Overactive Bladder - Diagnosis and Treatment

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Overactive bladder occurs when abnormal nerves send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. Voiding up to seven times a day is normal for many women, but women with overactive bladder may find that they must urinate even more frequently.

Symptoms of overactive bladder include:

  • urinary frequency—bothersome urination eight or more times a day or two or more times at night
  • urinary urgency—the sudden, strong need to urinate immediately
  • urge incontinence—leakage or gushing of urine that follows a sudden, strong urge
  • nocturia—awaking at night to urinate

    Inappropriate bladder contractions can cause your bladder to suddenly empty, often during sleep. It also can occur after drinking a small amount of water or when you touch water or hear it running. Medications such as diuretics and anxiety can worsen this condition. Medical conditions such as hyperthyroidism, uncontrolled diabetes, multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke and injury also can lead to or worsen urge incontinence.

    Alcohol, caffeine and acidic bladder irritants such as tomatoes and citrus make this condition worse. Also, being dehydrated causes the urine to become more concentrated and irritating. You may think you should drink less when you are experiencing overactive bladder, but drinking water actually dilutes the urine and makes it less irritating. Urinary tract infection and constipation also contribute to the problem.

    Treatment begins with evaluation to rule out a neurologic problem, stones, bladder tumors or infections, as well as any medications that could contribute to the problem. Anticholinergic medications can help relax bladder muscles and prevent bladder spasms. Botox has been shown to reduce bladder contractions and provide short-term improvement. Pelvic floor physical therapy, sometimes with biofeedback, can help you learn to control muscles. InterStim is an implantable device that controls bladder impulses. If these more conservative measures don't work and you are found to have a small capacity bladder, bladder augmentation may be an option.

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