Overactive bladder (OAB) is a feeling of urgency that may be accompanied by urge urinary incontinence and is usually accompanied by frequent urination and nocturia (night urination). OAB syndrome is the feeling of urgency, although there is no local pathological or metabolic reason that can explain these symptoms.
Detrusor (bladder muscle) overactivity (DAA) is a urodynamic observation and is characterized by the recording of detrusor contractions that occur spontaneously or with provocation during the bladder filling phase. These contractions may cause overactive bladder symptoms or may not be inhibited. DAA is examined in two parts:
-Neurogenic detrusor overactivity: It is used if there is a relevant neurological cause.
-Unexplained (Idiopathic) detrusor overactivity: Certain It is used if there is no reason.
Urgency is the key symptom and is a sudden compelling urge to urinate that is difficult to postpone. It is physiologically derived from the strong urge to urinate (urgency/strong) that occurs with overfilling of the bladder. Urgency causes frequent urination (frequency = at least 8 urinations/24 hours), night urination (nocturia) and urge urinary incontinence (RITI) in 1/3 patients.
OAB. 1/3 of the patients have HERNIA or Mixed type urinary incontinence (CUI), which are called Wet type OAB, and 2/3 do not have IR, a sudden feeling of urgency is evident, and these are called dry type OAB.
Reasons of OAB:
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Neurogenic causes:
-Stroke
-Parkinson's disease.
-Multiple sclerosis
-Medulla Spinal traumas
-Inflammatory diseases and developmental anomalies of the medulla spinalis.
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Non-neurogenic:
-Bladder infection
-Bladder Outlet Obstruction[benign prostatic hyperplasia(BPH), pelvic
organ prolapse, urethral diverticula .. ]
-After surgery (incontinence surgery)
-Bladder stone, bladder tumor� �lump and foreign body.
The incidence of OAB in the USA and Europe is 17% and 37% of them have urinary incontinence and treatment is required.
The frequency of wet and dry OAB It increases with age, dry OAB is common in men (M = 13.6% vs F = 7.6%). Wet OAB is common in women (F=9.3% vs M=2.4)
Urge urinary incontinence (URI) is often associated with BPH in men.
OAB must be identified and treated. because:
-OAB significantly impairs the quality of life
-The rate of depression in OAB is similar to diabetes, hypertension and rheumatoid arthritis
-OAB is linked to falls in the elderly increases injuries. According to studies, the probability of falls and fractures has increased by 26-34% in elderly people who have urge urinary incontinence once a week or more. cost)
DIAGNOSIS OF OVERACTIVE BLADDER:
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History is very important: bladder diary, frequency of urination during the day and at night, comfortable time between voidings , are there any sudden urges, how long can it be delayed, is there urinary incontinence and what type of incontinence, does it use pads and how often does it change, difficulty in starting and/or urinating, history of retention (inability to urinate),
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History of neurological disease
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History of vaginal or incontinence surgery
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Radiotherapy history
Treatment in OAB:
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Change in lifestyle
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Pelvic floor muscles training
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Behavioral treatments
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Electrical and magnetic stimulation
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Pharmacological treatments
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Intravesical treatments
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Sacral neuromodulation
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Surgical treatments.
Lifestyle intervention
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Loosing weight in obese people; StressTIK is 4.4 times more and HERIA 2.2 times more in obese people
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Reducing caffeine intake
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Restriction in areas of excess fluid and reduction of carbonated liquids
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Relieving constipation (foods with plenty of fibrin)
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Quitting smoking; Nicotine causes an increase in contractions with a direct stimulating effect on the detrusor.
Training of the pelvic floor muscles
It is based on the logic that pelvic floor muscle contractions reflexively or voluntarily inhibit detrusor contractions. For this purpose:
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Kegel exercises
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Biofeedback can be applied. .
Behavioral treatments
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Bladder training
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Timed voiding
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Habit training
Bladder training
It requires the active participation of the patient and is based on three main foundations.
1-Training: continence mechanisms are explained and urgency control techniques are taught.
-removing causal stimuli (e.g. dripping faucet, water sound)
-applying perineal pressure and contracting the pelvic muscles
-encouraging to think of other things
-standing, crossing legs and walking on tiptoes
2-Voiding schedule:
He is directed to urinate every hour, whether he catches it or misses it, it is voluntary in between.
He should not urinate, urgency control techniques are also used here.
If the voiding intervals in the voiding diary are less than an hour, it can be started with 30 minute
intervals. Patients should take their normal fluids.
15 minutes a week when a one-hour interval is provided.
3- Positive support:
Patients should follow their urination with a urination diary to evaluate compliance and progress with the program and to see the prolongation of urination intervals. During this training period, the doctor should see the progress every week and adjust the voiding intervals, encourage and support the patient
Timed voiding:
Fixed. An intermittent voiding schedule does not change throughout the entire treatment.
Especially for those who cannot toilet independently. a
the assistant has the assistant urinate every 2-4 hours.
In outpatients with moderate incontinence and those who do not show a frequent micturition
pattern, 2-hour intervals may be useful.
Electrical stimulation:
Electrical stimulation is given to the pelvic floor muscles with probes placed in the vagina. Application every day and for periods up to 2 years. Its important disadvantages are that it is required.
Electromagnetic treatment:
It aims to stimulate the pelvic muscles and sacral roots without a vaginal probe. Although its mechanism of action is not fully known, it is thought to act by passive pelvic floor exercises and suppressing detrusor overactivity. Its most important disadvantage is that it requires repeated sessions in the office environment. It has no known side effects. Both Heat TIC and Stress TIC may be effective.
Agents administered intra-bladder
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Capcaisin
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Resiniferatoxin (RTX)
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Botulinum toxin (botox=BTX)
The first two substances act by desensitizing and inactivating sensory neurons with different mechanisms with repeated applications. It has not been put into routine use and there are no preparations in Turkey.
Botulinum toxin, also known as Botox=BTX in the market, is applied especially in those who are resistant to anti-muscarinic treatment. It is both neurogenic. Effective results have been obtained in both idiopathic OAB. A total of 100-200 units of BTX are diluted and injected into 30 different areas in the bladder muscle, and it must be repeated every 6-9 months.
Sacral neuromodulation
It is based on continuous stimulation of the sacral 3 level (S3) in the spinal cord with an electrode and generator placed through an intervention. Although more than 50% improvement in storage symptoms is observed in 80% of the patients, it is a very expensive method.
Augmentation cystoplasty (Clam operation):
Treatment Last option in patients with severe symptoms of refractory, especially neurogenic OAB. The aim is to create a low-pressure, high-functional capacity bladder. Reducing detrusor contractions by dividing the bladder in half like a seashell, and increasing functional capacity by adding a piece of bowel in between. It is aimed to increase the strength and act as a buffer against involuntary contractions.
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