| Overactive
Bladder Syndrome |
 |
Urinary
urgency with or without urge incontinence, usually with
frequency and nocturia, in the absence of any pathologic
metabolic conditions that might explain these symptoms. |
|
| Symptoms |
|
Urgency |
|
Frequency |
|
Nocturia |
|
Urge
UI |
These
symptoms are not exclusive to overactive bladder, and
may have their origins in many other types of conditions. |
| |
| Possible
Etiologies of Overactive Bladder Symptoms |
|
UTI |
|
Bladder
cancer |
|
Carcinoma
in situ of the bladder |
|
Bladder
calculus |
|
Interstitial
cystitis |
|
Pelvic
mass, physiologic nocturnal diuresis, polyuria due to
diabetes, diuretic use, or excessive fluid intake |
|
Neuromuscular
disorders |
|
History
of pelvic trauma, radiation, or surgery |
|
Bladder
outlet obstruction (in males) |
|
Urethral
diverticulum, retroverted uterus, pelvic prolapse, gravid
uterus, estrogen loss (in females) |
| |
|
| Transient
Causes of Overactive Bladder |
| D |
elirium |
| I |
nfection |
| A |
trophic
urethritis or vaginitis |
| P |
harmaceuticals
or psychological problems |
| E |
xcessive
urine output |
| R |
estricted
mobility |
| S |
tool
impaction |
| |
|
| Urinary
incontinence may or may not have its origins in overactive
bladder. |
| |
|
| Mechanisms
of Urinary Control |
|
Differ
in males and females |
|
For
both sexes, urethral coaptability, bladder compliance,
and the neuropathic integrity of brain, spinal cord, bladder
and urethra are required to maintain continence. |
|
In
males, there are two mechanisms of urinary control: the
proximal urethral mechanism and the distal urethral mechanism.
Either one is sufficient to maintain continence independently. |
| |
|
| Evaluation
of Overactive Bladder |
|
Patient
history (includes important risk factors, medication review,
and a focused genitourinary history) |
|
Physical
exam |
|
Laboratory
data (urinalysis) |
|
Voiding
diaries, pad counts, evaluation of PVR (using BladderScan™) |
| |
|
| Residual
Urine Assessment |
|
Use
the BladderScan (Diagnostic Ultrasound Corporation) to
evaluate PVR noninvasively |
|
Enables
differentiation of the male patient with overflow UI |
| |
|
| Therapy |
| Pharmacologic: |
|
Oxybutynin
(Ditropan) |
|
Tolterodine
(Detrol) |
| Behavioral: |
|
Modification
of food and fluid intake |
|
Voiding
schedules |
|
Kegel
exercises (to help control urinary urgency) |
|
Biofeedback
therapy |
| Other: |
|
Electrical
stimulation therapy |
|
Catheterization
(less favored, due to associated risks of chronic infection,
calculus formation, and bladder malignancy) |
|
Bladder
augmentation surgery |
| |
|
| After
consideration of a patient’s symptoms, verification
of a benign urinalysis, and determination of minimal residual
urine, a trial of pharmacological therapy is appropriate.
|
| |
|
| |
|
