OVERACTIVE bladder (OAB) is a symptom that is characterised by urinary urgency. Urgency is the main symptom of OAB, is defined as the sudden compelling desire to urinate, a sensation that is difficult to defer. OAB is often associated with urinary frequency and nocturia in the absence of any obvious pathological conditions within the bladder such as urinary tract infections, ulceration , cancer of urinary bladder, neurologic conditions involving the bladder.
How common is Overactive Bladder?
The prevalence of OAB was similar in women and men, at 16.% .However, the prevalence of incontinence associated with OAB is higher in women at 9.3% compared to 2.6% in men. The prevalence of OAB increased with age and in women it increases with increasing body mass index (BMI).
Men tend to develop OAB slightly later in life than women do, What causes OAB? A normal bladder operates through a complex coordination of musculoskeletal, neurologic, and psychological functions that allow filling and voiding of the bladder contents.
The prime effector of continence is the synergic relaxation of bladder detrusor muscles and contraction of bladder neck and pelvic floor muscles.
The normal adult bladder accommodates 300-600 mL of urine; a CNS response is usually triggered when the volume reaches 400 mL. However, urination can be prevented by cortical suppression of the PNS or by voluntary contraction of the external sphincter.
Methods of Diagnosis
A diagnosis of OAB depends on the presence of urgency, which differs from a simple urge to void. A typical urge to void is a normal sensation that progressively strengthens when deferred. In contrast, urgency is an abnormal condition that is characterized by a sudden onset of urgency and difficulty in deferring urination.
Other causes of urinary frequency, urgency, and urinary incontinence must be excluded.
The Impact of Overactive Bladder
Urinary incontinence remains one of the most common indications for admission to nursing homes. They often have urinary tract infections, skin infections and irritations, and, or at increased risk of falls and fractures around 26%. It can prevent social interactions with friends, colleagues, and families. It can also induce fear, shame, and guilt .
TREATMENT Diet changes:
Decreasing consumption of caffeinated, reducing spices in food and carbonated beverages) may improve the symptoms of overactive bladder (OAB).
Bladder training:
This involves a program of patient education and a scheduled voiding regimen, which is progressively increased.
The goals of bladder training are to normalize urinary frequency, to improve control over bladder urgency, to increase bladder capacity, to decrease incontinence episodes, to prolong voiding intervals, and to improve the patient‘s confidence in bladder control.
Surgical Care
Surgery is rarely used to treat OAB and is reserved for patients who are severely debilitated by their incontinence and who have an unstable bladder (severe inappropriate contraction) and poor ability to store urine.
FOR INFORMATION CONTACT:
Dr N Anandan ,
Urologist & andrologist,
Malar Hospital,
Adyar M- 9840454640