Christopher Maher Urogynaecologist 

Phone: (07) 3876 7272

OVERACTIVE BLADDER
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NORMAL FEMALE BLADDER FUNCTION
OVERACTIVE BLADDER
TREATMENT STRATEGIES FOR URGE INCONTINENCE
MEDICAL THERAPY
SURGERY

NORMAL FEMALE BADDER FUNCTION
Aid your understanding click to see animation.

The adult bladder is a hollow organ with a muscular wall. Urine enters the bladder from two ureters which run from the kidney to the bladder. Urine is expelled from the bladder to the exterior via the urethra.

The detrusor muscle of the bladder wall is specifically designed to be able to store urine without increasing bladder pressure. The bladder acts as a reservoir relaxing to receive urine during the filling phase and only contracts to evacuate during the voiding phase.

The urethra acts reciprocally to contract during the filling phase to keep urine in the bladder and relaxing during voiding to allow for micturition. At rest the urethra is closed and the walls coapt against each other to form a seal that acts to keep urine in the bladder. Under situations of increased abdominal pressure ( coughing sneezing exercising ) contraction of the pelvic floor muscles and muscles around the urethra act to offer increased urethral resistance and maintain continence.

Bladder has two distinct roles,

  1. Storage of urine:- The storage of urine differentiates adults from infants and allows us to be social without the constant leakage of urine. Under control of the brain the bladder muscle is inhibited from contracting and the urethra is contracted to aid in storage of urine.
  2. Voiding phase (Micturition). As the bladder fills to capacity increasing messages are sent to the brain to void (pass urine). When comfortable to void the bladder contracts and the urethra relaxes to allow voiding. Women pass urine much faster then men, at a rate of 30-50 mls a second.

Normal Adult Female Bladder Function

1. Bladder capacity of approximately 500mls
2. Normal void is 350-700mls of urine
3. Normally voids 4-7 times a day
4. Normally wakes to void at night 0-1
5. With each decade after 60 years one extra void during the day or night is normal.
6. No urinary urgency, frequency( voiding more often then outlined above), infection, blood or tumours (contact your local doctor)

OVERACTIVE BLADDER
Aid your understanding click to see animation.

The overactive bladder is characterised by urinary frequency( 8 or greater voids in 24 hours) and urgency (a strong desire to void) with or without urge incontinence(involuntary loss of urine with urgerncy). This condition affects 15% of adults with half experiencing urge incontinence Women affected more frequently than men The incidence increases with advancing age

CAUSE
Unstable bladder:
Involuntary bladder contraction resulting in urgency or incontinence Most common cause and the reason is unknown May be related to the bladder muscle contracting to quickly Common triggers include washing hands, putting the key in the door, anxiety

Hypersensitive bladder:
Urinary urgency and or pain or urge incontinence when the bladder does not contract Causes include infection, inflammation, foreign bodies or tumours

Detrusor hyperreflexia:
When the unstable bladder is due to neurological disease( ie spinal cord injuries, parkinsons, alzhiemers, multiple sclerosis)

DIAGNOSIS
Is made by a combination of history, examination and investigation by your doctor. Infection is usually excluded with a urine test. Your doctor may ask you to complete a 24-hour urinary diary. This is an excellent means of confirming how many times you void, the volume voided and the amount of incontinence experienced Your fluid intake may also be recorded. To download a urinary diary click the Urinary Diary on the left. Women with a hypersensitive bladder classically pass small amounts of urine frequently. Women with an unstable bladder may have normal urinary frequency but experience significant urge incontinence. Urodynamics may be required to confirm the diagnosis.

Treatment
The overactive bladder is a treatable condition that you should discuss with your doctor.

The treatment options include behavioural therapy, medical and rarely surgical options.

Medical and behavioural therapies are commonly used together. Bladder retraining is the mainstay of bladder retraining which helps you to learn to overcome the urge to urinate. Pelvic floor exercises and avoiding excessive fluid intake are other methods to help control the overactive bladder.

Sue Croft
Physiotherapist
194 Gladstone Road
Highgate Hill, QLD 4101

Phone: 3848 9601
Fax: 3848 6811
Mob: 0407 659 357

TREATMENT STRATEGIES FOR URGE INCONTINENCE

Urge Incontinence (the loss of urine with the urge to go), urgency, frequency and nocturia (going too frequently in the night) are symptoms of an irritable or overactive bladder. The detrusor (the smooth muscle pump of the bladder) is spasming or contracting before you have made the toilet either with a full or less than full bladder. Bladder retraining is the technique used to try to increase the capacity of the bladder (normal capacity 350-500mls) and decrease the sensitivity of the bladder. By teaching your bladder how to store more urine without leaking or giving uncomfortable spasms, you will have more time between voids, less discomfort or pain and more freedom to go out without constantly seeking the nearest toilet. Points to follow:

URGE CONTROL TECHNIQUES

Once the urge has passed make a decision- is the bladder full? If not defer and when the urge is gone '"get on with life". If the bladder is full, use the following techniques to get to the toilet dry.

Aim to go 5 to 7 times per day and 0-1 per night. Remember it is quite often difficult in the first few days (or weeks!) so perseverance with your exercises and deferring is important. These strategies used in conjunction with the medication given by your doctor will help to relax the overactive bladder.

MEDICAL THERAPY

A WIDE VARIETY OF MEDICINES ARE AVAILABLE to treat the overactive bladder. The following are possible options available but is only a guide and you should consult your doctor before considering if any tablets are suitable.

Vaginal oestrogen therapy:
( Vagifem, Ovestin) maybe helpful in postmenopausal women to decrease urinary frequency, urgency and the need to pass urine at night (nocturia). Anticholinergic drugs act to quieten the bladder and may decrease uncontrolled bladder contractions.

Oxybutynin:
(Ditropan) Is an anticholinergic agent. Dose: 2.5mg 2x a day up to 5mg 3x a day Side Effect: Dry mouth, blurred vision, constipation, reflux are a few. This tablet is contraindicated in women with acute angle glaucoma.

Tolterodine:
( Detrusitol) This medication is a newer medication not freely available in Australia. It is more specific to the bladder receptors and as such has less effect on other organs. This results in the side effects occurring less frequently than with ditripan Dose: 2mg a day SE The same as for ditripan but are less frequent.

Medical treatment is normally initiated for 3 months. After that time the treatment may be able to be withdrawn depending on your symptoms. Bladder retraining techniques should continue.

Surgery:
Bladder distension is a very simple procedure performed under anaesthesia in an attempt to increase bladder capacity. This can be successful but continued bladder retraining is required to ensure the effect is longlasting. Invasive surgical treatment for the overactive bladder is only offered to the most difficult cases. Options include Neuromodulation of the S3 nerve to the bladder or bladder augmentation and need to be discussed with your specialist.

© Copyright Dr Christopher Maher 2003 .