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SALEM COMMUNITY HOSPITAL...Living with an overactive bladder

December 4, 2011
Salem News

Thanks to celebrities like Kris Jenner of the famed Kardashians, the topic of urinary incontinence has been in the spotlight recently.

However, about one in six adults have experienced the symptoms of an overactive bladder at some point in their lives.

"Each time a person eats or drinks, the body absorbs liquids," explained Urologist Christopher Stiff, M.D. "The kidneys then filter out waste and extra liquids to make urine, which is stored in the bladder. The bladder is a muscle that can expand like a balloon to hold up to two cups of urine. As the bladder fills, a person feels stronger and stronger urges to urinate. In the case of someone with an overactive bladder, the bladder muscle may start to spasm and push urine out before the bladder has a chance to fill to its capacity.

"This condition is identified with symptoms such as urine leakage, strong sudden urges to urinate, and going to the bathroom too often. Frequently, the leakage is due to a temporary problem, like a persistent cough, a urinary tract infection, or a new medication. However, sometimes the leakage becomes chronic, which means that it occurs over an extended period of time."

Symptoms of an overactive bladder may include:

-Leakage of urine.

-Pain when the bladder fills or while urinating.

-Progressive weakness of the urine stream or dribbling.

-Increased frequency of urination.

-Waking up often with the need to urinate; bed-wetting or leaking urine in your sleep.

-Frequent urinary tract and bladder infections.

-Sensation of needing to void, even though you just urinated.

Possible Causes

"In many cases, the symptoms of an overactive bladder occur because the muscles of the bladder involuntarily contract," Dr. Stiff continued. "This contraction creates the urgent need to urinate. However, in some people, this urge is purely sensory, meaning that they might feel the need to go to the bathroom, even though the muscles aren't contracting."

Several factors may contribute to signs of an overactive bladder and should be evaluated because they require specialized treatments. These factors include:

-Neurological disorders, such as Parkinson's disease, strokes and multiple sclerosis, which are often associated with an overactive bladder.

-High urine production which may be linked to poor kidney function or diabetes.

-Acute urinary tract infections.

-Abnormalities in the bladder, such as tumors or bladder stones; or factors that obstruct bladder outflow, like an enlarged prostate or constipation.

-Excess consumption of caffeine or alcohol.

-Medications causing an increase in urine production or that are taken with lots of fluids.


"Many people never talk to their doctors about their overactive bladder symptoms," Dr. Stiff stated. "Sometimes they assume that an overactive bladder is a normal part of aging, and they try to manage their condition by wearing absorbent undergarments or pads. However, symptoms of urgency and incontinence aren't an inevitable part of getting older, and treatments are available that might help."

Lifestyle interventions are the first step in managing an overactive bladder, and include:

-Fluid consumption: People who are safely able to reduce their fluid intake by about 25 percent may experience a decrease in symptoms.

-Bladder training: A person may start with very small delays in urinating, such as waiting 10 minutes, and gradually working up to urinating every three to five hours.

-Double voiding: After urinating, wait a few minutes and try to empty your bladder again.

-Scheduled toilet trips: Try to urinate at the same times every day, such as every two-four hours, rather than when you feel the urge to urinate.

-Pelvic floor muscle exercises: Kegel exercises strengthen pelvic floor muscles and urinary sphincter muscles that hold urine when bladder muscles involuntarily contract.

-Intermittent catheterization: Under a doctor's supervision, you can learn how to empty your bladder by passing a catheter periodically to empty it completely.

-Absorbent pads: Wear absorbent pads or undergarments to protect your clothing.


Medications that relax the bladder can be effective for alleviating symptoms and reducing episodes of urge incontinence. These drugs include tolterodine (Detrol), oxybutynin (Ditropan), an oxybutynin skin application (Gelnique), trospium (Sanctura), solifenacin (Vesicare), darifenacin (Enablex), and fesoterodine (Toviaz).

Other Treatment Options

"Sacral nerve stimulation involves electrical stimulation of the nerves that control the bladder," Dr. Stiff concluded. "A neurotransmitter device, implanted under the skin in the upper buttock area, transmits mild electrical impulses through a wire located close to the sacral nerve. The impulses, in turn, influence the bladder muscles and pelvic floor muscles to provide bladder control. Surgery to treat overactive bladder is reserved for people with severe symptoms who don't respond to other treatments. The goal of surgery is to improve the bladder's storing ability and reduce pressure in the bladder. "In the past, those with an overactive bladder may have felt embarrassed or isolated. The good news is that appropriate treatment may help reduce or eliminate symptoms and positively manage their impact on a person's daily life."

Christopher Stiff, M.D., is a Board certified Urologist affiliated with Salem Community Hospital's Medical Staff. His office is located at 2360 Southeast Boulevard in Salem (330) 337-1134; and 885 South Sawburg Avenue, Suite 105 in Alliance 330-823-1112.



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