What is it?
Overactive Bladder refers to a group of symptoms that include a sudden urge to pass urine that is difficult to ignore or postpone, that can even result in leakage (urge incontinence) before you can make it to the toilet, a frequent need to pass urine day or night (nocturia), or a sudden involuntary loss of urine without a preceding urge.
What causes it?
It results from an involuntary contraction of the bladder muscle. Triggers can include running water, the ‘key in the door’, seeing the toilet, or standing after sitting. In some patients there is an underlying neurological condition but in most we do not understand why they have developed these symptoms.
What tests are required?
A urine test to exclude infection or blood in the urine and a bladder diary. Further tests to exclude other pathology may include imaging of the kidneys and bladder and a cystoscopy to examine the inside of the bladder. Urodynamics is the main test for patients failing pelvic floor exercises and medication. The history and examination findings may not always lead to the correct diagnosis and this test helps confirm the diagnosis before proceeding with surgery and also detects other problems that may co-exist and influence treatment choice.
What is mixed incontinence?
Patients with Urge Incontinence may also have other problems such as Stress Incontinence. Then both conditions may require different treatments.
What are the non-surgical treatments?
- Pelvic Floor Exercises: (These do not require getting on the floor.) The muscles that support the bladder and urethra are called the ‘Pelvic Floor Muscles’.
- Bladder training exercises.
- Caffeine reduction, good diet and bowel function.
- Medications - There are several available in Australia. The anticholinergic medications include Oxybutynin (Ditropan), Amitriptylline (Endep), Tolteridine (Detrusitrol), Solifenacin (Vesicare), Oxybutynin Skin Patch (Oxytrol) and Darifenacin (Enablex). Mirabegron (Betmiga) is a beta agonist.
- Percutaneous Tibial Nerve Stimulation
What are the surgical options?
1. Botulinum Toxin (Botox) – injections into the bladder to reduce bladder muscle contraction.
2. Sacral nerve Neuromodulation – a device implanted into the lower back to control the bladder via electrical stimulation of the sacral nerve.
3. Augmentation Cystoplasty – a small bowel patch is placed on the bladder to make it larger and reduce its ability to contract.
Is there government funding for pads?
Financial support is available for patients, with severe incontinence, who qualify under the government Continence Aids Payment Scheme (CAPS).
Version: V4, July 2015