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A Difficult Condition
to Discuss and Treat
(OAB or Over Active Bladder:
Detrussor Instability)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 24 in the January 16, 2013 issue of
The Mississauga News under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

I find it interesting how a simple blue pill has brought erectile problems into the open. There is another more bothersome and prevalent condition that is still very much in the closet and rarely mentioned. OAB or Over Active Bladder is also known as detrussor instability.

Anytime there is trouble with control of our bodily functions, social stigmata start to influence our behavior, and we can quickly become trapped in a life style dictated by the condition.

Bladder control problems are under-reported and we really don't know what the true numbers are, but it has been estimated that as many as 20% of adults experience some degree of urgency, and of course this number rises with age.

In the normal human, it is common to feel some degree of a need to empty as the bladder distends with urine. Function depends on supporting structures around the bladder, at the urethra and various nerve signals. Pathological urgency is a signal to the brain to "empty" prematurely and frequently. It can be quite strong, and can be associated with unexpected wetting.

Some of the causes are easily diagnosed, such as stroke, diabetes or those associated with dementia. Most remain a mystery. A "prolapse" of the bladder is an anatomic deviation associated with certain conditions such as difficult childbirth and obesity. The bladder can be stressed if the uterus begins to drop, and simple laughter can cause urine leakage. Some of these cases can be helped with traditional and new surgical techniques, and others respond to Kagal exercises, designed to strengthen the pelvic floor.

We doctors tend to breach the subject during the physical exam. It is a difficult subject to discuss, never-mind treat. The first step is liquids. Trying to restrict liquids will help. Drinking only when thirsty is a start. Moderate use of caffeine and alcohol helps.

There is a common childhood myth that can make things worse. Mothers have been telling their daughter for eons to not "hold it". There is little basis for this notion. In fact, there is more support to suggest that teenage bladder habits persist into adulthood. This may be a hold-over from bed-wetting days when going to bed with an empty bladder helped.

There are some medications that can help, but have side-effects and none guarantee success. This is not a problem unique to women, as suggested by the filled plastic bottles that litter our highway ditches lend testimony to. Adult urinary sanitary aid products represent an expanding industry in our stores.

Anyone who has recovered from a simple urine infection can only begin to relate to OAB. People afflicted with OAB need our understanding and feel great embarrassment. They have trouble driving far distances, working in confined conditions, expressing intimacy, travelling on planes and sitting for long periods. This results in a trapped feeling, and increases the incidence of depression. The situation is rarely hopeless, and requires more open discussion.

Related resources:

Over-Active Bladder. Dr. Andrew Siegel discusses the management of the bladder that "squeezes without our permission." YouTube video, 8:40 min.

Pelvic floor exercises | Overactive Bladder Control Problems. YouTube video, 0:49 min.

Overactive Bladder (OAB) from MedicineNet.

Overactive bladder from Wikipedia.

Overactive Bladder - Causes from Mayo Clinic.

Bladder (Overactive) from C-Health, Canoe.ca. Overactive Bladder (OAB) Factsheet: Facts on Overactive Bladder, Causes of Overactive Bladder, Symptoms and Complications of Overactive Bladder, Diagnosing Overactive Bladder, Treating and Preventing Overactive Bladder.

What Causes an Overactive Bladder? By Jill Leviticus, eHow Contributor. "The condition is actually a symptom of a number of medical disorders and has numerous causes. According to the National Association for Continence, 1 in 5 adults over 40 suffer from the symptoms of an overactive bladder."

Overactive Bladder from Cleveland Clinic. Symptoms, Causes / Risk Factors, Diagnosis & Testing, Treatment, Bladder Irritating Foods, Nocturia, Nocturnal Polyuria.

Overactive Bladder from eMedicine Health, article by Siamak T. Nabili, MD, MPH, Medical Editor: Melissa Conrad Stöppler, MD, Chief Medical Editor. Overactive Bladder Overview, Causes, Risk Factors, Symptoms and Signs, Diagnosis, Treatment, Self-Care at Home, Medications, Surgery, Complications, Follow-up, Prevention, Prognosis.

Urge incontinence from Wikipedia.

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