One of Hollywood’s most celebrated actresses with a career spanning over 50 years, Debbie Reynolds led a very active life till she began to experience the symptoms of an overactive bladder. However, the actress thought that these more frequent trips to the bathroom were just a natural part of the aging process. She had no idea that her

symptoms signalled a medical condition or that there were treatments available. Besides, she was too embarrassed to talk to anyone about the situation.

Impacting the quality of life
Not just Reynolds, there are millions of women who suffer from the involuntary loss of urine called urinary incontinence (UI). Some women may lose a few drops of urine during coughing, sneezing or running and so on.
Normally, the urinary bladder stores urine and empties it when desired. The brain controls this urinating mechanism. An Overactive Bladder (OAB) is a condition that results from a sudden and involuntary contraction of the urinary bladder. This causes a sudden compelling desire to urinate, a sensation that is difficult to defer.
Often, urine leaks before one can reach the toilet. Abnormal nerve signals might be the cause of these bladder spasms. Certain medications such as diuretics, uncontrolled diabetes or emotional states such as anxiety can worsen OAB.
An Overactive Bladder is a “silent struggle” for many women. It causes embarrassment and social inactivity, but it is treatable. While women have many urological issues, the most overlooked and common medical condition is OAB. This condition can be associated with other medical problems such as urinary tract infection (UTI), skin infection and, in elderly persons, an increased risk of falls and fractures. Patients should not hesitate to discuss the symptoms of OAB.

Treatment for OAB
Persons with OAB may have poor sleep quality due to frequent urination during the night. This causes chronic fatigue and difficulty in performing daily activities. Increased incidences of hip fractures due to falls in elderly persons have been attributed to OAB.
In some people the problem is severe and it interferes with normal daily activities. The sufferer may gradually stop engaging in outdoor activities and may become a social recluse. OAB may affect one’s work and ability to travel. Urine loss can occur during sexual activity and cause a lot of emotional distress.
While there are many causes of OAB, often no distinct etiology is found. An involuntary contraction of the bladder muscles can occur because of the damage to the nerves of the bladder, to the spinal cord and brain, or to the bladder muscles themselves. A clinical diagnosis of OAB can be made on the basis of the history and a physical examination, in conjunction with a few simple tests.
Behavioural therapies: Patients are educated about how urine is formed, stored and then expelled out of body when desired. Some patients benefit by making it a point to urinate at regular intervals of time, a habit called timed voiding. As one gains urinary control, the time between scheduled urination is extended. Behavioural treatment also includes pelvic floor muscle exercises to strengthen the muscles that help hold in urine.
Medications for OAB: There are medications available now which reduce the contractility of the bladder muscle. However, their use is limited by side-effects, like a dry mouth, drowsiness and constipation. The newer ones have fewer side-effects.
Behavioural therapy combined with medicines offers good results in OAB patients, with up to 80 per cent of cases improved. Severe OAB refractory to the oral medications can be treated by injecting Botox into the bladder muscle. But in a few patients, it can paralyse the bladder muscle completely so that they are unable to pass urine.

if medications don’t work
Biofeedback: Biofeedback can help one to become aware of the body’s functioning. By using electronic devices or diaries to track when the bladder and urethral muscles contract, one can gradually control these muscles. Biofeedback is a useful adjunct in treating urinary incontinence.
Neuromodulation: For OAB not responding to behavioural treatments or medicines, stimulation of the spinal nerves to the bladder can be effective in some patients. Neuromodulation is a new technique approved for the management of OAB. It requires the surgical implantation of a small device for sacral nerve stimulation. Although it can be effective, it requires careful patient selection.
Surgery: Augmentation cystoplasty is rarely necessary in idiopathic OAB. In this reconstructive procedure, a patch of the bowel is joined to the bladder. This increases the bladder
capacity and disrupts the coordinated contraction of the bladder muscles.

The writer is Director-Urology and Renal Transplantation
Fortis Escorts Heart Institute
New Delhi