Overactive bladder ( OAB ) is a condition where it often feels the need to urinate to a level that negatively affects a person's life. Frequent urination can occur during the day, night, or both. If there is a loss of bladder control then it is known as incontinence drive . More than 40% of people with overactive bladder experience incontinence. Approximately 40% to 70% of urinary incontinence is due to overactive bladder, It is not life-threatening. Most people with this condition have problems for years.
The cause of overactive bladder is unknown. Risk factors include obesity, caffeine, and constipation. Uncontrolled diabetes, poor functional mobility, and chronic pelvic pain can exacerbate symptoms. People often have symptoms for a long time before seeking treatment and these conditions are sometimes identified by caregivers. Diagnosis is based on signs and symptoms of a person and requires other problems such as urinary tract infections or neurological conditions that should be excluded. The amount of urine passed during each urination is relatively small. Pain during urination indicates that there is a problem other than an overactive bladder.
Special care is not always necessary. If the desired treatment pelvic floor exercises, bladder training, and other behavioral methods are initially recommended. Weight loss in those who are overweight, reducing caffeine intake, and drinking moderate fluids, can also have benefits. Drugs, usually of the anti-muscarinic type, are only recommended if other measures are not effective. They are no more effective than behavioral methods; However, they are associated with side effects, especially in the elderly. Some non-invasive electric stimulation methods seem to be effective when they are in use. Injection of botulinum toxin into the bladder is another option. Catheter or urine surgery is generally not recommended. A diary to track problems can help determine if the treatment is working.
Overactive bladder is estimated to occur in 7-27% of men and 9-43% of women. It becomes more common with age. Some studies show that this condition is more common in women, especially when associated with loss of bladder control. The overactive economic cost of the bladder was estimated in the United States at 12.6 billion USD and 4.2 billion euros in 2000.
Video Overactive bladder
Signs and symptoms
Overactive bladder is characterized by a group of four symptoms: urgency, urinary frequency, nocturia, and incontinence drive. Urgency incontinence does not exist in the "dry" classification.
Urgency is considered a typical symptom of OAB, but there is no clear criteria for what is an urgency and studies often use other criteria. Urgency is currently defined by the International Continence Society (ICS), in 2002, as "Urgent and urgent desire for difficult to defer urinate." The previous definition is "A strong desire to cancel with fear of leak or pain." This definition does not address the immediacy of the urge to cancel and has been criticized as subjective.
The urinary frequency is considered abnormal if the person is urinating more than eight times a day. These frequencies are usually monitored by having the patient keep a urine diary in which they record episodes of urination. The number of episodes varies depending on sleep, fluid intake, medication, and up to seven is considered normal if consistent with other factors.
Nocturia is a symptom in which people complain of disturbed sleep because of the urge to cancel and, like the urinary frequency component, is affected by lifestyle and similar medical factors. Individual wake events are not considered abnormal, one study in Finland setting two or more voids per night as affecting quality of life.
Urinary incontinence is a form of urinary incontinence characterized by unintentional loss of urine for no apparent reason while sensing urine urgency as discussed above. Like frequency, one can track incontinence in a diary to aid in diagnosis and management of symptoms. Urge incontinence can also be measured by pad tests, and this is often used for research purposes. Some people with incontinence encouragement also have stress incontinence and this can complicate clinical studies.
It is important that physicians and patients reach consensus on the term, 'urgency'. Some common phrases used to describe OAB include, 'When I have to go, I have to go,' or 'When I have to go, I have to hurry, because I think I will wet myself.' Therefore, the term 'fear of leakage' is an important concept for the patient.
Maps Overactive bladder
Cause
The cause of OAB is unclear, and indeed there may be many causes. Often associated with urinary muscle detrusor overactivity, bladder muscle contraction patterns are observed during urodynamics. It is also possible that the increased contractile properties originate in the urothelium and lamina propria, and abnormal contractions in these tissues may stimulate dysfunction in the detrusor or whole bladder.
If bladder or urinary spasm occurs in the drainage bag when the catheter is inserted, the catheter may be clogged with blood, thick sediments, or strain on a catheter or drainage pipe. Sometimes seizures are caused by a catheter that irritates the bladder, the prostate or the penis. Such seizures can be controlled with drugs such as butylkopolamine, although most patients end up adjusting to the irritation and seizures away.
Diagnosis
The diagnosis of OAB is made primarily on the signs and symptoms of a person and to the exclusion of other possible causes such as infection. Urodynamics, bladder scope, and ultrasound are generally unnecessary. In addition, urine culture can be done to rule out infection. Frequency/volume graphs can be maintained and cystourethroscopy can be performed to exclude tumors and kidney stones. If there is an underlying metabolic or pathological condition that explains the symptoms, the symptoms may be considered part of the disease and not OAB.
