Overactive Bladder Health Channel

	Feature Article Illustrations for this article Click on an image below to enlarge Female urinary tract Male urinary tract Urge incontinence Definition Urge incontinence involves a strong, sudden need to urinate, followed by a bladder contraction, which results in leakage. Alternative Names Overactive bladder; Detrusor instability; Detrusor hyperreflexia; Irritable bladder; Spasmodic bladder; Unstable bladder; Incontinence - urge Causes, incidence, and risk factors A person's ability to hold urine and maintain continence depends on normal function of the lower urinary tract, the kidneys, and the nervous system. The person must also have a physical and psychological ability to recognize and appropriately respond to the urge to urinate. The bladder's ability to fill and store urine requires a functional sphincter muscle (which controls the flow of urine out of the body) and a stable bladder wall muscle (detrusor). The process of urination involves two phases: Filling and storage Emptying During the filling and storage phase, the bladder stretches so it can hold the increasing amount of urine. The bladder of an average person can hold 350 mL to 550 mL of urine. Generally, a person feels like they need to urinate when approximately 200 mL of urine fills up in the bladder. The nervous system tells you that you need to urinate, and also allows the bladder to continue to fill. The emptying phase requires that the detrusor muscle contract, forcing urine out of the bladder. The sphincter muscle must relax at the same time, so that urine can flow out of the body. The bladder of an infant automatically contracts when a certain volume of urine is collected in the bladder. As the child grows older and learns to control urination, part of the brain (cerebral cortex) helps prevent bladder muscle contraction. This allows urination to be delayed until the person is ready to use the bathroom. Undesired bladder muscle contractions may occur from neurological problems and bladder irritation. URGE INCONTINENCE Urge incontinence is leakage of urine due to bladder muscles that contract inappropriately. Continue reading this article

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Frequent or urgent urination (2 Images) (Doctor-Reviewed information)
Frequent urination means needing to urinate more often than usual. Urgent urination is a sudden, compelling urge to urinate, along with discomfort in your bladder. A frequent need to urinate at night is called nocturia. Most people can sleep for 6 to 8 hours without having to urinate. Middle aged and older men often wake to urinate once in the early morning hours. Reviewer: Marc Greenstein, DO, Urologist, North Jersey Center for Urologic Care, Denville, NJ. Review provided by VeriMed Healthcare Network.Date: 07/23/2007
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Urination - excessive at night (2 Images) (Doctor-Reviewed information)
Excessive urination at night is a condition in which you wake up several times during the night to urinate. Waking up several times a night to urinate is called nocturia. Reviewer: Marc Greenstein, DO, Urologist, North Jersey Center for Urologic Care, Denville, NJ. Review provided by VeriMed Healthcare Network.Date: 06/05/2007
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Neurogenic Bladder (Doctor-Reviewed information)
Definition Neurogenic bladder is a dysfunction that results from interference with the normal nerve pathways associated with urination. Description Normal bladder function is dependent on the nerves that sense the fullness of the bladder (sensory nerves) and on those that trigger the muscle movements that either empty it or retain urine (motor nerves). The reflex to urinate is triggered when the bladder fills to 300-500 ml. The bladder is then emptied when the contraction of the bladder wall muscles forces urine out through the urethra. The bladder, internal sphincters, and external sphincters may all be affected by nerve disorders that create abnormalities in bladder function. There are two categories of neurogenic bladder dysfunction: overactive (spastic or hyper-reflexive) and underactive (flaccid or hypotonic). An overactive neurogenic bladder is characterized by uncontrolled, frequent expulsion of urine from the bladder. There is reduced bladder capacity and incomplete emptying of urine. An underactive neurogenic bladder has a capacity that is extremely large (up to 2000 ml). Due to a loss of the sensation of bladder filling, the bladder does not contract forcefully, and small amounts of urine dribble from the urethra as the bladder pressure reaches a breakthrough point. Causes and symptoms There are numerous causes for neurogenic bladder dysfunction and symptoms vary depending on the cause. An overactive bladder is caused by interruptions in the nerve pathways to the bladder occurring above the sacrum (five fused spinal vertebrae located just above the tailbone or coccyx ). This nerve damage results in a loss of sensation and motor control and is often seen in stroke , Parkinson's disease , and most forms of spinal-cord injuries. An underactive bladder is the result of interrupted bladder stimulation at the level of the sacral nerves. This may result from certain types of surgery on the spinal cord, sacral spinal tumors, or congenital defects. It also may be a complication of various diseases, such as syphilis , diabetes mellitus , or polio . Diagnosis Neurogenic bladder is diagnosed by carefully recording fluid intake and urinary output and by measuring the quantity of urine remaining in the bladder after voiding (residual urine volume). This measurement is done by draining the bladder with a small rubber tube (catheter) after the person has urinated. Kidney function also is evaluated by regular laboratory testing of the blood and urine. Cystometry may be used to estimate the capacity of the bladder and the pressure changes within it. These measurements can help determine changes in bladder compliance in order to assess the effectiveness of treatment. Doctors may use a cystoscope to look inside the bladder and tubes that lead to it from the kidneys (ureters). Cystoscopy may be used to assess the loss of muscle fibers and elastic tissues and, in some cases, for removing small pieces of tissue for biopsy. Treatment Doctors using begin treating neurogenic bladder by attempting to reduce bladder stretching (distension) through intermittent or continuous catheterization. In intermittent catheterization, a small rubber catheter is inserted at regular intervals (four to six times per day) to approximate normal bladder function. This avoids the complications that may occur when a catheter remains in the bladder's outside opening (urethra) continuously (an indwelling catheter). Intermittent catheterization should be performed using strict sterile technique (asepsis) by skilled personnel, and hourly fluid intake and output must be recorded. Patients who can use their arms may be taught to catheterize themselves. Indwelling catheters avoid distension by emptying the bladder continuously into a bedside drainage collector. Individuals with indwelling catheters are encouraged to maintain a high fluid intake in order to prevent bacteria from accumulating and growing in the urine. Increased fluid intake also decreases the concentration
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Stress incontinence (5 Images) (Doctor-Reviewed information)
Stress incontinence is an involuntary loss of urine that occurs during physical activity, such as coughing, sneezing, laughing, or exercise. Reviewer: Melanie N. Smith, M.D., Ph.D., Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.Date: 05/15/2006
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