What is an overactive bladder?
One of the primary functions of the bladder is to store urine. An overactive bladder (OAB) is not a disease but rather a combination of bothersome symptoms related to the storage of urine. These include having to pass urine very often (frequency); the need to rush to the toilet (urgency); passing urine multiple times at night (nocturia); and sometimes, wetting yourself (incontinence).
Who gets it and what is the cause?
OAB is found in both men and women but more commonly in women. Normally, the bladder is relaxed as it fills; however, in an overactive bladder, the nerve signals with the brain are not in sync and the brain makes the bladder empty when it isn’t yet full. In the majority of people, no underlying cause is found. Neurological conditions e.g., multiple sclerosis and Parkinson’s disease should be ruled out.
How is it diagnosed?
It is important to rule out reversible causes, like a urinary tract infection. If you have had blood in your urine, have associated pain, continuous urine leakage or sudden onset symptoms, you should see a specialist urgently. Diagnosis is otherwise based primarily on the history of the symptoms, with the help of questionnaires and a bladder diary.
What tests do I need?
In the first instance, some simple tests are required. A urine sample should be tested for infection and an ultrasound of your kidneys and bladder with a scan after passing urine to make sure the bladder is empty form the mainstay of tests. You may need an inspection of your bladder with a camera – this is called a flexible cystoscopy .
Are there any preventative measures?
Most people develop idiopathic OAB, which means there is no known cause. It is understood that maintaining a healthy lifestyle is beneficial as being overweight and smoking does worsen symptoms.
Can it be cured?
OAB symptoms can be controlled, but there
is no one-off cure. Treatment starts with lifestyle modification, including bladder retraining exercises and dietary changes e.g., avoiding caffeine and alcohol. Tablet treatment generally works to relax the bladder muscle and stop it from contracting at the wrong times. They can be very effective but do have side effects, including a dry mouth and eyes.
I have tried tablets, what next?
If symptoms persist and are very bothersome, you may require further investigations of your bladder. You are then likely to be offered Botox injections.
What is Botox?
Botox is a neurotoxin that works at the nerve receptors in muscles to cause temporary paralysis. It has been used in the bladder for well over 35 years. It is injected into the bladder wall using a camera passed into the waterpipe. It is typically carried out under local anaesthetic and requires only a few hours stay in hospital. It has been shown to be highly effective but wears off gradually and will need repeating approximately every six to nine months. Side effects include a temporary inability to pass urine, infection and blood in the urine.
Overactive bladder is common and affects both men and women. There is usually no cause found but symptoms can be managed. You are likely to need investigations carried out by a Urologist. If conservative measures and tablets fail, then Botox injections into the bladder can be very effective.
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