Urgency Overactive Bladder (OAB) Urge Incontinence (UI) Detrusor Instability (DI)
- OAB may be a combination of urgency and urge incontinence; where you experience an overwhelming need to go to the toilet. Often you can’t hold on and have to rush to a toilet. The most common cause is bladder muscle spasms. The Detrusor muscle receives impulses from the brain telling it the bladder is VERY full and needs to empty immediately
- What’s known as an overactive bladder will cause incontinence. If your bladder constricts too frequently it will leave little or no time to get to the toilet. Your bladder muscle may receive incorrect messages from your brain, and it will automatically empty
What causes OAB
- Overactive bladder can have one or multiple causes. In some cases, the exact cause of overactive bladder may be unknown. Causes include:
- Bladder Abnormalities
Having bladder stones or tumours can cause involuntary bladder contractions
- Damage to Bladder Nerves
Nerves in the bladder typically transmit messages to the brain when you are purposefully using the restroom. However, trauma or certain medical conditions can damage the nerves.
Traumatic injuries that can affect bladder nerves include back or pelvic surgery, a herniated disc, and radiation. Medical conditions that can affect the bladder’s nerves include diabetes, multiple sclerosis, Parkinson’s disease, and stroke
- Oestrogen Deficiency
After menopause, the estrogen levels in a woman’s body drop. This can increase the urge to urinate.
- Excess Fluid Intake
The bladder’s muscles work on a supply-and-demand basis. If you increase the supply by taking in lots of fluids, your bladder will need to release the excess via urination. Approximately 1.5 -2 litres a day is often a recommended intake. This may vary due to physical activity and room temperature. Normal urination or voiding is 4-6 times per day and 0-1 times at night
- Excess Weight
Being overweight can place extra pressure on the bladder muscles, weakening them and leading to overactive bladder
A bladder or urinary tract infection (UTI) can irritate the nerves in the bladder. This can stimulate the urge to urinate or cause involuntary bladder contractions.
- Medications and Diuretics
Alcohol and caffeine can have an effect on the bladder. This means that they cause the bladder to fill rapidly. Medications can also affect nerve transmissions or cause the bladder to fill rapidly. This is true for diuretics such as Lasix (furosemide) or Bumex (bumetanide). There are many other food and or fluids that can be classified as ‘bladder irritants’ and may contribute to OAB symptoms.
- Obstruction to Urine Flow
An enlarged prostate can affect urine flow from the urinary tract
Constipation or having undergone previous operations to the urinary tract can also obstruct urine flow due to possible scarring and or adhesions around the bladder or urethra.
- Weakened Pelvic Muscles
As the bladder fills it relies on increasing support around the bladder neck from the pelvic floor muscles. Some women only experience involuntary loss of urine with a ‘full bladder’ and /or cough, sneeze, heavy exercise. This is usually known as Stress urinary Incontinence.
- Pregnancy and childbirth can weaken the pelvic muscles around the bladder. This can cause it to sag or affect its position. The bladder’s opening can also stretch after childbirth, causing it to leak.
- Symptoms of OAB
An overactive bladder can cause a variety of symptoms that affect the need and frequency of urination. Symptoms include:
– Nocturia, or the need to get up and urinate more than 2 times per night
– Urgent need to urinate, especially around triggers such as running water, key in the door that you cannot control
– Urinary leakage when you feel the need to urinate
– Urinating more than eight times per da
- What can be done
See your GP first to exclude UTI and other bladder pathology
Come and see your Women’s health Physio so we can help determine the causes and start to treat it. OAB often needs a multi – approach
– PFM strengthening if needed
– Bladder re- training program
– Deferment re- training
— Strong PFM contraction
— Perineal pressure
—Curling toes under and contracting calf muscle strongly (stimulates the Tibial nerve)
– Lifestyle changes -fluids and food irritants
– Tibial nerve stimulation
– Drug therapy