Overactive bladder causes a frequent and sudden urge to urinate that is difficult to control. The person will have the feeling of the need to pass urine many times during the day and night, and at times, unintentional loss of urine (urgency incontinence). Rather than being a disease, it causes embarrassment, isolation, and limitation to work and social life. The good news is that a brief evaluation can determine whether there’s a specific cause for the overactive bladder symptoms. In most cases, symptoms of an overactive bladder can be managed with simple behavioural strategies, such as dietary changes, timed voiding and bladder-holding techniques using pelvic floor muscles.
Signs & symptoms
- A sudden urge to urinate which is difficult to control
- Unintentional loss of urine immediately after an urgent need to urinate (urgency incontinence)
- Urinate frequently, usually eight or more times in 24 hours
- Wake up more than two times in the night to urinate (nocturia)
Causes
The exact cause of an overactive bladder is mostly unknown. But several conditions may contribute to signs and symptoms of overactive bladder, including:
- Neurological disorders, such as stroke and multiple sclerosis
- Diabetes
- Urinary tract infections that can cause symptoms similar to those of an overactive bladder
- Hormonal changes during menopause in women
- Abnormalities in the bladder, such as tumours or bladder stones
- Factors that obstruct bladder outflow — enlarged prostate, constipation or previous operations to treat other forms of incontinence
Other risk factors include:
- Medications that cause a rapid increase in urine production
- Excess consumption of caffeine or alcohol
- Declining cognitive function due to ageing, which may make it more difficult for the bladder to understand the signals it receives from the brain
- Difficulty walking, which can lead to bladder urgency when the person is unable to get to the bathroom quickly
- Incomplete bladder emptying, which may lead to symptoms of overactive bladder.
Pathophysiology
Three main factors have been proposed regarding the cause of overactive bladder: myogenic (related with muscles), neurogenic (related with nerves) and urotheliogenic (related to the lining of urinary organs). Disturbance of any of the three factors or a combination of these factors can attribute to an overactive bladder. Normally, as the urinary bladder fills, nerve signals sent to the brain eventually trigger the need to urinate. When urinated, these nerve signals coordinate the relaxation of the pelvic floor muscles and the muscles of the urethra (urinary sphincter muscles). The muscles of the bladder tighten (contract), pushing the urine out. When this process and the contraction mechanism becomes completely deranged, involuntary bladder contractions occur leading to an overactive bladder. It happens when the muscles of the bladder start to contract involuntarily even if the volume of urine in the bladder is low. Such involuntary contractions create an urgency to urinate. Metabolic derangement, bladder outlet obstruction and inflammation can increase the excitability of the nerve, the detrusor muscle and alter the sensory and barrier functions of the urothelium. The detection of proteins in the urine such as NGF, PGE2, and proinflammatory chemokines leads to the pathophysiology of overactive bladder and offer novel diagnostic biomarkers of overactive bladder.
Diagnosis
- Medical history
- Physical examination
- Urine sample analysis
- Neurological examination
- urodynamic tests
Measuring urine left in the bladder (post-void residual urine)
Measuring urine flow rate.
- Testing bladder pressures.(Cystometry)
- USG
- CT scan
- MRI
Treatments
A combination of treatment strategies may be the best approach to relieve overactive bladder symptoms.
Behavioural therapies
Behavioural interventions are the first choice in helping manage an overactive bladder. They’re often effective, and they carry no side effects. Behavioural interventions may include:
- Pelvic floor muscle exercises.Kegel exercises are used to strengthen pelvic floor muscles and urinary sphincter. Strengthened muscles can help stop the bladder’s involuntary contractions.
- Biofeedback therapy
- Maintaining a healthy weight
- Scheduled toilet trips
- Intermittent catheterization
- Absorbent pads
- Bladder training.
Medications
After menopause – vaginal oestrogen therapy
Medications that relax the bladder include:
- Tolterodine (Detrol)
- Oxybutynin, which can be taken as a pill (Ditropan XL) or used as a skin patch (Oxytrol) or gel (Gelnique)
- Trospium
- Fesoterodine (Toviaz)
- Mirabegron (Myrbetriq)
- Bladder injections – Botox injection, is a protein from the bacteria that cause botulism illness. In small doses when injected into bladder tissues, this protein helps the muscles to relax.
Nerve stimulation therapy like Sacral nerve stimulation, Percutaneous tibial nerve stimulation etc.
Surgical procedures include:
- Surgery to increase bladder capacity.This procedure uses pieces of the bowel to replace a portion of the bladder.
