Overactive Bladder

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What is Overactive Bladder?

Overactive Bladder (OB) is a very common condition where there is micturition urgency (a feeling of having to urinate right away), frequency (more than 8 times in 24 hours, including 2 or more during the night) and urinary urge incontinence (uncontrolled urination or wetting accidents) among adults or children. Those afflicted have bladder muscles that act inappropriately.

How common is it?

More than 17 million people in the United States are afflicted with this condition. It is more prevalent than diabetes mellitus (7 million), asthma (15 million), Alzheimer's (4 million), and osteoporosis (10 million). In the United States alone, the cost of urinary incontinence in 1995 among patients older than 65 was about $26.3 billion.

How does our urinary bladder work?

After the kidneys filter the blood that goes through them, urine is formed, containing all the impurities and waste products the body wants to eliminate. The urine flows down to the bladder where it is stored. When the bladder is full, the nerves in the bladder send a signal to the brain. In response to this, the brain causes us to feel "an urge to go," and transmits a "command" to the sphincter muscles to relax, then "orders" the detrusor (bladder wall) muscles to contract and allow urination to take place. In normal situation, where you have full control of your bladder, you urinate when you want to, but with an overactive bladder, the detrusor muscles may contract involuntarily, causing wetting accidents.

What is the cause of overactive bladder?

Why some people develop overactive bladder or lose control of their bladder is not known, but the symptom complex is clear and definitely indicative of the condition. Women are more likely to experience urinary urge incontinence (involuntary urine loss) compared to men.

What are the other bladder control problems?

Besides overactive bladder, the other bladder control problem is stress incontinence, where the muscles around the urethra (opening where urine comes out from) become weak. Laughing, coughing, sneezing, walking briskly or exercising can cause involuntary release of urine or wetting accident. Mixed incontinence is the other, which is a combination of overactive bladder and stress incontinence.

Is overactive bladder a normal part of aging?

No, it is not, and people do not have to accept it as a normal part of aging and surrender, and suffer from it. Once diagnosed, this condition can be treated effectively, with a once-a-day pill that is now available in drug stores.

Are diabetics more prone to develop this condition?

There is no medical evidence that suggests persons with diabetes are more prone to develop overactive bladder syndrome.

What condition can mimic an overactive bladder?

Urinary tract infection (UTI) can be confused with an overactive bladder because individuals with UTI might also feel the urge to void frequently, and may have burning sensation on urination. UTI may lead to serious kidney and other complications. Among men, prostatic hypertrophy (enlargement of prostate) might have the same symptoms as those with overactive bladder. This is why consultation with a physician is essential.

What is the treatment for OB?

Today, there is a convenient and effective way to treat overactive bladder. An oral preparation of oxybutynin chloride (brand name Ditropan XL), is one such medication available in most pharmacies. It is an extended-release tablet that is taken once a day (swallowed whole, not chewed or crushed), the first such long-acting drug effective for overactive bladder.

How effective is it?

Oxybutynin chloride is very effective in most patients in stopping or reducing urgency, frequency and wetting mishaps (from 16 to 2, or 90% reduction in a clinical study). Before effective drug was available, men, women and children with overactive bladder suffered and felt helpless about their sad state.

How soon does the drug take effect?

Responses of individuals vary, but in general relief from symptoms may be experienced after taking this drug for about two weeks. Indeed, this is one instance among the hundreds of thousand benefits the progress in medicine and pharmacology has contributed to the amelioration of the health and well-being of individuals.

Are there side effects?

About 7% of patients (7 out of 100) in clinical studies experienced some adverse side effects from the medication and had to discontinue the pills. Dryness of the mouth (6%) is the most frequent side effect. Others include constipation (13%), diarrhea (9%), blurred vision (8%), drowsiness (12%), dry eyes (6%), runny nose (6%), and dizziness (6%). In very hot condition, heat prostration occurs more readily when on oxybutynin chloride.

What happens to the shell that contains the drug?

Oxybutynin chloride is contained in a non-absorbable shell. After the medication is released into the body, the shell is eliminated in the colon. Occasionally, persons taking this drug might notice something that looks like a tablet in their stool. This is normal.

Who should not take oxybutynin chloride?

Oxybutynin chloride is contraindicated among people who have urinary retention, uncontrolled narrow-angle glaucoma, gastric retention, persons who are at risk of developing these conditions, and those who are allergic to this drug or to any of its components. Never self-medicate. Check with your physicians before taking any medications.

Are there any other safety concerns?

Yes, there are. Patients with overactive bladder who also have a gastrointestinal disorder or esophagitis (inflammation of the food pipe), or esophageal reflux (backing up of stomach contents to the food pipe), or esophageal blockage, should discuss in detail with their physician the use of oxybutynin chloride.

©2003Raoul R. Diez, M.A.O.D.