Over Active Bladder

International continence society defines overactive bladder as sudden urge to urinate that may be difficult to control and frequent need to pass urine many times during day and night and sometimes accompanying with urgency incontinence which is unintentional loss of urine. This definition is valid on the conditions that there is no other reasons causing frequent urination such as storage disorder or sleeping disorder.

30% of women and 11% of men experince overactive bladder.

The ratio of urgency incontinence in women is higher than that of men.

Overactive bladder is among the top ten chronical diseases affecting the quality of life. 50% of the patients experince fecal incontinence.

Symptoms of Overactive Bladder

  • Frequent urination, sometimes 8 or more times in a day
  • Sometimes experiencing incontinence with the fear of being unable to control urine
  • Experiencing incontinence outside when getting closer to the home – reaching the target
  • Experiencing incontinence while the tap is open

How to diagnose?

When discussing the medical history of the patient, we look for some clues that might be contributing factors such as; Shaking, erectile dysfuntion, constipation, diabetes, hypertension, sleep apnea and heart rythm disorder.

We don’t need urodynamic testing but we need to eliminate the following diseases to be able to diagnose oab:

  • Urinary tract infection
  • Apparent or invisible tumors in bladder
  • Urinary and/or bladder stones
  • Infections of sexual intercourse
  • Vaginitis
  • Excess fluid consumption
  • Diuretic use
  • Cirhossis

Treatment

1st level treatment:

  • Behavioral Therapies: Instructions of urologists and liquid limitation help to relieve 60% of the symptoms caffeine limitation doesn not decrease urine incontinence but helps to decrease the urge to urinate and frequent urination
  • Weight loss: If the patient is overweight, loosing around 7 kg may ease symptoms of both stress urinary incontinence and overactive bladder.
  • Bladder control strategies
  • Avoiding constipation

2nd level treatment:

Bladder reliever medication:effective in 40% patients,the others give up.(high give up rate.)

Majority of the patients can not get the expected result, the rest quits due to side effects.

3rd level treatment:

  • Percutaneus tibial nerve stimulation: 70% sypmptom relief observed among the patients who did not respond to the second level treatment. The only problem is, getting the response is in 8 to 10 weeks.
  • Sacral nerve stimulation: We put a pacemaker-like device in the patient’s back at the base of spine. It is 75 % effective within 5 years
  • Botox injection into the bladder (under local anaesthesia): 25 % patients have total recovery,6 % patients use probes, 60 % patients has less urine incontinence.

What is Botox Treatment and How is it Performed?

When the overactive bladder can not be treated by the above mentioned methods, we should consider botox injection. The injections are done in the clinic under general or local anaesthesia. After performing cystoscopy, small injections of botox is injected into the bladder wall. Then it helps muscles relax and block the nerve signals that trigger overactive bladder. Partially paralysing the bladder, the botox injection reduces the urgency urination, frequent urination and urinary incontinence. Most people get symptom relief quickly in a few days. The reatment results last about 6 to 8 months

4th level treatment (when the first 3 treatment methods fail):

Augmentation Cystoplasty (Bladder Augmentation): This is a surgery to make the bladder larger. Urinary diversion re-routes the flow of urine. This is a very important way of treatment providing long term solutions for severe cases who couldn’t be treated by the first 3 methods. The patient stays at hospital for 6 days.