own to help control your overactive bladder.

1.    Balance your Fluid Intake

In some people with OAB, decreasing fluid intake can noticeably reduce urinary frequency. However, be cautious not to shift to far in the opposite direction as drinking too little fluid may result in constipation or kidney stones. Ideal fluid intake is controversial but should be responsive to your thirst.

pouring cola drink to glass with ice2.    Say No to Alcohol and Caffeine

Caffeine and alcohol consumption may worsen the symptoms of overactive bladder. They can act as diuretics and bladder irritants. Keep in mind that caffeine does not only include your morning cup of coffee. Caffeine-loaded drinks/foods may include soda, tea, chocolates and certain medications. It helps to keep caffeine to less than 200mg per day (or less than 2 cups of coffee). The small amount of caffeine in decaffeinated coffee does not have an effect on OAB symptoms.

3.    Avoid Artificial Sweeteners

Artificial sweeteners have become increasingly common as a weight control entity to reduce calorie intake. The National Association for Continence has stated that artificial sweeteners in diet drinks may increase OAB symptoms as much or  more as compared to regular sugary drinks.

4.    Exercise your Pelvic Muscles

Women can effectively strengthen their pelvic muscles to avoid and reduce leak and control involuntary urge. These are often referred to as Kegel exercises. You may read more about these on our web site or watch these videos describing them. Some patients may benefit from learning these exercises from a pelvic floor therapist.

5.    Lose Weight

Being obese or overweight can pose a number of health risks, one of which includes an overactive bladder. The increased weight may apply pressure on your bladder and pelvic muscles affecting urination frequency and urgency. Weight loss has been shown to reduce urinary incontinence.

Colin M. Goudelocke, M.D.

Taming Your Overactive Bladder

People have preconceptions about getting older. It’s assumed you’ll lose strength. Your skin will become much less pliable. You’ll become less sharp mentally.

And you’ll have to urinate more often.

While the first three issues are mostly true, the fourth is not a condition of aging. Having to urinate more than eight times in a day could be a sign of an overactive bladder (OAB). OAB can affect different people in different ways: some people have a sudden urge to urinate; others urinate frequently during the day or night; others have some urine leakage.

Because some people feel embarrassed by their OAB, they often don’t tell their doctor about their symptoms. They just assume it’s a “part of getting older,” but this isn’t true, and by not sharing this information with your doctor you’re missing out on the many available treatment options.

At UT Urology, we are experts in the diagnosis and treatment of OAB and urinary incontinence. Our Overactive Bladder Clinic is a specialized clinic dedicated to the problem.

What causes overactive bladder?

Overactive BladderWhen in normal function, your bladder should store at least 10 ounces of urine before it signals the brain that you need to urinate. This process begins with that signal and then the brain tells the bladder to squeeze out the urine. At this time, the pelvic muscles and sphincter muscle, whose job it is to keep the urine in the bladder, will relax. When you have OAB, the message is sent that your bladder is full, even if it isn’t. This leads to frequent urination and possible urine leakage.

While OAB can be a condition on its own, it can also be a sign of various diseases of the urinary tract and nervous system. That’s why you need to share your symptoms with your doctor. If he or she seems nonplussed by your situation, it may be a good idea to seek out specialists such as the team at UT Urology.

Know that you are not alone. As many as 30 million Americans have symptoms of OAB. The condition affects both men and women.

Diagnosing overactive bladders

When evaluating your condition, we begin with questions such as how frequently you urinate and if or how often you have leakage. We’ll ask about medications, previous surgeries, and your consumption habits. We’ll perform a physical exam, as well. Our diagnosis doesn’t usually require any invasive testing.

 

We’ll have you keep a bladder diary. This will chart your daily input of things such as coffee along with your urine output.

We’ll conduct a simple in-office urine test. Once we look at this we may opt to send it to the lab for additional testing.

If it seems relevant, we may perform a painless ultrasound of your bladder to see how well you’re emptying it.

Treatment options

In most cases our first choice in treatment of OAB is behavior change. This may be as simple as reducing certain foods and beverages that may be irritating your bladder. It may involve reducing total fluid intake, after reviewing your bladder diary. We may put you on a timed voiding schedule, as this helps train your body to expand the time interval between urination. It may even involve Kegel exercises to strengthen your pelvic floor muscles, the muscles that are responsible for urination control.

Medications, particular when prescribed in combination with behavioral changes, can be incorporated. These medications help to relax the bladder and reduce the signals to the brain telling you to urinate before your bladder is actually full.

If you’re losing sleep and feeling as if you’re missing out on social activities due to having to urinate too frequently, give us a call at UT Urology, 423-778-8765. We can help.

Image courtesy of marin at FreeDigitalPhotos.net

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