The results of a survey show that the overall prevalence of overactive bladder (OAB) in people over 18 years of age in China is 5.9%, and shows a gradual increase with age – the overall prevalence of OAB in people over 40 years of age is about 10 times higher than that in people under 40 years of age, with more women than men.
OAB is a common disease, but due to a variety of reasons, patients do not receive timely treatment, which seriously affects the quality of life of patients. The following are the answers to the doubts commonly encountered by patients in clinical practice. Doubt 1. Long-term urinary frequency, urinary urgency, and even symptoms of urinary incontinence due to urinary urgency, and no definite lesions of the urinary system can be detected at the hospital visit, and the doctor says that it is not even a urinary tract infection. So what is the disease?
Solution 1: In the past, it was often diagnosed in general terms as cystourethral syndrome. Because of the lack of definition and inaccurate diagnosis, general treatment often did not work.In 2010, the International Continence Control Society (ICS) defined it as overactive bladder syndrome (OAB), which is due to unconscious contraction of the detrusor muscle and does not include symptoms caused by acute urinary tract infections or other forms of localized lesions of the bladder urethra. These symptoms can occur individually or in any composite form.
Can frequent and urgent urination caused by bladder tumors or stones irritating the bladder be classified as OAB? There are three ways to classify OAB: firstly, by etiology, i.e. idiopathic OAB without a clear etiology and secondary OAB with a clear etiology; secondly, by pathogenesis, i.e. hyperreflexia of the detrusor and detrusor instability; and thirdly, by urodynamics. The third category is divided according to urodynamics: type I, II, III and IV according to urodynamic examination and subjective patient perception. This classification can help the physician understand whether the instability of the patient’s forced urinary muscle is the cause of urge incontinence and the presence or absence of obstruction of the bladder outlet and the anatomical level of obstruction.
Doubt 3. What do urgency, frequency, nocturia and urge incontinence refer to respectively?
Solution: Urge to urinate refers to a sudden and strong desire to urinate that is difficult to delay. Frequent urination refers to excessively frequent urination, more than 6 times a day. Nocturia refers to the need to get up to go to the bathroom 2 or more times during the night. Urge incontinence is when uncontrollable leakage of urine occurs after the onset of urgency.
Is OAB limited to middle-aged and elderly female patients?
Answer: No, this is not true. In addition to middle-aged and elderly women, OAB also likes to bother the following people: long-term vegetarians, people who like to drink coffee and beverages, people who work long hours, people who smoke too much and for a long time, people who drink alcohol regularly, people who have given birth and menopause, people who have given birth or scraped a lot, and people who have benign prostatic hyperplasia.
Why are OAB patients often not treated in a timely manner?
The first reason is that many patients have temporary symptoms; the second reason is that even if they are seen, doctors do not know enough about the disease and patients often give up treatment because they do not get a clear diagnosis; the third reason is that patients are misdiagnosed as having vesicourethral syndrome, prostatitis, lower urinary tract infection, etc. and receive ineffective treatment.
Doubt 6. What are the common treatment measures for OAB at present?
Solution: Behavioral therapy is the preferred treatment modality: including health education, timely or delayed voiding, bladder training, pelvic floor muscle exercises, and lifestyle changes. The second is biofeedback therapy; the application of biofeedback therapies amplifies the information about bladder distension and bladder wall pressure so that the patient’s cerebral cortex accepts these sensations more clearly and consciously controls the bladder’s response to these stimuli by actively urinating or temporarily holding back from urinating. The third is pharmacological treatment: drugs preferred are M-blockers, such as tolterodine and fostrodine; other anticholinergics, such as oxybutynin, are both antimuscarinic and calcium channel blockers, but one should be wary of adverse effects.
In addition, intravesical infusion of capsaicin and intramuscular bladder injection of carnosine are also effective in some patients; other neuromodulation therapies, including perineural sensory nerve stimulation and sacral nerve electrical stimulation, are the preferred second-line treatment options for OAB; bladder denervation and bladder enlargement are suitable for patients with severe small-volume hypocompliant bladder that has affected upper urinary tract function and for whom other Some patients have other co-morbidities that must be treated simultaneously. For example, in some menopausal women, the symptoms of frequent and urgent urination may be related to the decrease of estrogen level in the body, and estrogen can be added appropriately in the treatment.