INTRODUCTION

• Overactive bladder is also known as OAB /Overactive bladder syndrome.
• It is also referred as URGE INCONTINENCE
• OAB is characterized by sudden urge to urinate as a result of Uncontrolled contractions of bladder muscles with no evidence of infection or pathologies
• Sometimes few people may experience the urinary leak instead of frequent urination 
• It is not a disease rather a symptomatic entity which is why named as OAB syndrome 
• This is a chronic condition which impacts the quality of life while doing daily activities socially and personally.

ETIOLOGY AND RISK FACTORS 

• • The definitive cause or etiology is unknown 
  • But OAB , can caused by union of several factors.some possible causes are
  • During pregnancy & childbirth the muscles tend to stretch and sag out than from its normal form this leads to Weakening up of  pelvic muscles .this could be a possible reason for a leak
  • Infections ,the microorganisms can cause irritation and damage to the tissues in and around the organs can cause the need to urinate without a wait .Commonly  in urinary tract infections 
  • Obese ,heavy weight can build the pressure over the lower abdomen region leading to urge for urination
  • Nerve damage,this could be another reason which on infections can cause failure to control impulses .
  • Probably it may be due to trauma / surgeries that damaged the nerve in and around the bladder,stroke,Parkinson’s disease,radiation or hernia etc 
  • Medications,certain medications such as diuretics known as water pills can rapidly fill the amount of water in the bladder and cause leakage.

• Age greater than 40 are more prone to OAB

• • Bladder stones can cause obstruction which on cause stagnation 

• Bladder or prostate cancer

• Other hormonal changes especially in women

• Spicy foods,carbonated beverages,smoking and drinking alcohol 

PATHOPHYSIOLOGY

However there are various theories proposed to explain the pathophysiology of which the 3 are most acceptable.they are

• Neurogenic theory 
• Myogenic theory
• Autonomous bladder theory
• Afferent signaling theory

All these theories attempt to explain what and why is the detrusor overactivity. 

1.In myogenic theory the major muscle known as detrusor muscle becomes over sensitive and leads to  overactivity which upon increases the activity

2.In neurogenic theory attempts to explain if in case of any neurological diseases this fails to send the neural impulse response from brain to the bladder thus leads to increase in afferent impulses from bladder and triggers the voiding reflex 

3.Afferent signaling theory least acceptable out of 3 but explains as if sudden spontaneous contractions of bladder result in increased output afferently and hence creates a sense of awareness of filled bladder 

4.Autonomous bladder theory explains about the activity exacerbated by muscarinic stimulation 

CLINICAL FEATURES

• urgency 
• Leakage 
• Frequent urination than usual-8voids/day
• Nocturia(Urination during night )->1 / night
• Need to urinate more and more 

As mentioned before ,some may have to face  urge incontinence (wet) while few won’t (dry).In case of wet the above leaking is evident 

INVESTIGATIONS

• Bladder dairy can provide useful information regarding fluid intake or volume etc & Can be assessed day to day patterns and habits which are useful in determining the volume of urination,frequency and voiding patterns
• Basic laboratory tests are recommended to assess the urine this includes blood test ,urine test ,cultures to rule out the infective incontinence or hematuria, glycosuria 
• Urine cytology plays a major role to rule out bladder cancer if there are any recent onset of signs or symptoms 
• Early imaging would provide post-void residual measurements.They include  ultrasound , Catheters are used

EVALUATION

• Proper health /family/drug History with evaluation for any urinary tract associated infections or disorders .
• This is a first appropriate step to rule out the risk factors or other conditions such as Diabetes, neurological diseases are the reasons for incontinence or not.
• General physical examination for any recent surgeries associated with any other organs or bladder ,hernia etc 
• Direct examinations other than bladder include rectum ,vagina .

TREATMENT AND MANAGEMENT

There are several options to manage OAB 

1.life style modifications

2.medications or any related surgical procedures 

I.Lifestyle modifications includes 

Diet

• Regular checks on what you eat/drink can sometimes rule out the cause 

Exercises

• Physical exercises such as  kegel exercises or stress relieving exercises can help for at least 3 times a day 

Bladder diary 

• Track on counting number  of times urinated,fluid uptake etc 

Delayed or Double voiding

• Control urination or wait after the first pass of urination to empty the bladder completely 2nd time 
• This seems to be effective in the management of incontinence 

Timed urination

• Fixing up the time intervals between successive passages (may be 15 mins/20mins )  for every time to pass out the urine

