Many people find that their lives can be made worse by untimely urinary urgency and incontinence. The following information will help you recognize this common and embarrassing condition. This will enable you to discuss it with your urologist and choose the right treatment option.
What is overactive bladder syndrome?
Overactive bladder (OAB) is a syndrome characterized by the sudden onset of discomfort in urination with or without leakage, often occurring frequently throughout the day.
OAB occurs when the detrusor muscle of the bladder is squeezed or contracted more frequently than normal at inappropriate times. unlike the normal situation where the detrusor muscle is resting during urine filling, in OAB the detrusor muscle contracts when the bladder is full.
Why does it cause OAB? By definition, the etiology of OAB is not clear. However, a number of underlying conditions can be identified: medication side effects, nerve damage or neurological disorders (e.g., multiple sclerosis, Parkinson’s disease, etc.), or stroke. A number of conditions associated with frequent, urgent urination – bladder cancer, urinary tract infections and amphoteric prostatic hyperplasia (BPH) – must also be taken into account during the examination.
Some experts believe that some individuals are more likely to develop OAB. there is evidence that individuals with depression, anxiety, and attention deficit disorder are more likely to have symptoms of OAB than the general population. Some studies suggest that depression, anxiety, eating disorders, pain, bowel stress syndrome, fibromyalgia and altered urination are associated with disturbances in neurotransmitters in brain circuits, particularly 5-HT. fibromyalgia and bowel stress syndrome are more likely to be seen in individuals with OAB and interstitial cystitis (IC).
How is overactive bladder disease diagnosed?
The first step in diagnosing OAB is to keep a urinary diary. The recorded symptoms, including urgency, can assist the urologist in making the correct diagnosis.
A routine urinalysis must be performed to rule out infection and to check for urine sugar, red blood cells, white blood cells or urine specific gravity. Subsequently, ultrasound or catheterization is required to clarify the amount of residual urine. For some patients, cytology or cystoscopy is necessary. Sometimes it is also useful to perform cystometry. This can document overactivity of the detrusor muscle during bladder filling and rule out obstruction. Urography, CT or MRI are rarely used.
How is OAB treated? Behavioral therapies Behavioral therapies can reduce urinary frequency and incontinence. These include simple exercises like timed voiding and biofeedback therapy. Pelvic floor exercises (Kegel exercises) are excellent in reducing urge incontinence and can be practiced alone or while taking M-blockers. Also, patients can treat OAB by changing their diet (e.g., reducing consumption of caffeinated or alcoholic beverages), losing weight, and quitting smoking. Medications Medications that relax the detrusor muscles or prevent bladder contraction are effective in treating OAB and urge incontinence. Acetylcholine is a chemical released from the nerves innervating the bladder that acts on the M receptors to cause bladder contraction and thus urination.M receptor blockers are used to treat OAB and urge incontinence. these drugs include: oxybutynin, tolterodine and solifenacin.
In some refractory OAB, bladder forcing muscle toxin injections can also be taken to achieve good inhibition of the contraction of the forcing muscles.
Neuromodulation This is the option when pharmacological and behavioral therapies are ineffective in treating patients with OAB and urge incontinence. Electrical stimulation of the nerves or skin innervated by the lower spinal cord, vagina or anus is also effective in reducing OAB and urge incontinence.