It can develop at any age: A frequent, sudden urge to urinate isn’t just a nuisance, it’s a real burden. It even makes you get up in the middle of the night to go to the toilet, which robs you of sleep and lowers your quality of life.
Some sufferers accidentally wet themselves at times. They may isolate themselves out of embarrassment and not even speak to their family doctor about the problem. There are, however, effective treatment strategies for an overactive bladder.
“It’s important that a gynaecologist or urologist make a careful diagnosis,” says Dr Bjoern Lampe, who heads a hospital gynaecology and obstetrics department.
Though an overactive bladder can affect both men and women of any age, “older women in particular are often affected,” notes Dr Christian Dannecker, who holds a position similar to Lampe’s.
Since a frequent need to urinate can signal an infection — of the bladder, for instance — the examining doctor generally checks the patient’s urine first. If it’s found to be normal, further examinations follow.
“An overactive bladder can be caused, for example, by bladder stones or a tumour in the bladder region,” Dannecker says.
“Sometimes the cause is psychological,” says urologist Sonja Kukuk, pointing to stress, anxiety and unresolved conflicts. Psychotherapy can then help.
Having to go to the toilet frequently can also be a symptom of a disease such as Parkinson’s or multiple sclerosis. A metabolic disorder such as diabetes, or taking certain medications, are also possible causes. Older patients plagued by constant pressure on their bladder may be suffering from cardiac insufficiency, which can be treated with drugs.
Uterine prolapse, which occurs when pelvic floor muscles and ligaments stretch and weaken, causing the uterus to descend towards or into the vagina, can also lead to an overactive bladder, says gynaecologist Dr Anca Dizdar, adding that sometimes the exact cause of the condition remains unclear.
Keeping a voiding diary can help the doctor make a diagnosis. It records the patient’s fluid intake and acts of urination for a period of at least two full days. In some cases the problem can be solved simply by a change of drinking habits.
Treatment isn’t always so simple, though. Pelvic floor muscle training can strengthen those muscles along with the urinary sphincter, stopping the bladder’s involuntary contractions.
“This is accompanied by an analysis of unfavourable drinking and voiding habits,” explains physiotherapist Petra Linkenbach. The patient and therapist work out techniques to delay voiding and lengthen the intervals between trips to the toilet.
Electrostimulation is another way to strengthen pelvic floor muscles, Dizdar remarks. The therapy sessions involve insertion of a rod-shaped electrode into a female patient’s vagina or male patient’s anus.
Often the doctor will prescribe a medication that relaxes the bladder. “The medications can have side effects such as mouth dryness or constipation, however,” Kukuk says.
If neither pelvic floor muscle training nor medications help, there are other treatment options.
“A Botox injection can be very effective in treating an overactive bladder,” Lampe says. The doctor injects Botox at various sites of the bladder wall, which relaxes the overactive bladder muscles. As the effect of Botox wears off after several months, further injections are usually necessary.
Surgical options include implantation of a bladder pacemaker and tiny electrodes that sends mild electrical pulses to the nerve that helps control bladder function. – dpa
