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I find it interesting how a simple blue pill has brought erectile problems into the open. There is another more bothersome and prevalent condition that is still very much in the closet and rarely mentioned. OAB or Over Active Bladder is also known as detrussor instability. Anytime there is trouble with control of our bodily functions, social stigmata start to influence our behavior, and we can quickly become trapped in a life style dictated by the condition.
Bladder control problems are under-reported and we really don't know what the true numbers are, but it has been estimated that as many as 20% of adults experience some degree of urgency, and of course this number rises with age.
In the normal human, it is common to feel some degree of a need to empty as the bladder distends with urine. Function depends on supporting structures around the bladder, at the urethra and various nerve signals. Pathological urgency is a signal to the brain to "empty" prematurely and frequently. It can be quite strong, and can be associated with unexpected wetting. Some of the causes are easily diagnosed, such as stroke, diabetes or those associated with dementia. Most remain a mystery.
A "prolapse" of the bladder is an anatomic deviation associated with certain conditions such as difficult childbirth and obesity. The bladder can be stressed if the uterus begins to drop, and simple laughter can cause urine leakage. Some of these cases can be helped with traditional and new surgical techniques, and others respond to Kagal exercises, designed to strengthen the pelvic floor.
We doctors tend to breach the subject during the physical exam. It is a difficult subject to discuss, never mind treat. The first step is liquids. Trying to restrict liquids will help. Drinking only when thirsty is a start. Moderate use of caffeine and alcohol helps. There is a common childhood myth that can make things worse. Mothers have been telling their daughter for eons to not "hold it". There is little basis for this notion. In fact, there is more support to suggest that teenage bladder habits persist into adulthood. This may be a hold-over from bed-wetting days when going to bed with an empty bladder helped. There are some medications that can help, but have side-effects and none guarantee success. This is not a problem unique to women, as suggested by the filled plastic bottles that litter our highway ditches lend testimony to.
Adult urinary sanitary aid products represent an expanding industry in our stores. Anyone who has recovered from a simple urine infection can only begin to relate to OAB. People afflicted with OAB feel great embarrassment and need our understanding. They have trouble driving far distances, working in confined conditions, expressing intimacy, travelling on planes and sitting for long periods. This results in a trapped feeling, and increases the incidence of depression. The situation is rarely hopeless, and requires more open discussion.
Please join me at the Hockey Hall of Fame on Thursday, April 14, 2011 at 7 p.m. for some exciting post-season Leaf activity, as Mr. Johnny Bower unveils his new Merlot in support of the George Brown Student Scholarship Fund. A four-time Stanley Cup champion, in a Leaf uniform yet, Bower seems to have found the secret to enjoying the golden years.
Related resources:
● Overactive Bladder (OAB) from MedicineNet.com, by Siamak Nabili, MD, MPH. Causes, risk factors, symptoms, treatment, complications, prognosis.
● Overactive bladder from Wikipedia, the free encyclopedia. "Overactive bladder (OAB) is a urological condition defined by a set of symptoms: "urgency, with or without urge incontinence, usually with frequency and nocturia." Frequency is usually defined as urinating more than 8 times a day."