Overactive bladder syndrome seriously degrading quality of life

By Lee Sung-hun

There are an unfortunately large number of people who are inconvenienced by frequent urination. Some of them are overly concerned about where toilets are when they have to conduct a meeting away from their normal surroundings. Others have experienced wetting their underwear to a varying degree because they urinated just before pulling their pants down in the toilet. Others even worry about drinking water or soda while they are outside, fearing that they might need to look for a place to relieve their needs. Such people may be suffering from overactive bladder (OAB) syndrome.

OAB generally designates the conditions where even a small amount of urine forces the patient to urinate due to over-sensitivity. The name may be unfamiliar to the general public, but it is estimated that approximately 6 million Koreans are suffering from OAB syndrome, about 12.2 percent of the entire population. When this is compared to diabetes, which affects 9.8 percent of the population, this is certainly not a rare illness.

OAB syndrome is denoted by urinary urgency (sudden and abrupt need to empty the bladder to the point where it is unbearable) without any other particular illness, frequency of eight or more times per day, and the frequent need to urinate even in the middle of the night. It may develop to urgent urinary incontinence where one wets the underwear because the need is too urgent. It is, however, different from stress urinary incontinence (generally among middle-aged woman) where increase in the abdominal pressure due to sneezing, coughing or exercise, forces the patient to wet their pants.

The entire process of filling up the bladder and then emptying it is a complex interaction between the functions of the kidneys, neural signaling, and muscle contractions. A normal bladder can hold approximately 500 milliliters of urine. Once urine starts to fill up the bladder, it blows up like a balloon, and until enough is filled inside, the sphincter vesicae contracts to prevent urine from leaking out of it. When enough of urine passes down from the kidney to the bladder, a normal person would feel the need to empty it and head towards the toilet. The brain then signals to the bladder and urethra, so that the bladder contracts and the sphincteral muscles in the urethra relax to allow the urine to be emptied out.

The exact cause for OAB syndrome is yet to be identified. Generally it is believed that the muscles in our bladder age much as the rest of our body does, and they lose the elasticity and become rigid to lessen its volume that forces us to feel the need to empty it. Others point to the false neural signals from the bladder muscles to the brain, where one feels that it is filled more than actually is, causing the bladder to contract in order to empty it. What is definite about OAB syndrome is that physical and psychological stress affects it adversely.

Although OAB is not life-threatening in any way, it significantly affects the quality of life. Frequent need to visit the restroom interrupts daily work schedule. Frequently having to wake up in the middle of the night makes it nearly impossible to get a good-night’s sleep. Many patients avoid sexual activities, and when going out, they seek places with known toilet locations. It even affects one’s self-esteem to the extent where the patient develops a depression. When considering OAB’s effect on normal daily life, it is arguably worse to suffer than diabetes.

In Oriental medicine, the kidneys are regarded as the organ that oversees the functions of the bladder. The kidneys are where the Qi that we receive from our parents are stored upon our birth, and it is where Qi essence from other internal organs is gathered. As a person’s body ages, the Qi of the kidneys becomes consumed and deficient. When the kidneys’ Qi becomes weak, bladder functions also become poor, increasing the possibility of OAB syndrome. As mentioned before, stress affects OAB adversely. Stress, in Oriental medicine, is Qi of fire, and its accumulation in the body is the cause for worsened OAB. Therefore, for treatment of OAB, Oriental medicine focuses on replenishing the deficient kidneys’ Qi, and bringing down the fire Qi.

Anti-cholinergic drugs, prescribed for OAB treatment in Western medicine, has the side effects of dry mouth, constipation, and impaired vision. When the patient stops taking the drug, OAB recurs, and it means that the drug has to be taken for a long term. Considering these factors, Oriental treatment can be a good alternative.

Behavior therapy is also important to reinstate the right urination practice. There are bladder drills to correct the urination mechanism and intervals.

Caffeinated drinks such as coffee, black tea, and Coke are known to be diuretics and stimulate the bladder directly, and thus intake should be reduced. Alcohol can also worsen the condition, and the patient should observe his own personal correlation between alcohol consumption and OAB symptoms, and adjust it accordingly. Drinking adequate amounts of water is very important. However, excessive water consumption naturally worsens OAB syndrome, and reduced water consumption can concentrate the urine to irritate the bladder. Generally, about two liters of water per day is the sufficient amount.

The writer practices Korean Oriental medicine at the UN Oriental Medical Clinic in Hannam-dong, Seoul. He can be reached at sung_hun@naver.com.