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Frequent Urination & Overactive Bladder


 

The Symptoms:

Men and women can develop these symptoms very slowly over time so that they gradually adjust their activities and lifestyle and may not realize how much they have been affected, or that treatments are readily available. Most individuals who need to urinate every two hours or more during the day, or several times at night, have correctable underlying abnormalities.

A common term now is Overactive Bladder used to describe the symptoms of urinary frequency, urgency, and urge incontinence. There are many causes of overactive bladder symptoms. For example, an inflammation or infection may make the bladder too irritated to store urine. Or the bladder may be emptying poorly due to weak contractions or blockage from an enlarged prostate. In rare cases a tumor or cancer in the bladder or prostate may be to blame.

Pelvic floor muscle dysfunction and spasms often accompany overactive bladder symptoms causing further symptoms of frequency, urgency, constipation, pelvic pain, and painful intercourse.


Causes of Frequent Urination:

Since there are many causes of frequency/urgency, be careful of blind treatments with Detrol or Ditropan, which are very popular now. Although these drugs may improve symptoms and in many cases are an important part of treatment, they do not correct the underlying problem and in some cases can make matters worse if the underlying problem is not sorted out first. Fortunately with proper evaluation and treatment, almost all patients can expect to find the cause of their symptoms and marked or complete cure.
Below is a brief idea of some of the more common causes of frequent urination and their treatments. Please keep in mind this is just a basic overview to give you ideas for further thought. The important message is that if you do suffer from frequent and/or urgent urination we can usually help.

Common causes of frequent urination/ urgent urination/ urge incontinence symptoms (the so called “Overactive Bladder”)

  • In Women: Urethritis, urethral stenosis, interstitial cystitis, pelvic floor dysfunction.
  • In Men: BPH (enlarged prostate), chronic prostatitis, interstitial cystitis, pelvic floor dysfunction.

Be aware that for both men and women frequency/urgency can also be a sign of a serious problem such as bladder or prostate cancer, urinary retention, neurological disease, diabetes, etc. and warrants evaluation to appropriately guide therapy.

  • In Children: Overactive bladder in children manifests as bedwetting, daytime urgency or accidents, and constipation individually or in combination. See section on bedwetting.


Common Effective Treatments:

  • Urethritis urethral stenosis: antibiotic prophylaxis, urethral dilation, estrogen creams
  • Interstitial cystitis: hydrodistension, Elmiron, UTI prevention, food allergy avoidance, DMSO instillations
  • BPH: alpha blockers, Proscar, TURP, TUNA, TUMT, Laser (see also BPH section)
  • Chronic Prostatitis: antibiotic prophylaxis, alpha blockers, Proscar, NSAIDS, biofeedback, stress management.
  • Pelvic Floor Dysfunction: biofeedback, stress management, Interstim neuromodulator implant


General Measures (Often used in addition to specific treatments above):

Bladder relaxers such as Ditropan or Detrol  until the underlying disorder is corrected timed urination, bladder irritant avoidance such as caffeine, fluid restriction, and biofeedback.

  • Biofeedback: This refers to pelvic floor muscle physical therapy and is becoming a major component of treatment for frequency/urgency, urge incontinence, chronic pelvic pain, bedwetting, and constipation syndromes. Pelvic muscle spasticity often accompanies these types of symptoms and may not resolve even though the underlying disorder has been corrected. Just as physical therapy is an important part of correcting back pain after a slipped disc is repaired, biofeedback therapy can be an important part of treating overactive bladder.
  • Interstim Pelvic Neuromodulator: A new and exciting option. This is an implanted device similar to a pacemaker that modulates bladder contractions through pelvic floor muscle control. Reserved for rare cases where Biofeedback is ineffective.
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