Overactive Bladder Syndrome Understanding How the Bladder Functions:The kidneys make urine all the time. A trickle of urine passes constantly to the bladder down the ureter (the tubes from the kidneys to the bladder). You make different amounts of urine depending on how much you drink, eat and sweat. The bladder is like a balloon with its walls made of muscle. It expands as it fills with urine. The outlet for urine, the urethra is normally kept closed. This is helped by muscles beneath the bladder (pelvic floor muscles) that sweep around the urethra that acts like a valve. When the bladder is nearly full with urine, you become aware of the bladder getting full. When you then want to pass urine, you allow the bladder muscles to contract (squeexe) and the valve at the urethra, ie the pelvic floor muscles to relax thus allowing the urine to flow out. Complex nerve messages are sent between the brain, the bladder and the pelvic floor muscles. These tell you how full your bladder is and tell the right muscles to contract or relax at the right time. What is Overactive Bladder Syndrome: An Overactive Bladder Syndrome is when the bladder contracts without you having full control over it, particularly when it is not full. An Overactive Bladder Syndrome is sometimes called an irritable bladder or detrusor instability (Detrusor is the anatomical name for the bladder muscle) Symptoms: • An urgent feeling to go to the toilet • going to the toilet frequently (more than 7 times a day) • urge incontinence - leaking urine before you can get to the toilet • nocturia - waking up at night to go to the toilet more than once. What Causes Overactive Bladder Syndrome: Many physical conditions can cause the problem. OAB affects millions of people all over the world. It is estimated that about 15% of the population in USA and Europe are affected. In Asia it is more like 50%. The usual causes are: • Urinary infection • Neurologic disorders • Bladder tumours • Enlarged Prostate • Weak Sphincter • Psychochological causes. If you are feverish with a burning sensation while passing urine, the urine is discoloured, smelly or blood stained or you notice total incontinence you must seek urgent medical advice. Of the many causes of incontinence the commonest are due to weak sphincters. As we get old there is a tendency for the pelvic floor muscles to get weaker. This can often lead to weak sphincter causing urge incontinence or nocturia. OAB can be diagnosed easily. Once the more serious causes of an irritable bladder is ruled out, it can be treated effectively by Pelvic Floor Muscle strengthening exercises with or without medication (anti-cholinnergic drugs). The bladder training programme consists mainly of exercises to strengthen the pelvic floor muscles. Arnold Henry Kegel (1894-1981) an American Gynaecologist was the first to advocate these exercises for patients suffering from urinary stress incontinence and genital prolapse in women. The Kegel exercises are now proven to be very effective for both men and women suffering from stress incontinence. There is a tendency among patients to drink less fluids to reduce incontinence. This you must never do as water is essential to wash out all the toxins and waste products that collect in your body. You must drink between 1.5 to 2 litres of water a day to keep the kidneys healthy. Kegel Exercises as advocated by “The Women’s Health” - Mayo Clinic • Find the right Muscles: To identify your Pelvic Floor muscles, stop urination in mid stream. If you succeed you have got the right muscles. • Perfect your technique: Once you have identified your muscles, empty your bladder and lie on your back. Tighten your pelvic floor muscles hold your contraction for five seconds and relax for five seconds. Try it four or five times in a row. Work up to keeping your muscles contracted for ten seconds at a time, relaxing for ten seconds between contractions. • Maintain your focus: For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead breathe freely during the exercises. • Repeat three times a day: Aim for atlast 3 sets of 10 repetitions a day. Don’t make a habit of using Kegel exercises to start and stop your urine stream. Doing Kegel exercises while emptying your bladder can actually weaken the muscles as well as lead to incomplete emptying of the bladder - which increases the risk of a urinary infection. K.Badrinath