OAB causes symptoms similar to some other conditions such as urinary tract infection (UTI), bladder cancer, and benign prostatic hyperplasia (BPH). Urinary tract infections often involve pain and haematuria (blood in the urine) that are not usually present in OAB. Bladder cancer usually includes haematuria and may include pain, both unrelated to OAB, and the general symptoms of OAB (urgency, frequency, and nocturia) may be absent. BPH often includes symptoms at the time of urination and sometimes includes pain or haematuria, and these are usually absent in OAB. Diabetes insipidus, which causes high frequency and volume, though not always urgent.
Classification
There is some controversy about the classification and diagnosis of OAB. Some sources classify overactive bladders into two different variants: "wet" (ie, an urgent need to urinate with accidental leak) or "dry" (ie, an urgent need to urinate but no leakage is not deliberate). Wet variants are more common than dry variants. The difference is not absolute; one study showed that many were classified as "dry" in fact "wet" and patients with no history of any leak may have other syndromes.
OAB is different from urinary incontinence stress, but when they occur together, this condition is usually known as mixed incontinence.
Management
Lifestyle
Treatment for OAB includes nonpharmacological methods such as lifestyle modification (fluid restriction, caffeine avoidance), retraining of the bladder, and pelvic floor muscle exercises (PFM).
Time restriction is a form of bladder training that uses biofeedback to reduce the frequency of accidents due to poor bladder control. This method aims to improve patient control over time, place and frequency of urination.
The time-out program involves making a schedule for urination. To do this a patient fills in the blanks and leaks. From the patterns that appear in the graph, the patient can plan to empty his bladder before he will leak. Some people find it useful to use a reminder clock that vibrates to help them remember to use the bathroom. The vibrating watch can be set to die at a certain interval or at any given time of the day, depending on the hour. Through this bladder exercise exercise, patients can change their bladder schedule to save and empty the urine.
Drugs
A number of antimuscarinic drugs (eg, from phenacin, hyoscyamine, oxybutynin, tolterodine, solifenacin, trospium, fesoterodine) are often used to treat overactive bladders. ? 3 adrenergic receptor agonists (eg, mirabegron), may be used, as well. They are, however, second-line treatment because of the risk of side effects.
Few people get complete help with drugs and all drugs are no more than effective enough.
The typical person with an overactive bladder can urinate 12 times per day. Drugs can reduce this amount by 2-3 and reduce the incidence of urinary incontinence by 1-2 per day.
Procedures
Various devices (PC Urgent PC Neuromodulation System) can also be used. Botulinum A (Botox) toxin is approved by the Food and Drug Administration in adults with neurological conditions, including multiple sclerosis and spinal cord injury. Botulinum Toxin Injections into the bladder wall can suppress bladder contractions by blocking nerve signals and may be effective for up to 9 months. The growing knowledge about the overactive pathophysiology of the bladder triggers a large number of basic and clinical studies in this pharmacotherapy field. Surgical intervention involves enlarging the bladder using intestinal tissue, although it is commonly used as a last resort. This procedure can increase the volume of urine in the bladder.
OAB can be treated with electrical stimulation, which aims to reduce the strained muscle contractions around the bladder and cause urine to come out of it. There is a choice of invasive and non-invasive electrical stimulation. Non-invasive options include introduction of the probe to the vagina or anus, or the insertion of an electric probe to the nerves near the ankle with fine needles. This non-invasive option appears to reduce symptoms when they are being used, and better than no treatment, or treatment with medication, or pelvic floor muscle care, but low-quality evidence. It is not known which electrical stimulation option works best. Also, it is not known whether the benefits survived after treatment stopped.
Prognosis
Many people with symptoms of OAB have symptoms subside within a year, with estimates as high as 39%, but most have symptoms for several years.
Epidemiology
Earlier reports estimated that about one in six adults in the United States and Europe have OAB. The prevalence of OAB increases with age, so it is expected that OAB will become more common in the future as the average age of people living in developed countries is increasing. However, a recent Finnish population-based survey shows that prevalence has been overstated due to the methodological shortcomings of age distribution and low participation (in previous reports). Allegedly, then, that OAB affects about half the number of individuals as previously reported.
The American Urological Association reports studies showing rates as low as 7% to as high as 27% in men and rates as low as 9% to 43% in women. Urgency incontinence is reported to be higher in women. Older people are more likely to be affected, and the prevalence of symptoms increases with age.
See also
- National Association For Continence
- Inactive bladder
References
External links
- National Association For Continence
- Incontact.org
- The Continence Foundation
- Sistitis & amp; Overactive Bladder Foundation - Inggris Raya
Source of the article : Wikipedia
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