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Millions of people find their lives disrupted by the urge to urinate at inconvenient times and the loss of bladder control before reaching a toilet. This is a medical problem and nearly everyone can be helped.
Dr. Koushik Shaw and Dr. Lawrence Tsai team up with Dr. George Shashoua, a well respected Austin Uro-Gynecologist, to provide the ONLY Austin and Central Texas team to work under one roof to provide the best of two specialties to achieve optimum results, including precision urodynamic testing (like an EKG for your bladder!) Over the last decade, I have had the opportunity to help many women with this condition. Overactive bladder can affect a woman in several ways. This can include discomfort with intercourse, general pelvic discomfort that worsens with exercise or as the day wears on, embarrassing social leakage, and weight gain due to exercise avoidance to mention a few. Dr. Shaw, Dr. Tsai, and their staff are happy to sit down with you and better understand your symptoms, perform an exam to precisely understand your unique situation and arrive at a precise treatment plan to wellness.
Overactive bladder (OAB) is a condition characterized by a sudden, uncomfortable need to urinate with or without urine leakage usually with daytime and nighttime frequency. OAB occurs when the smooth muscle of the detrusor muscle of the bladder squeezes or contracts more often than normal and at inappropriate times. Instead of staying at rest as urine fills the bladder, the detrusor contracts while the bladder is filling with urine.
By definition, the cause of OAB is unknown. However, identifiable underlying causes can include: drug side effects, nerve damage or neurological disease (e.g., multiple sclerosis, Parkinson’s disease, etc.) or stroke. There are also conditions that are associated with urgency and frequency – including bladder cancer, urinary tract infections and benign prostatic hyperplasia (BPH) – that must be excluded during an examination. Some experts believe that some individuals are predisposed to OAB. Circumstantial evidence suggests that individuals with depression, anxiety, and attention deficit disorder may experience symptoms of OAB more often than the general population. Some investigators suggest that depression, anxiety, feeding disturbances, pain, irritable bowel syndrome, fibromyalgia and changes in urination are associated with disturbances in brain circuits using specific chemical messengers between nerves known as neurotransmitters, in particular, serotonin 5-hydroxytryptamine (5-HT). Fibromyalgia and irritable bowel syndrome are conditions seen more often in patients with OAB and interstitial cystitis (IC) than the general population. These conditions are associated with an overactive bladder and possibly with depression, which provides a potential link with 5-HT metabolism and OAB.
Risk factors related to OAB happen around the childbearing ages, when the process of pregnancy and a vaginal delivery can affect bladder control. However, this problem usually goes away in the majority of patients with OAB during pregnancy or immediately after childbirth. The next series of events in life affecting OAB are around the time of menopause for women, and enlargement of the prostate in the fifth and sixth decades of life in men. Enlargement of the prostate gland occurs in the majority of the men living in the western society and may affect bladder function. Menopause can also affect bladder function. The other independent event affecting bladder function is aging and the changes that occur within the tissues of the lower urinary tract and the bladder itself. Given that the above risk factors could affect almost everyone living in the society, it is estimated that up to 50 percent of women and 30 percent of men will have bladder control problems during their lifetime.
One of the first steps toward diagnosing OAB is to keep a urination diary. Documenting symptoms – including urgency – can help your urologist make the proper diagnosis.A urinalysis (UA) must be performed to rule out infection and to look for glucose (sugar), blood, white cells or difficulty concentrating the urine (specific gravity). After urination, residual urine is also checked using an ultrasound or catheterization. In some patients, a urine cytology or endoscopy (cystoscopy) of the bladder is warranted. It is sometimes useful to perform bladder pressure testing using cystometry (CMG) to document bladder (detrusor) overactivity during filling and exclude obstruction. Imaging of the urinary tract with cystogram, computerized tomography (CT) scan or magnetic resonance imaging (MRI) is rarely needed.
Behavioral regimens have been shown to reduce incontinence and urinary frequency. These regimens range from simple maneuvers such as timed or prompted urination and fluid management to biofeedback.
Additional options exist when drugs and behavioral therapies fail to improve symptoms in patients with OAB and urge incontinence. Electrical stimulation of nerves or regions of the skin, vagina or rectum innervated by the lower spinal cord can reduce OAB and urge incontinence. The two stage sacral nerve stimulation technique using the Axonics neuromodulation device has been reported to be effective in many patients refractory to medical therapy.
In some women with OAB and urinary incontinence, who also exhibit vaginal prolapse (e.g., cystocele, enterocele) and urinary incontinence, correction of these conditions can improve the overactive bladder.
If you would like to know whether you have OAB, answer our questionnaire. If you answer “yes” to two or more questions, you may have OAB, and should seek medical attention.