Overactive
Bladder
:::.What is overactive bladder?
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‘Overactive
bladder’
(OAB)
is increased urinary urgency, with or without urge urinary
incontinence (UI), usually with frequency and nocturia.
Urgency is the sudden, intense desire to urinate. Urge
incontinence is defined as the unwanted urine leakage
(referred to as "wetting accidents")
that happens shortly after urgency. Urge UI is caused by
involuntary bladder contractions that occur as your bladder
fills. With urge UI, a person may be aware of the urge
sensation but will be unable to stop leakage before reaching
the toilet. Urine loss is usually in large amounts that soak
underwear and even outer clothing. Frequency is urinating
more often than usual
(more than eight times in a day).
An additional
symptom seen very often, especially in the elderly, is
nocturia, awakening more than one time at night to void.
Getting up at night to urinate during the night will often
disrupt sleep. Many people find it difficult to discuss
their OAB problem with their doctor or nurse.
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Prevalence:
OAB is a bothersome medical condition that affects more than
17 million men and women of all ages, although its incidence
increases significantly with age. In the past, many experts
believed that such voiding dysfunction symptoms as urgency
and frequency were harmless and did not cause significant
problems for individuals.
New research shows that the triad of symptoms - urinary
frequency, urgency and urge incontinence, alone or in
combination - can have a significant impact on someone's
quality of life. Other medical conditions or diseases such
as urinary tract infection or bladder tumors can cause
bladder irritation leading to OAB. Some medical conditions,
especially strokes, impair inhibition of bladder
contractions
(detrusor
hyperreflexia).
Considered abnormal at any age, overactive bladder is a
highly prevalent condition that affects both men and women
but is more common in women. Many people never report
symptoms of OAB due to their perceptions that treatment is
not available or effective or that the symptoms are normal
consequences of aging or childbirth. Effective treatment
includes the combination of drug therapy with behavioral
interventions.
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Impact:
OAB adversely affects a person's daily routines and quality
of life. Approximately two-thirds of men and women report
that their symptoms have an effect on daily living such that
they have a poor quality of sleep, more depression, and an
overall lower quality of daily life than persons who do not
experience OAB. In fact, compared with persons with diabetes
mellitus, persons with OAB experience a lower quality of
life. Weekly or more frequent urge incontinence with
associated urgency and nocturia has been shown to increase
the risk of falls in elderly women who are attempting to
urinate during the night. OAB that includes urge
incontinence is also a major contributor to the decision to
admit an older person to a nursing home.
Overactive bladder has been called the closet disorder since
only one-third of regularly incontinent women discuss their
problem with a health care provider and two-thirds of
patient's first seeking medical advice have had their
symptoms for more than two years. Instead of seeking help,
many people with OAB adjust their habits and lifestyle to
accommodate the management of symptoms and may adopt such
coping mechanisms as restricting fluids and urinating to a
timed schedule or at the first sensation of urgency. Car
trips and vacations are limited. Shopping, visiting public
places, entertaining or socializing are curtailed and in
some cases stopped. Finding accessible public toilets, a
behavior referred to as 'toilet mapping', becomes a
source of major anxiety. Initially, increasing the frequency
of bladder emptying, often referred to a "defensive voiding"
may reduce the number of incontinent episodes.
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Treatment of Overactive Bladder:
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Drugs
Agents that relax the detrusor or prevent a bladder
contraction are effective for OAB and urge incontinence.
Acetylcholine is a chemical released from nerves supplying
the bladder that acts at muscarinic receptors to trigger a
bladder muscle contraction, thereby producing urination.
Antimuscarinics agents are used to treat OAB and urge
incontinence. There are many antimuscarininc agents in the
market and patient should consult her/his doctor before
taking any of them.
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Behavioral
Therapies
In addition to
drug therapies for OAB and urinary incontinence, behavioral
regimens have been shown to reduce symptoms of OAB. These
regimens range from simple maneuvers such as timed or
prompted urination
(Bladder
Retraining)
and fluid management to
biofeedback.
Pelvic muscle exercises
(Kegel
exercises)
are beneficial in appeasing urge incontinence, and can be
done alone or in combination with antimuscarinic drugs.
Also, patients may want to change certain aspects of their
diets
(e.g., decreasing caffeine or alcohol intake),
lose weight and stop smoking.
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Neuromodulation
Additional options exist when drugs and behavioral therapies
fail to improve symptoms in patients with OAB and urge
incontinence. Electrical stimulation of nerves or regions of
the skin, vagina or rectum innervated by the lower spinal
cord can reduce OAB and urge incontinence.
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Surgery
Surgery to enlarge the bladder - called augmentation
cystoplasty - can be considered when the bladder is
extremely small or generates high pressure. This is major
surgery with potential complications and should be attempted
as a last resort. Other surgeries such as neurolysis to cut
the nerves supplying the bladder are rarely performed. In
some women with OAB and urinary incontinence who also
exhibit vaginal prolapse
(e.g.,
cystocele, enterocele)
and stress urinary incontinence, correction of these
conditions can improve the overactive bladder.
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