‘I NEED TO GO NOW!’
Frequent, overwhelmingly urgent and uncontrollable urges to urinate are a sign of an overactive bladder.
MANY of us would have experienc-ed this situation before: we just can’t hold our pee in any longer and have to make an urgent dash to the toilet.
Perhaps we had ignored earlier warnings from our bladder that it needed to be emptied, or perhaps we were holding it in while trying to finish up something else first.
Like a balloon, our bladder is an expandable organ that enlarges as urine – produced by the kidneys – fills it up.
While it can typically hold around 400 to 500ml of urine, nerve receptors in the bladder will signal the brain that you need to urinate when it is about a quarter full.
Urination, or bladder emptying, is an action that we learn to voluntarily control as we grow up.
As babies, the signal from the bladder is interpreted by the brain as a sign to urinate instantly.
However, as we grow older, we eventually learn to control the sphincter muscles that keep the bladder closed and prevent the release of urine.
Most children will have achieved voluntary control of urination during the day between the ages of two to five years old.
Once toilet-trained, we can hold our urine even if our bladder is full.
Therefore, if you are experiencing frequent urgent and unstoppable urges to urinate – especially if you have not had an unusually large amount of liquid intake recently – then something is not right.
Low awareness
An overactive bladder is exactly what it sounds like.
While not a medical condition in itself, it is the term for a group of symptoms involving the bladder.
These include:
> Urinary urgency (the most common symptom) – the failure to control or postpone urination.
> Frequent urination – a significant
increase in the number of times you need to urinate compared to previously.
> Urinary incontinence – involuntarily leaking urine as soon as the urge to urinate is felt.
> Nocturia – having to get up to urinate at least twice while asleep at night.
Interestingly, an online survey conducted by the Star Media Group, in collaboration with Astellas Pharma Malaysia Sdn Bhd, found that 85% of the 358 respondents had experienced two or more of the above symptoms.
However, only 39% of the respondents had heard of the term overactive bladder before.
And of this group, more than half (57%) did not know that this group of symptoms is actually treatable.
The age factor
The top reason the respondents believed to be responsible for this frequent and uncontrollable urge to urinate was age, with 46% of them believing so.
This was followed by not knowing the cause (34%) and a medical condition (33%).
While an overactive bladder can strike at any age, it does tend to affect those who are older.
So it is perhaps unsurprising that half of the respondents who reported having such symptoms were above 60 years of age, with another 24% aged between 51 to 60.
However, it is important to note that having an overactive bladder is not a normal part of ageing (1), and should be treated as a medical condition, rather than brushing it off as part of the challenges of growing older.
Also, while women are more prone to having an overactive bladder, nearly three-quarters (72%) of the respondents with symptoms were men.
According to the Mayo Clinic in the United States, risk factors that may contribute to an overactive bladder include (2):
> Neurological disorders, e.g. stroke and multiple sclerosis
> Diabetes
> Urinary tract infections > Hormonal changes during menopause
> Bladder abnormalities, e.g.
tumours or stones
> Bladder outflow obstruction, e.g. an enlarged prostate or constipation
Certain medications like diuretics, and excessive consumption of caffeine or alcohol, can also contribute to these symptoms.
Lack of professional consultation
Over seven out of 10 (72%) respondents with symptoms felt that their condition impacts their daily lives, with 64% feeling embarrassed about their frequent visits to the toilet and/or their urinary incontinence.
Most of them have changed their lifestyle to accommodate their symptoms, including researching toilet facilities at intended destinations (29%) and preplanning activities around toilet breaks (23%).
Some even decreased their outdoor activities (22%) and are using adult diapers or sanitary pads (9%).
This combination of embarrassment from having to visit the toilet frequently and constantly disrupting a social outing, plus the added chore of having to plan ahead for toilet breaks every time you go out, tends to cause those suffering from an overactive bladder to decrease, or even stop, going out altogether.
This self-imposed social isolation does no favours for the person’s mental health and can indeed eventually lead to depression.
Despite this, only 35% had seen a healthcare or related professional for their condition (see Who they consulted).
The top professional respondents had (correctly) visited or thought was the best to treat an overactive bladder was an urologist, i.e. a doctor specialising in the urinary system.
Managing the condition
Despite many respondents with symptoms feeling like the condition had impacted their lives, the reasons given by nearly half of those who had not seen a healthcare or related professional for their condition was that either it did not require medical attention (25%) or it was not necessary to see such a professional (23%) (see No to the doctor).
Less than a quarter (24%) of respondents with symptoms were taking medication for their condition.
Medications can be very effective in the treatment of an overactive bladder.
These include anticholinergic medications, which block the chemical messenger acetylcholine that triggers the symptoms of an overactive bladder; and beta-3 adrenergic agonists, which help relax the bladder’s muscles and allows it to store more urine without triggering the abnormal preemptive urge to urinate.
These two types of drugs can also be combined for better effect when one type alone is not working well.
While the older medications are known to have frequent side effects, notably dry mouth and constipation, these are lesser with newer drugs like the beta-3 adrenergic agonists.
However, it is important for patients on such medications to be under the care of an urologist who can help monitor and manage any potential side effects.
Behavioural changes can also help manage the condition.
Such changes include dietary modifications to decrease items that can irritate the bladder, like citrus fruits, spicy food, and caffeinated, alcoholic and soft drinks; controlling the amount and types of fluids you take; and retraining your bladder muscles.
The latter involves resisting the frequent urge to urinate, postponing urination, and urinating according to a timetable rather than in response to the urge to do so.
Note that these retraining exercises should only be undertaken with the advice and guidance of a doctor.
According to the Cleveland Clinic in the US, it can take up to six to eight weeks for a bladder retraining programme to show results (3).
Doctors may prescribe a combination of medication and behavioural changes to help patients control their condition.
While an overactive bladder may significantly impact a person’s quality of life, especially socially and mentally, it is a condition that can be overcome with the right management and help from the appropriate healthcare professionals, like your urologist.
Those suffering from it should seek help and not suffer in silence.
This article is courtesy of Astellas Pharma Sdn Bhd as part of its “Hold On To More” campaign to raise public awareness of overactive bladder. For more information about Astellas Pharma Malaysia Sdn Bhd, go to www.astellas.com/my. To learn more about overactive bladder, visit holdontomore.my.
References:
1. Urology Care Foundation: What is Overactive Bladder (OAB)? webpage
2. Mayo Clinic: Overactive bladder Symptoms & causes webpage
3. Cleveland Clnic: Overactive Bladder webpage