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Overactive BladderWelcome to Active Bladder! Here is an overview of Overactive bladder (OAB)

16.5 % of American’s report symptoms of over active bladder. It affects men, women and children worldwide. The primary symptom of OAB is a sudden urge to urinate. This urgency may, or may not, be associated with incontinence, the involuntary loss of urine. These symptoms occur in the absence of any demonstrable urinary pathology producing OAB symptoms such as urinary tract infection. A comprehensive evaluation to eliminate treatable disease must be undertaken to make a diagnosis OAB.

Risk Factors

Overactive bladder affects men and women equally but differently. Many more women experience incontinence with OAB than men. The consideration of OAB in children is unique and should be considered differently.

While age is considered to be a risk factor, OAB cannot be considered a normal part of aging. Certain disease states put individuals at risk for OAB including diabetes, multiple sclerosis, oral hormone replacement, obesity and arthritis.

Physiology

The normal events in appropriate bladder filling, sensation and voluntary release of urine are complex. The sequence of events involves muscles, nerves and psychological input. The physical, muscular events to maintain continence involves simultaneous relaxation of the detrusor muscle and contraction of the bladder neck and muscles of the pelvis. Most symptoms of OAB stem from hyperactivity or irritability of the detrusor muscle. This stimulates the sudden urge to void and unbalances the synergistic relationship with other muscles that control urine.

In the past anticholinergic drugs have been the mainstay of treatment and remain the first line of treatment. This family of pharmaceuticals seems to work on both inhibition of the involuntary contractions of the detrusor muscles, as well as an effect on muscarinic receptors within the bladder wall. Side effects can include dry mouth, constipation, blurred vision and fatigue. Of the two most commonly used, oxybutynin (Ditropan) and tolterodine, the latter is reported to produce fewer side effects. Oxybutynin is provided in several forms; the transdermal patch has fewer reported side effects than other delivery methods. Anticholinergics should be used with caution with pre-existing glaucoma, urinary or bowel retention. They have been noted to increase confusion in elderly patients and those with dementia.

Other medications include tricyclic antidepressant therapy. This has been a standard treatment of enuresis in children. Capsaicin, derived from chili peppers, is currently under investigation for use topically.

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Other Treatment Modalities

There are numerous adjunctive therapies for use in OAB. Many are indicated in those with incontinence as a major complaint. Current studies suggest that a combination of anticholinergic medication with a bladder training program yields better results than either treatment alone. Many behavioral adaptations have already been initiated by a patient with OAB. Caffeine avoidance may improve symptoms. Limiting fluid intake and timing liquids is often automatic. Many plan a restroom itinerary as part of their daily schedule.

Other medical treatments include surgery, Botox injections, neurostimulators and other sophisticated procedures to help refractory incontinence.The range of available options is limited only by the extent of symptomatology and etiology.


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