Incontinence Clinic

All aspects of quality of life may be affected when suffering from an overactive bladder. Travelling may be difficult due to concerns over possible urine leakage or locating the nearest toilet. An individual with overactive bladder may feel distress, embarrassment, inconvenience, loss of self-esteem and self-control. There will also be an effect on the sufferers’ personal relationships with others.

It is not always easy to identify a common feature responsible for bladder over-activity, however the following are possible causes:

• Urinary Tract Infection – A bacterial infection of the bladder/kidneys
• Outflow Obstruction - Men with benign prostatic obstruction may complain of symptoms of overactive bladder
• Neurogenic - Those with conditions such as Parkinson’s Disease, Multiple Sclerosis or those who have suffered a stroke may also develop overactive bladder
• Medicines - Some medications may be associated with overactive bladder.These include diuretics, phenothiazides and opioids
• Alcohol/caffeinated beverages - can increase symptoms of OAB

Signs and symptoms of overactive bladder may mean you:

• Feel a strong, sudden urge to urinate
• Experience urge incontinence, the involuntary loss of urine immediately following an urgent need to urinate
• Urinate frequently, usually eight or more times in 24 hours
• Awaken two or more times in the night to urinate (nocturia)
• Although you may be able to get to the toilet in time when you sense an urge to urinate, frequent and night time urination, as well as the need to suddenly ‘drop everything’ can disrupt your life

• In a basic diagnostic work-up, your doctor will look for clues that may also indicate contributing factors.The exam will likely include:
• A medical history
• A physical examination with particular focus on your abdomen and genitals
• A urine sample to test for infection, traces of blood or other abnormalities
• A focused neurological exam that may identify sensory problems or abnormal reflexes

• Your doctor may order urodynamic tests, which are used to assess the function of your bladder and its ability to empty itself steadily and completely.These tests usually require a referral to a specialist in urinary disorders in men and women(urologist) or urinary disorders in women (urogynecologist).Tests include:
• Measuring urine left in the bladder.When you urinate or experience urinary incontinence, your bladder may not empty completely.The remaining urine (postvoid residual urine) may cause symptoms identical to an overactive bladder.To measure residual urine after you have voided, a thin tube (catheter) is passed through the urethra and into your bladder. The catheter drains the remaining urine, which can then be measured. Alternatively, a specialist may use an ultrasound scan, which translates sound waves into a measurement of the amount of urine remaining in your bladder.
• Measuring urine flow rate.Auroflowmeter is a device into which you urinate to measure the volume and speed of your voiding.This device translates the data into a graph of changes in your flow rate.
• Testing bladder pressure. Cystometry measures bladder pressure during filling. Pressure-flow studies measure the amount of pressure needed to urinate and the speed of the urine flow.A catheter is used to fill your bladder slowly with water.Another catheter with a pressure-measuring sensor is placed in your rectum or for women, in your vagina. This procedure can identify involuntary muscle contractions, indicate the level of pressure at which you feel an urge or experience leakage, and measure pressure used to empty your bladder.
• Measuring bladder nerve impulses.Electromyography assesses the coordination of nerve impulses in the muscles of the bladder and the urinary sphincter. Sensors are placed either on or in the skin in your pelvic floor.
• Creating images of bladder function.Video urodynamics use either X-ray or ultrasound waves to create pictures of your bladder in combination with cystometry and a pressure-flow study as your bladder is filling and emptying. Your bladder is filled using a catheter, and you urinate to empty your bladder. The fluid contains a special dye that's detected by X-ray technology.
• Looking inside the bladder.A cystoscope, a thin tube with a tiny lens, enables your doctor to see the inside of your urethra and bladder. With the aid of this device, your doctor can check for abnormalities in your lower urinary tract, such as bladder stones or tumours.
• Your doctor will review the results of these tests with you and suggest a treatment strategy.

The choice of a particular treatment depends on the severity of the symptoms and the extent that the symptoms interfere with the patient’s lifestyle.The three main approaches to treatment include pharmacotherapy, behavioural therapy, and surgery.

Lifestyle Changes

• Fluid Intake: ideal fluid intake for an adult is 2 - 2.5 litres a day. If night time frequency is an issue, lessening fluid intake during the evenings may help. Prolonged fluid reduction causes concentrated urine, not drinking enough can lead to bladder irritability.
• Smoking:Nicotine can irritate the bladder muscle, causing bladder contraction and urgency.Coughing, as a result of smoking, may cause urinary leakage.
• Stress: It may be helpful to learn basic relaxation techniques such as meditation, yoga, breathing techniques and music relaxation.
• Exercise: Being overweight can cause pressure on the bladder, which may increase the symptoms of overactive bladder.Try to adopt a healthy diet, which should assist with weight loss as well as regulating bowel movement.If you are overweight or tired from disrupted sleep, you may find it difficult to exercise.Although it may be hard initially to make the effort, many people report feeling better physically and psychologically as a result.

Medications

Medications that relax the bladder can be effective for alleviating symptoms of overactive bladder and reducing episodes of urge incontinence. These drugs include tolterodine (Detrol), oxybutynin (Ditropan), an oxybutynin skin patch (Oxytrol), trospium (Sanctura), solifenacin (Vesicare) and darifenacin (Enablex). These medications are usually used in combination with behavioral interventions.

Surgery

Surgery to treat overactive bladder is reserved for people with severe symptoms who don't respond to other treatments. The goal is to improve the bladder's storing ability and reduce pressure in the bladder.However, these procedures won't help relieve any bladder pain you might be experiencing.Interventions include:

Botulinum Toxin – Intravesical Injections

Botox is now being used in our hospital as a treatment for OAB. Botox, (Botulinum A-toxin), is injected into the wall of the bladder to control the contractions. Whilst some patients have reported an immediate improvement in their symptoms it does not work for everyone and has to be repeated as the effect wears off. One side effect may be urine retention therefore a patient is taught intermittent self-catheterisation (ISC). It is advisable to fully discuss all the options and possible side effects with your consultant.

We are a centre of Excellence in Botulinum Toxin therapy for Overactive Bladder in the country for all refractory states , not responding to medical management.

• Surgery to increase bladder capacity.This major surgical procedure uses pieces of your bowel to replace a portion of your bladder.If you undergo this procedure, you may need to use a catheter intermittently for the rest of your life to empty your bladder.Because this is a major surgical procedure with the potential for serious side effects, this surgery is reserved for people with severe overactive bladder that hasn't improved despite other treatments.
• Bladder removal.This procedure is used as a last resort and involves removing the bladder and surgically constructing a replacement or an opening in the body (stoma) to attach a bag on the skin to collect urine.

Behavioural therapy combined with pharmacologic therapy offers good results in OAB patients, with up to 80% of cases improved and excellent long-term results

We have all facilities of Uroflowmetry, Ultrasonography, Urodynamics and Videourodynamics available in state of art form. At Kokilaben Hospital, a complete reconstruction team from Botox work to Augmentations of Bladder is the available at the hospital.