II.Medications includes

• Antimuscarinics– non selective 

                          Oxybutynin 5mg ,given orally TID

• M3 selective

            Solifenacin 5-10mg

• Beta -3 agonists

                       Mirabegron 25-50mg,given orally

• Botox treatment 

     Effective for 6months to 1 year 

                Injected via cystoscopy into the bladder to inhibit the muscle contractions 

• Nerve stimulation

Done to manipulate the sensory pathway of bladder innervation 

            PTNS /percutaneous tibial nerve stimulation 

             Sacral neuromodulation

• Bladder reconstruction

Bladder augmentation cystoplasty may be considered in case of neurogenic bladder dysfunction .A method to enlarge the bladder is considered

• Suprapubic catheter 

It is advised as an alternative option If he/ she is not fit for augmentation or any other procedures 

Even Though the treatment is taken additional care is indicated with the other behavioral and physical practices to improvise their own well being 

• In extreme cases of severe OAB that is refractory ,urinary diversion in the form of an ileal conduit with or without cystectomy may be considered after thorough counseling .

OUTCOME

• The condition is often manageable with the proper guidance , knowledge with excellent long term results
• Can be managed with conscious awareness, planning and communication with the expert 
• Without worrying much about the symptoms , as they are relieved gradually with the treatment options.
• It doesn’t cure completely but can be treated or managed to some extent
• However,Person with OAB can live a normal healthy life with proper treatment plan

PROGNOSIS

• The overall prognosis is good or better 
• Multiple behavioral and pharmacological approaches helps to improve the quality of life in a better way
• It significantly helps to control the condition with certain basic or advanced medical recommendations.

NATURAL COURSE OF DISEASES

• When a healthy bladder fills,nerve signals are sent to the brain which helps the contraction of muscle to push the urine out,where in the presence of infection or any involuntary conditions then the muscles fail to work in response to brain stimulus. 
• So the muscle contracts on it own even though the bladder isn’t completely filled and create urgency 
• The cause can be anything out of the following etiological reasons mentioned above. However ,the exact cause is unknown.

FAQ’S 

1.What is the best medication for overactive bladder?

•  Behavioral modifications, bladder strengthening exercises,Anticholinergic drugs (oxybutynin),mirabegron 

2.How can i stop overactive bladder?

• Cannot stop completely but can self manage by Using absorbent pads ,bladder training , biofeedback,bladder exercises, medications 

3.What is the main cause of overactive bladder?

• Main cause is unknown but there are multifactorial causes such as infections,neurological disturbances ,dietary food irritants,other hormonal changes etc 

4.What vitamins help with bladder control?

•  Vitamin C tends to decrease the urgency mainly from foods
• Vitamin c and calcium have positive impact over the storage and incontinence 

5.What helps overactive naturally?

•     Avoiding foods such as diary,alcohol,coffee/tea,tomatoes,honey ,sugar,vinegar etc 
•     Exercises,double voiding,timed urination etc 

6.Can probiotics help overactive bladder?

•   There is no clear solution to the question but there is some unknown complexity existed between them with some beneficial effects 

7.What are the main 4 symptoms of OAB?

• Urine urgency

• Frequent urination than usual-8voids/day
• Nocturia(Urination during night )->1 / night
• Need to urinate more and more

8.How do you know that you have an overactive bladder?

•  By the following symptoms mainly urgency ,nocturia,bladder leak,bladder spasms etc 

9.Does drinking water help with OAB?

• Absolutely no.More fluid intake means more trips to empty .it usually ends up worsening the person condition 

10.What is the best medicine for bladder control?

• Behavioral modifications,timed urination, bladder strengthening exercises,Anticholinergic drugs (oxybutynin),mirabegron

11.OAB in men and women?

• Common in women than men when associated with urinary tract infections but still common in both the genders and affects equally regarding their quality of  life  

12.Overactive bladder at night?

•  Person wakes up to urinate while sleeping for more than once .this condition is known as nocturia which is one of the symptoms associated with OAB 

13.How long does OAB last?

• Lifetime ,but can be manageable and treatable but not curable 

14.What is the main cause for OAB?

• Unknown,but multifactorial etiology 

15.Is OAB reversible?

• Yes,but not completely

16.Safest drug for women 

• Oxytrol is considered as the safest drug with OAB.

17.Is OAB simply part of aging?

• Not a common consequence of aging and exceedingly common in elders