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Bladder problems

 Bladder-problems-expertise-nurse-with-female-patient-and-husband

Bladder problems are extremely common and can significantly affect the quality of life of men and women suffering from these symptoms. Bladder problems include:

Mr Malde offers a rapid and comprehensive service to diagnose and treat the cause of your symptoms in a caring and professional way. Specialist appointments can be booked at any of his private urology clinics near you.


Male and female bladder dysfunction

What are lower urinary tract symptoms?

Lower urinary tract symptoms may be related to disorders of the bladder or bladder outflow. In men, the bladder outflow consists of the bladder neck, prostate, external sphincter muscle and urethra. In women the outflow consists of the urethra and external sphincter muscle.

Symptoms may be related to disorders of any of these structures and so any urinary symptoms should be investigated thoroughly in order to identify the underlying cause.

Symptoms that may result from a disorder of the bladder or bladder outflow are:

  • Passing urine more frequently during the day
  • Passing urine more frequently during the night (nocturia)
  • Having a sudden urge to pass urine that you cannot control and which may result in leakage (urge incontinence)
  • A weak flow
  • Straining to pass urine
  • A feeling that your bladder has not completely emptied after you pass urine
  • Dribbling of urine

 

How we can help you

Mr Malde offers urgent appointments in his specialist private urology clinics across London. He provides a comprehensive assessment and investigation of lower urinary tract symptoms in both men and women, and will perform further urology tests as required in order to identify the underlying cause and treat the symptoms most effectively.


Nocturia

What is nocturia?

Nocturia is a condition in which you have to wake up more than once during the night because you need to urinate. It becomes more common with age and occurs in both men and women. It can disrupt your sleep and so can have a major impact on your quality of life.

 

What causes nocturia?

Nocturia can be caused by a number of different conditions affecting different organs in the body:

  • You produce more urine than normal every day (polyuria). This can be caused by excessive intake of fluids or diabetes
  • You produce more urine than normal at night-time (nocturnal polyuria). This can be due to heart failure, liver or kidney disease, sleeping disorders (such as sleep apnoea) or certain medications
  • You produce more urine at night than your bladder is able to hold (low bladder capacity). This can be due to conditions such as overactive bladder, interstitial cystitis, urinary tract infections, bladder cancer and benign prostatic hyperplasia

 

How can nocturia be treated?

The treatment will depend on the cause of nocturia in your specific case. A number of general measures can be effective and we will discuss these with you at your consultation.

Mr Malde offers specialist appointments for further investigation and treatment of nocturia in both males and females at his private urology clinics across London.

 

How we can help you

Mr Malde is an expert in the investigation and treatment of male and female nocturia.

Your assessment will include a detailed history and physical examination, including prostate examination in men. He will ask you to complete a three-day bladder diary to work out whether you produce too much urine or whether you drink too much fluid.

He will perform further specialist urine tests to rule out infection, blood tests to rule out other medical conditions that may cause nocturia and a urinary flow test. Further investigations with ultrasound scan, urodynamics or inspection of the bladder with a telescope (cystoscopy) will be performed if required.


Overactive bladder

What is overactive bladder (OAB)?

Overactive bladder (OAB) is a common condition that affects millions of men and women worldwide. The commonest symptom is a sudden urge to urinate that you cannot control and this may result in the leakage of urine (urge incontinence). Having to pass urine more frequently during the day or night are also symptoms of OAB.

OAB can disrupt your work, social life and sleep and can be extremely distressing.

 

What causes OAB?

Although the cause is unknown in the majority of cases, a number of conditions can lead to symptoms of OAB. These include:

  • Conditions affecting the nerve supply to the bladder (such as multiple sclerosis or Parkinson’s disease)
  • Certain medications
  • Diabetes
  • Urinary tract infections
  • Bladder tumours
  • An enlarged prostate gland in men
  • Excess intake of caffeine or alcohol
  • Incomplete bladder emptying
  • Previous surgical procedures or radiotherapy treatment

If these symptoms are affecting your quality of life or leading to anxiety or depression, then you should seek medical advice.

Mr Malde offers specialist appointments for further investigation and treatment of OAB in both males and females in his private urology clinics across London.

 

How can OAB be treated?

Conservative measures:

  • Fluid modification – reducing the amount of caffeine and alcohol that you drink may help improve your symptoms and reducing your fluid intake in the evenings may reduce nocturia
  • Bladder training – the aim of bladder training is to slowly train the bladder to hold larger and larger volumes of urine, thereby improving the symptoms of OAB. We will explain how to do bladder training at your consultation
  • Pelvic floor exercises with a trained physiotherapist

Oral medications:

  • If there is not enough improvement with bladder training alone, then we may recommend medications to relax your bladder
  • Although they can be quite effective, they may result in side effects and we will discuss these with you at your consultation

Bladder botox injections:

  • This procedure may be considered if your symptoms are still bothersome despite oral medications
  • It involves injecting botulinum toxin A (botox) into your bladder to dampen down the overactive contractions
  • It is performed under local anaesthetic through a small, flexible telescope (cystoscopy) that is passed through your water pipe (urethra) and into your bladder
  • It will take 5-10 minutes to perform and you can go home the same day
  • Botox injections are effective in 7 out of 10 people (70%)
  • The effects typically last between 6 and 12 months and then need to be repeated
  • In a small number of people, the botox injections may make it harder for your bladder to empty and so you may need to pass a catheter tube into your bladder in order to get it fully empty (self-catheterisation)

Sacral nerve stimulation (sacral neuromodulation):

  • This procedure may be considered if your symptoms are still bothersome despite oral medications and you do not wish to undergo botox injections
  • It involves inserting a small pacemaker-like device under the skin of your lower back to send electrical signals to the nerves that control your bladder
  • The treatment involves two separate operations a few weeks apart. The first stage involves inserting a temporary test wire to the nerves that supply your bladder to see if the treatment will work well for you. The second stage involves inserting a permanent device under the skin of your lower back if you have found the test phase to be effective in treating your symptoms
  • Sacral neuromodulation is effective in 7 out of 10 people (70%)

Percutaneous tibial nerve stimulation:

This is another way to stimulate the nerves controlling the bladder.

It is performed under local anaesthetic and involves stimulation of nerves in your ankle, which then stimulate the nerves controlling your bladder.

Surgery:

  • If the above measures are not successful, then surgery is sometimes recommended to treat OAB syndrome
  • Augmentation ‘clam’ cystoplasty involves increasing the size of your bladder using a small piece of your intestine (bowel). This is major surgery and we will discuss this in more detail with you at your consultation, if appropriate

 

How we can help you

Mr Malde is a leading specialist in the management of OAB in men and women, and offers a comprehensive service to investigate and treat this condition.

A detailed medical history will be followed by a physical examination of the external genitalia and nervous system. Further tests are aimed at ruling-out other causes for OAB symptoms and consist of blood tests to check for diabetes or kidney disease, urine tests to check for infection or blood, review of your bladder diary, a test of your urine flow and bladder emptying, and specialist urodynamic studies to evaluate the function of the bladder and urethra (and prostate in men). Further scans or direct inspection of the bladder with a flexible telescope (cystoscopy) will be carried out if required.

Mr Malde offers the full range of treatment options and procedures for this condition. This includes behavioural and fluid advice, bladder training and pelvic floor exercises, oral medications, bladder botox injections, sacral nerve stimulation (sacral neuromodulation) and augmentation (‘clam’) cystoplasty.

Specialist appointments can be booked at any of his private urology clinics across London.


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To make an enquiry or book an appointment, email info@londonurologist.net or call us on 020 3488 2636