Dr. Umesh Gunvantrai Oza

A problem pertaining to the storage function of the bladder that results in bouts of sudden, often uncontrollable urge to urinate is referred to as an overactive bladder. This condition which is marked by unconditioned or involuntary loss of urine can sometimes be quite difficult to stop. People who experience such a condition often feel humiliated and as such tend to limit their social and work life. Despite such, only a few are conscious that a brief evaluation can help them manage and overcome an overactive bladder.

Mechanism of Urination

During urination, the urine proceeds from the bladder and flows into the urethra which is located at the tip of the penis in men and above the vagina in women. As the bladder fills, the nerve signals in the brain prompts urination by coordinating the relaxation and contraction of the urinary sphincter muscles.

Causes and Symptoms of an Overactive Bladder

Primarily caused due to involuntary contraction and relaxation of sphincter muscles, several conditions can lead to overactive bladder. 

Some of them are: 
1. Parkinson's disease, Alzheimer's and other neurological disorders
2. Poor kidney function due to diabetes
3. Medications that lead to increased production of urine
4. Bladder abnormalities like tumors or stones
5. Constipation
6. Excessive consumption of caffeine or alcohol

Some of the common signs of an overactive bladder are:
1. Bouts of sudden, uncontrollable urge to urinate
2. Awakening at night frequently to urinate
3. Urinating more than eight times a day

Risks
The risk of an overactive bladder gradually increases with age. Conditions, such as diabetes and an enlarged prostate results in the increased likelihood of an overactive bladder. People who have previously faced strokes and heart attacks experience cognitive decline, which often times lead to the development of an overactive bladder.

Urinary incontinence as well as a host of associated factors can be detrimental to your life. Emotional distress, interrupted sleep cycles and depression are some of the observed complications of this condition.

Thus if you experience or entertain suspicion of an overactive bladder, you should consider visiting a general physician who might refer you to a specialist, if need be.

Our kidneys act as filters which constantly flushes out toxins and excess minerals with water in form of urine. Urine contains lots of minerals which may precipitate and form stones. Urine has lots of pro-precipitating agents and anti-precipitating agents. When their balance disturbs due to some disease, stones start forming. These stones may often lead to abdominal pain which is referred to as renal colic. 

What exactly is renal colic? 

Renal or ureteric colic is the term used for typical pain in one side of abdomen in flank region starting from back and radiating forward towards lower abdomen up to scrotum. This is usually associated with nausea, vomiting and urinary discomfort. There may be blood in urine. 

How kidney stones are related to renal colic? 

Kidney stones usually form inside kidney and lies there without causing any pain. But whenever they are dislodged and stuck at mouth of kidney (pelvis) or anywhere in ureter, they block the passage of urine of that kidney. This causes swelling in kidney termed as hydronephrosis. This swelling in kidney causes renal / ureteric colic. This colic is protective phenomenon and tries to push out the stones. Small stones do come out in urine by this natural process. This spontaneous expulsion of small stones is common and many local practitioners used to get credit of it feigning benefit of their medicine. However large stones need some form of intervention to come out. Otherwise, they do harm to kidneys in long term. 

Symptoms of kidney stones along with renal /ureteric colic - 

1. Most stones which are lying in calyces of kidney are asymptomatic 
2. Nausea & vomiting 
3. Frequent urinary tract infections 
4. Fever with chills 
5. Foul smelling urine 
6. Hesitency, frequency and burning in urination 
7. Blood in urine (urine with a reddish, pink or brownish hue) 
8. Passage of small stones in urine 

Treatment of renal colic 

Treatment of ureteric/renal stones involves control of symptoms and stone removal. 

1. Expectant Treatment or Medical Expulsion Therapy: Small stones of less than 4 mm size usually pass on its own and some medicines like alpha-blockers and steroid hasten up their expulsion. Medium size stone (4-6 mm), sometimes passes with aid of these medications. But stones larger than 6 mm usually require intervention. 
2. Lithotripsy: This method involves breaking of stones by shock waves into small dusty particles which pass through urine on its own. This is usually suitable for stones upto 1.5 cm and lying in kidneys. This is non-operative treatment which can be done on OPD or Daycare basis. 
3. Ureteroscopy (URS): This method involves entry of very thin semirigid scope through urethra into ureter. Stone is broken by LASER and removed. This involves single day admission and spinal anaesthesia. 
4. RIRS- Retrograde Intra Renal Surgery: In this method very thin flexible scope in maneuvered through urethra into the upper ureter and pelvi-calyceal system of kidney. Stones in kidney or upper ureter are broken by LASER and removed. This is also done under anaesthesia and requires a day admission. 
5. Mini- PCNL: This method is suitable for large renal stones. In this technique, a small hole is made into the kidney through back and tiny scope is entered into the kidney. Stones are broken by LASER and removed. This is done under anaesthesia and require two to three days admission. If you wish to discuss about any specific problem, you can consult an urologist.