Overactive Bladder (OAB)

What is Overactive Bladder?

Overactive bladder is a symptom complex of Urgency with or without incontinence usually with frequency and nocturia as defined by Abrams et al 2002.

Prevalence

The overall prevalence is around 10 to 15%. It is more common in male than female. People of extreme of ages are more commonly involved. Elderly females are more involved. Females are more common for incontinence due the small urethra and sphincter anatomy.

Symptoms

•    Uncontrollable desire of urination
•    Frequent urination even more than 20 times a day
•    Incontinence i.e., involuntary loss of urine
•    Waking up for voiding at night more than 1 to 2 time

Causes

There are multiple factors involved in voiding cycle. Signals start from brain goes to spinal cord and then bladder and urinary sphincter. So, in overactive bladder there is a disturbance in coordination of higher center and bladder.

a)    Absence of negative reflex from brain
b)    Involuntary local reflexes from spinal cord to bladder
c)    Smooth muscle in bladder gets activated due to certain irritant which activates afferent nerve fibres.

Conditions Which Can Cause Overactive Bladder:

a)    Drinking too much water
b)    Smoking/alcohol
c)    Dietary irritants/spices
d)    Recurrent UTI
e)    Tea/coffee
f)    Other condition like stones/cancers

Investigation of Overactive Bladder:

a)    Urine analysis: To look for protein, crystals, glucose, pus cells, RBCs
b)    PVR: It is necessary to check the post void residual by scan to rule out bladder outlet obstruction
c)    Ultrasound: To look for any pathology in kidney and bladder.
d)    Urodynamic study: Usually done in patients who are not responding to treatment.

Management

a)    Life style modification: Restrict fluid intake, stop smoking and alcohol, restrict tea/coffee, and avoid spices.
b)    Bladder training: To go to void timely, resists the urge so that it can be postponed
c)    Pelvic floor muscle therapy is exercise to train pelvic muscle. It has been seen to help people to postpone the urge and remain dry.

Treatment

There are certain medications which help are anticholinergic drugs, beta-3 agonist and alpha-blockers. Dose titration and scheduling is very important. Intermittent catheterisation may be needed. Neuromodulation, sacral nerve stimulation may be beneficial in selected patients. There are few patients who need intravesical Botulinum injection for retractable and recurrent symptoms. There are last resorts in form of surgical intervention like Detrusor myomectomy, augmentation cystoplasty.

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