Article contributed by:
Dr Siow Woei Yun,
Specialist, Urology,
Raffles Hospital,
Singapore
for New Dimension -
biannual newsletter of
the
Society for Continence,
Singapore
“I cannot control my
bladder!”
Individuals with
overactive bladders
often complain of
urinary frequency i.e. a
need to empty the
bladder less than two
hours after it was last
emptied. They also
complain of urgency i.e.
a strong need to empty
the bladder; a need that
is so strong it cannot
be denied or postponed.
For some, this sensation
of urgency may result in
urge urinary
incontinence i.e.
urinary leakage before
the individual makes it
to the toilet.
And, these symptoms may
also be associated with
nocturia i.e. waking up
many times from sleep to
pass urine.
This combination of
symptoms i.e. urinary
frequency, urgency,
urges urinary
incontinence and
nocturia forms the
overactive bladder
syndrome.
Overactive bladder
syndrome is not a
life-threatening
condition; however, it
can adversely affect
one’s quality of life.
In addition, certain
diseases of the bladder
e.g. infection, stones
and tumours may share
the same symptoms as
overactive bladder and
these need to be
identified and treated.
Thus, individuals with
problems controlling
their bladders must be
carefully evaluated
before being started on
overactive bladder
medication.
Seeking a consultation
Your doctor will ask you
detailed questions
regarding your urine
symptoms and ascertain
the impact of these
urine symptoms on your
quality of life.
Thereafter, a physical
examination will be
performed.
Urine tests form the
basic investigations.
If the urine tests are
abnormal, further
treatment e.g.
antibiotics therapy or
additional
investigations may be
needed.
Special tests that may
be required
Special tests include CT
urogram i.e. a computer
scan of the kidneys and
ureters and cystoscopy
i.e. introducing a
bladder scope into the
bladder to check on the
bladder and the urethra.
Occasionally, a
specialised test known
as urodynamics study may
be performed to study
the dual functions of
the bladder i.e. storage
and voiding of urine.
This may be requested by
your doctor to document
the extent of bladder
overactivity.
Treatment of overactive
bladder
Once the diagnosis of
overactive bladder has
been confirmed,
medication forms the
mainstay of treatment.
Over the years,
medication has increased
in sophistication, with
the newer medicines
requiring fewer doses a
day and causing fewer
and milder side effects.
Approximately six
different medications
are available in
Singapore for this one
condition alone!
This is because
different individuals
have different disease
severity and different
response to treatment,
thus therapy must always
be tailored and
individualized.
Botox for my bladder!
Not all individuals will
respond satisfactorily
to oral overactive
bladder medicines.
Some individuals with
overactive bladder fail
to respond to oral
medications while others
complain of intolerance
to the side effects of
oral medications.
For these individuals,
Botulinum toxin A
injection into the
bladder wall may be
considered as an
alternative treatment
option.
Botulinum toxin A works
by causing partial
paralysis of the bladder
muscles. This
helps to alleviate the
symptoms of urinary
frequency, nocturia,
urgency and urge urinary
incontinence.
Individuals selected for
Botulinum toxin A
injection will have the
medication injection
into their bladder walls
via the cystoscope.
There is no need for
skin incisions.
This procedure may be
performed under local
anaesthesia, regional
anaesthesia or general
anaesthesia. The
effect of one treatment
session lasts for six to
nine months. The
rate of symptom
recurrence varies from
individual to
individual. When
the recurrent urinary
symptoms once again
become bothersome, a
repeat injection can be
administered.
Conclusion
Loss of bladder control
is a common complaint.
It is both distressing
and debilitating.
The causes of this are
varied and a detailed
evaluation is necessary
to determine the cause
in each individual.
Once an accurate
diagnosis is made, more
precise and effective
therapy can be tailored
and planned.
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Article contributed by:
Dr Siow Woei Yun,
Specialist, Urology,
Raffles Hospital,
Singapore
for New Dimension -
biannual newsletter of
the
Society for Continence,
Singapore
Dated: June 2015
Please click
here
for Chinese version of this article.
|
The
Society for
Continence,
Singapore
(SFCS) is a
non-profit
organization
that
originated
from the
dedicated
efforts of a
group of
doctors,
nurses and
rehabilitation
therapists
who
recognised
the special
needs of the
incontinent
as far back
as 1988.
The mission
of the
society is to
promote
bladder and
bowel health
and to work
towards a
community
free of the
stigma and
restrictions
of
incontinence.
The society
aims to
disseminate
information
and educate
healthcare
professionals
and the
public on
methods to
promote
urinary &
bowel
continence
and to
promote the
education,
training and
rehabilitation
of the
incontinent
and their
general
interests
and welfare. |
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