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Bladder

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Bladder

The bladder is a muscular organ located in the pelvis. When empty, the bladder is usually about the size and shape of a pear. When urine is produced in the kidneys, it travels down two tubes called ureters to the bladder, where stored until full. This allows urination to be infrequent and voluntary. Many common conditions affect the ability of the bladder to function properly.

The bladder has two primary functions: to store and eliminate urine. Urine exits the bladder via the urethra, which carries it out of the body. Restriction of flow at the level of the urethra is another common cause of improper bladder function.

Common Bladder Conditions

Cystitis

Inflammation or infection of the bladder causing chronic pain or discomfort.

Urinary Stones

Most urinary stones form in the kidney. Some stones, however, are formed in the bladder and can block urine flow from the bladder. They can cause significant irritation when voiding, even bleeding with urination.

Bladder Cancer

A tumor in the bladder is usually discovered after blood is noticed in the urine. Cigarette smoking and certain workplace chemical exposures can increase the risk of developing bladder cancer. There is also a hereditary predilection to bladder cancer. Click here for more information on bladder cancer.

Incontinence

This is simply the involuntary loss of urine; that is, leaking urine when you do not intend or expect it. Click here for more information on incontinence.

Overactive Bladder

Occurs when the bladder muscle contracts involuntarily, which can cause urine to leak out. It is a common cause of urinary incontinence, especially in women.

Hematuria

When blood is found in the urine. It may be caused by several benign factors, but it may be caused by malignancy or other serious conditions. This should be reported to your physicians immediately so that it can be carefully evaluated.

Urinary Retention

Happens when a bladder is not able to empty because of obstruction or poor contractility. Sometimes a patient has few symptoms if it develops gradually. Often there is a feeling of fullness and visible distention of the lower abdomen.

Cystocele

The bladder, in women, can drop and can press on the vagina due to weakened pelvic muscles. Childbirth and hysterectomy can contribute to their development. This condition can lead to urinary problems.

Bed-Wetting (nocturnal enuresis)

When a child age 5 or older urinates during his/her sleep at least one or two times per week over a period of three months or more. This is a very common condition, often normal, and only rarely associated with serious health concerns. This, most often, resolves with time.

Dysuria (painful urination)

Pain during urination due to infection or inflammation of bladder. Can sometimes be a sign of more serious urinary problems and should be discussed with your physician.

Overactive Bladder Treatment

 

Behavioral Therapies

In addition to drug therapies for OAB, behavioral regimens have been shown to reduce urinary urgency and frequency. These regimens range from simple maneuvers such as timed voiding and fluid management to biofeedback (education of how to contract the pelvic floor muscles with the aid of gentle electrostimulation). Pelvic muscle exercises (Kegel exercises) are beneficial in controlling urinary urges and can be done alone or in combination with drug therapy. Also, patients may help their voiding problem by changing certain aspects of their diets (e.g., decreasing caffeine or alcohol intake), losing weight and stopping smoking.

 

Drugs

Medications that relax the detrusor (bladder muscle) or prevent a bladder contraction are effective for OAB. These medications are called anticholenergics.  A new class of medications, beta 3 agonists, are now also available to help with bladder over activity.

 

Sacral Nerve Stimulation

After a test procedure to confirm benefit, a small neurostimulator is implanted to help regulate unstable bladder contractions or help emptying of the bladder. This method of treatment is often used in patients that are not benefited by the medications or are unable to tolerate their side effects. This is an outpatient procedure with a short time to recovery.

 

Botulinum Toxin

Botulinum toxin (Botox) may be injected into the bladder wall to control the overactive bladder muscle. This is mainly used in patients with neurological conditions which lead to unstable bladders.

About Overactive Bladder

Overactive bladder (OAB) is a condition characterized by a sudden need to urinate, usually with daytime and nighttime frequency.

OAB occurs when the bladder muscle (detrusor) squeezes or contracts more often than normal and often at inappropriate times. Instead of staying at rest as urine fills the bladder, the detrusor contracts while the bladder is filling with urine.

How is Overactive Bladder Diagnosed?

Most often, the diagnosis is made by the physician taking a history and ruling our more concerning causes of urinary symptoms.

A urination diary is often helpful in keeping an accurate log of urinary symptoms. Documenting symptoms can help your urologist make the proper diagnosis.

A urinalysis (UA) must be performed to rule out infection and to look for glucose (sugar), blood, white cells or difficulty concentrating the urine (specific gravity). After urination, residual urine is often checked using an ultrasound or catheterization. In some patients, a urine cytology or endoscopy (cystoscopy) of the bladder is warranted. It is sometimes useful to perform bladder pressure testing using cystometry (CMG) to document bladder (detrusor) over activity during filling and exclude obstruction. Imaging of the urinary tract with cystogram, computerized tomography (CT) scan or magnetic resonance imaging (MRI) is rarely needed.