OVERACTIVE BLADDER

According to a two-year study undertaken at the University of North Carolina School of Nursing, Chapel Hill, older rural women can improve their urinary incontinence problem through behavioral management intervention. Molly Dougherty, PhD, RN and a professor at the university led the study group. The National Institute of Nursing Research, part of the NIH, funded the research.

There were a total of 178 subjects involved in the study group, all of whom resided in Florida and were 55 years of age or older. The behavioral management intervention involved the women setting goals for their continence. Three behavioral phases in sequence were also established.

The first sequence involved emptying the bladder at regular timed intervals. These timed intervals were gradually increased in timing, until it reached 2 1/2 hours or more. The women kept a bladder diary that included such information as descriptions of their liquid intake and intervals between urination.

Another intervention that was used sought to strengthen the muscles to prevent leaking urine. This involved pelvic muscle (kegel) exercises. More information about nursing research is available at the NINR website at http://www.nih.gov/ninr

Aging can bring with it many debilitating disorders, some more limiting then others. One disorder that can be quite embarrassing and have profound implications, both socially and medically, is overactive bladder. This disorder involves a complex of symptoms including urinary urgency, frequency and urge incontinence. These symptoms result from instability in the detrusor muscle in the bladder. The origin of this instability is presently idiopathic.

The involuntary loss of urine (urinary incontinence) effects 15 to 20% of ambulatory elderly people. Some consider it a major reason for social isolation among the elderly. It is a possible reason for the smells associated with nursing homes.

Spontaneous contraction of the detrusor muscle usually occurs when the bladder fills to approximately 150 to 250 ml. Most people can suppress the urge to void under normal circumstances. The elderly have difficulty suppressing this urge, losing the capacity to inhibit flow despite the bladder being not full.

Urge incontinence results from an uninhibited bladder (or detrusor instability) and occurs when there is an inability by patient to suppress sensations of bladder fullness; consequently, when a certain bladder volume is achieved, voiding occurs often within moments. The urge to void is very transient and is incompletely suppressible. You will see this problem in individuals who have had a stroke or are demented, but also it is not uncommon among individuals over 65 years of age.

The symptoms of overactive bladder tend to adversely affect the patient’s quality of life, but typically do not cause progressive bladder deterioration or subsequent renal failure. In contrast, a "neurogenic bladder" results from detrusor hyperflexia secondary to a known neurologic disease (stroke or dementia).

The symptoms of an overactive bladder and neurogenic bladder may be quite similar; however, the neurogenic bladder frequently results in progressive deterioration of the bladder function due to progressive nature of the underlying neurologic disease process. Subsequently, without aggressive intervention neurogenic bladder can compromise patient’s renal function.

In general, the goal of managing an overactive bladder is to improve a patient’s symptoms and then improve quality of life, whereas the goal of managing a neurogenic bladder is to preserve renal function. However, success of therapy for neurogenic bladder can be difficult because of the underlying neuropathic disorder causing the bladder dysfunction.

Table 1: Prevalence percentages in men and women of overactive bladder

Bladder difficulties can be divided into two basic categories:

1. Bladder that fail to successfully empty
2. Bladder that fails to adequately store urine.

Patients can have an overactive detrusor muscle, but also the detrusor contraction may be weak and subsequently the patient cannot empty the bladder sufficiently.

Anticholinergic therapy is a cornerstone for treatment of overactive bladders that fail to store properly. Oral medications such as hyosycamine, flavoxate and oxybutynin have been used extensively with oxybutynin being one of the most widely used. Adverse affects include dry mouth and constipation.

Two oral agents have been introduced: tolterodine tartrate (Detrol) and an extended-release form of oxybutynin chloride (Ditropan XL). Also newly introduced is Detrol LA (once-daily dosing).

Overactive bladder is treatable. However, perfect treatment options for patients with overactive and neurogenic bladder have yet to be found. Behavioral therapy involving regular relieving oneself is advised by many treating physicians as well as strengthening of bladder muscle. These steps involve diligent practice on part of the individual with overactive bladder.

FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"

Harold Rubin, MS, ABD, CRC, Guest Lecturer
updated February 22, 2003

e-mail: hrubin12@nyc.rr.com or rubin@brainlink.com

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