Overactive bladder

Overactive bladder
Other namesOveractive bladder syndrome
SpecialtyUrology
SymptomsFrequent feeling of needing to urinate, incontinence
ComplicationsUTIs, anxiety
Usual onsetMore common with age[1]
DurationChronic
TypesAge-related, or Secondary to other illness
CausesOld age; detrusor muscle injury; over-consumption of water and caffeine; UTI; pelvic injury
Risk factorsOld age, obesity, caffeine, constipation
Diagnostic methodBased on symptoms after ruling out other possible causes[2][1]
Differential diagnosisOther neurological conditions[2][1]
TreatmentPelvic floor exercises, bladder training, drinking moderate fluids, weight loss,[3] medications, Botox, surgery
MedicationAnticholinergic drugs, β3 agonists
PrognosisOften but not always incurable
Frequency~40% of elderly adults, increasing with age

Overactive bladder (OAB) is a common condition where there is a frequent feeling of needing to urinate to a degree that it negatively affects a person's life.[2] The frequent need to urinate may occur during the day, at night, or both.[4] Loss of bladder control (urge incontinence) may occur with this condition.[1] This condition is also sometimes characterized by a sudden and involuntary contraction of the bladder muscles, in response to excitement or anticipation. This in turn leads to a frequent and urgent need to urinate.

Overactive bladder affects approximately 11% of the population and more than 40% of people with overactive bladder have incontinence.[5][6] Conversely, about 40% to 70% of urinary incontinence is due to overactive bladder.[7] Overactive bladder is not life-threatening,[1] but most people with the condition have problems for years.[1]

The cause of overactive bladder is unknown.[1] Risk factors include obesity, caffeine, and constipation.[5] Poorly controlled diabetes, poor functional mobility, and chronic pelvic pain may worsen the symptoms.[1] People often have the symptoms for a long time before seeking treatment and the condition is sometimes identified by caregivers.[1] Diagnosis is based on a person's signs and symptoms and requires other problems such as urinary tract infections or neurological conditions to be excluded.[2][1] Uroflowmetry is also a good diagnostic aid.[8]

The amount of urine passed during each urination is relatively small.[1] Pain while urinating suggests that there is a problem other than overactive bladder.[1]

Specific treatment is not always required.[1] If treatment is desired pelvic floor exercises, bladder training, and other behavioral methods are initially recommended.[3] Weight loss in those who are overweight, decreasing caffeine consumption, and drinking moderate fluids, can also have benefits.[3] Medications, typically of the anti-muscarinic type, are only recommended if other measures are not effective.[3] They are no more effective than behavioral methods; however, they are associated with side effects, particularly in older people.[3][9] Some non-invasive electrical stimulation methods appear effective while they are in use.[10] Injections of botulinum toxin into the bladder is another option.[3] Urinary catheters or surgery are generally not recommended.[3] A diary to track problems can help determine whether treatments are working.[3]

Overactive bladder is estimated to occur in 7–27% of men and 9–43% of women.[1] It becomes more common with age.[1] Some studies suggest that the condition is more common in women, especially when associated with loss of bladder control.[1] Economic costs of overactive bladder were estimated in the United States at US$12.6 billion and 4.2 billion Euro in 2000.[11]

  1. ^ a b c d e f g h i j k l m n o p American Urological Association (2014). "Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline" (PDF). Archived from the original (PDF) on 26 April 2015. Retrieved 1 June 2015.
  2. ^ a b c d Gormley EA, Lightner DJ, Faraday M, Vasavada SP (May 2015). "Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment". The Journal of Urology. 193 (5): 1572–80. doi:10.1016/j.juro.2015.01.087. PMID 25623739.
  3. ^ a b c d e f g h Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, Das AK, Foster HE, Scarpero HM, Tessier CD, Vasavada SP (December 2012). "Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline". The Journal of Urology. 188 (6 Suppl): 2455–63. doi:10.1016/j.juro.2012.09.079. PMID 23098785.
  4. ^ "Urinary Bladder, Overactive". Retrieved 1 June 2015.
  5. ^ a b Gibbs, Ronald S. (2008). Danforth's obstetrics and gynecology (10 ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 890–891. ISBN 9780781769372. Archived from the original on 2016-03-05.
  6. ^ Hargreaves, Emma; Baker, Katherine; Barry, Gill; Harding, Christopher; Zhang, Yingying; Kandala, Ngianga-Bakwin; Zhang, Xiaowen; Kernohan, Ashleigh; Clarkson, Carl E (2022-09-23). Cochrane Incontinence Group (ed.). "Acupuncture for treating overactive bladder in adults". Cochrane Database of Systematic Reviews. 2022 (9): CD013519. doi:10.1002/14651858.CD013519.pub2. PMC 9502659. PMID 36148895.
  7. ^ Ghosh, Amit K. (2008). Mayo Clinic internal medicine concise textbook. Rochester, MN: Mayo Clinic Scientific Press. p. 339. ISBN 9781420067514. Archived from the original on 2016-03-05.
  8. ^ Nowakowski Ł, Futyma K, Ziętek A, Bogusiewicz M, Gałczyński K, Rechberger T (2016). "Use of free uroflowmetry vs pressure-flow studies in the diagnosis of overactive bladder syndrome in females". Eur J Obstet Gynecol Reprod Biol. 207: 137–140. doi:10.1016/j.ejogrb.2016.10.054. PMID 27852010.
  9. ^ Ruxton K, Woodman RJ, Mangoni AA (August 2015). "Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: A systematic review and meta-analysis". British Journal of Clinical Pharmacology. 80 (2): 209–20. doi:10.1111/bcp.12617. PMC 4541969. PMID 25735839.
  10. ^ Stewart F, Gameiro LF, El Dib R, Gameiro MO, Kapoor A, Amaro JL (December 2016). "Electrical stimulation with non-implanted electrodes for overactive bladder in adults". The Cochrane Database of Systematic Reviews. 12 (2): CD010098. doi:10.1002/14651858.CD010098.pub4. hdl:2164/8446. PMC 6463833. PMID 27935011.
  11. ^ Abrams, Paul (2011). Overactive bladder syndrome and urinary incontinence. Oxford: Oxford University Press. pp. 7–8. ISBN 9780199599394. Archived from the original on 2016-03-05.