- Bladder removal.Used as a last resort and involves removing the bladder and surgically constructing a replacement bladder or an opening in the body to attach a bag to the skin to collect urine.
Prognosis
The overall prognosis for overactive bladder is good in young patients. Many medicines and non-invasive therapies are available and surgery can be done as a last resort. Yet, overactive bladder along with other co-morbidities in old age people show a bad prognosis.
Complications
- urinary tract infections
- skin irritation
- skin infection
- urinary calculi especially in the bladder
- falls/fractures in elderly
- Sleep disturbances and interrupted sleep cycles
- negative impact on quality of life
- anger, aggression and depression
- anxiety
- Sexual problems
- mixed incontinence, when both urgency and stress incontinence occur.
Disease & Ayurveda
Diseases of the urinary system are elaborated in detail in Ayurveda classics. All of them are classified broadly into two. The first set of diseases are those where urine content is low & the flow is obstructed(mootraghata) and the second set comprises diseases in which the urine output is high & the flow is uncontrollable (Prameha). Overactive comes under the term prameha which broadly enumerates the diseases of uncontrolled, increased & turbid urination (prabhoota&aavila mootrata). 20 types of Prameha are described. Overactive bladder with clear urine can be compared with udakameha.
Nidana
- The diet which enhances medas(fatty tissue), mootra(urine) and kapha in the body
- Madhura(sweet)-amla(sour) and lavana(salty) tastes
- Snigdha(oily)-guru(heavy)-picchila(sticky) & seetala(cold) food items
- Navadhaanya – new cereals
- Suraa – alcoholic drinks from ground & fermented cereals
- Anoopamamsam – the meat of animals in anupadesa(humid regions)
- Ikshu- sugar cane
- Guda – jaggery
- Gorasam- milk etc.
- Ekasthaanaasanarati – Sedentary lifestyle
- Vidhivarjitasayanam – unhealthy ways of sleeping
- And all the habits of unwholesome diet & lifestyle
Purvaaroopa
- Dantaadinam malasanchaya – deposits on teeth & oral cavity
- Panipada daha – the burning sensation of hands & feet
- Dehe chikkanataa – stickiness in the body
- Thrishna – excessive thirst
Samprapti
Due to the causative factors, the vitiated doshas, mainly kapha vitiate the whole body (especially kleda, sweda, medas, rasa and aamisham) and starts the disease. In turn the kapha is lessened and Pitta-Rakta get aggressive. Thus, Paittikaprameha develops which in turn leads to Vaatikaprameha when chronic.
Lakshana
Accham(clear),
Bahu (more in quantity),
Sitam (whitish discolouration), urine output
Seetam (cold in touch),
Nirgandham (without any smell),
Udakopama(watery)
Divisions
Not mentioned for udakameha
Prognosis
Saadhya
Chikithsa
Ayurveda treatment of Prameha for a strong patient starts with Sodhana therapies for cleaning the body by expelling the accumulated toxic waste materials. It should be done after oleation with kledahara snehadravyas like Sarshapataila, arishtataila nikumbhataila akshataila or karanjataila. Once the doshas are expelled out and the body is clean, the patient should be given strengthening preparations like meat soup.
Samana
Aamapachanam
Agnideepanam
Haridra+dhatreerasa + honey in empty stomach in the morning
Sodhana
Vamanam
Virechanam
Kashayavasti
Commonly used medicines
Gandharvahstaadi kashayam
Sukumaram kashayam
Katakakhadiradi kashayam
Nisakatakadi kashayam
Ayaskriti
Mehari choornam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Keraleeya Ayurveda samajam
Vaidyaratnam oushadhasala
Home remedies
- Maintain a healthy weight. Get rid of obesity.
- Drink adequate amounts of fluid, avoid dehydration and stress.
- Limit foods and drinks that might irritate your bladder such as caffeine, alcohol, tea, carbonated drinks, citrus juices etc.
- Get regular, daily physical activity and exercise.
- Quit smoking.
- Manage chronic conditions, such as diabetes, that might contribute to overactive bladder symptoms.
- Learn pelvic floor muscles exercises and then strengthen them by doing them regularly like Kegel exercises
Diet
- To be avoided
Sweet food items and artificial sweetners
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, obstruct channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, ragi, raw jackfruit, etc.
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from extreme climate changes.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid a sedentary lifestyle.
Yoga
Regular stretching and mild cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve the bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://pubmed.ncbi.nlm.nih.gov/26676700/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476015/
*These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake. Ayurveda Supplement with GMP Certification from India.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
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