Three years ago, Agatha Maseruka started going to the toilet 10 to 14 times a day. The third grade teacher would on many occasions have to rush out in the middle of class to use the bathroom.

“On some occasions, I would not make it in time,” she says adding that after a while, it became too much that she decided to see a doctor where she was diagnosed with over active bladder syndrome.

An over active bladder (OAB) is a contraction of detrusor muscles in the bladder. “These muscles are what make up the bowl shape of the bladder. They relax during the storage phase of urine in the bladder and must work together with the pelvic floor muscles but are superior in determining the contraction of the pelvic floor muscles and the bladder neck muscles,” Dr Franklin Wasswa of Entebbe General Hospital, explains.

For a bladder to store urine, the detrusor muscles relax and the bladder neck and pelvic floor muscles contract. However, with an overactive bladder, Dr Wasswa says, the detrusor muscles contract and push or give you the urge to urinate.
Aisha Nabisubi, the administrator of AAR Clinic in Bugolobi, says the condition is more common among women than in men since the woman’s bladder muscles are affected in pregnancy and child birth.

Neurological causes
This is where a disease causes the brain to send abnormal signal levels. These diseases include multiple sclerosis, and Parkinson’s disease. “The disorders could also disturb the flow of signals from the brain such as diabetic neuropathy (when diabetes damages the nerves that supply the bladder), stroke and spinal code injury,” he says.

Non-neurological
This is where the cause is not related to the brain signals that control the detrusor muscles mainly but also the bladder neck and pelvic floor muscles on when to contract and relax. These include pregnancy when the space in the pelvis is reduced owing to the growing foetus. Nabisubi also mentions that obesity, constipation and caffeine are other non-neurological causes.

Dr Wasswa says these muscles are smooth that with just a touch, you stimulate them and can cause a movement more so those found in the bladder. “So a change in posture, cough, or laughing just stimulates the contraction of the muscles and the abdominal muscles compress bladder,” he adds.
Besides that, some drugs may cause an OAB such as diuretics (used to treat hypertension patients) as they increase the rate of formation urine. This rapidly fills the bladder causing an overactive bladder.

Treatment
Maseruka was a heavy coffee drinker and was told to cut back. “Now, I only drink one cup a day because beyond that, I start running to the toilet continuously. I ensure I know where the toilets are but just in case they are far off, I am always wearing a pad to avoid accidents. Besides that, I avoid drinking liquids three hours before bed,” she shares.

Dr Wasswa says non-neurological issues are easy to treat as they are more about behaviour treatment while neurological causes are treated by drugs that target the receptor that relaxes the bladder. Nabisubi says kegel or pelvic floor muscle exercises help stop one’s bladder’s involuntary contractions. However, she says, it may take six to eight weeks before you notice an effect.
Though it is a gradual process, Nabisubi says bladder training may help to gradually increase the time one can wait before going to the bathroom.

Evasive treatment
When all else has failed, including having a catheter, Dr Wasswa says evasive treatment is the option. This involves using an injection in the bladder muscles that relaxes them by paralysing them.

jsalmon@ug.nationmedia.com