Diagnosis and Treatment of Overactive Bladder

• Objective: To review the diagnosis and treatment of overactive bladder (OAB). • Methods: Qualitative assessment of the literature. • Results: OAB syndrome is a highly prevalent disorder that remains vastly underreported. Typical symptoms include urinary frequency, urinary urgency, and urinary urge incontinence. Symptoms can be disruptive and impair quality of life. Behavioral therapy is the cornerstone of treatment and consists of patient education, fluid and dietary management, timed voiding or bladder training, pelvic floor exercises, and voiding diary. Antimuscarinic medication remains the most commonly prescribed drug treatment and results in statistically significant improvement in symptoms. Dry mouth is a common side effect. Combining behavioral and pharmacotherapy appears to give superior symptom relief than either treatment alone. • Conclusion: Most patients with OAB do not seek treatment and are not aware that their condition is treatable. It is important for physicians to be able to identify and treat this disorder. The overactive bladder (OAB) is a highly prevalent disorder that impacts the lives of millions of people worldwide. Despite its high prevalence, most sufferers do not seek medical attention and are not aware that OAB is treatable. OAB remains vastly underreported and its sufferers untreated. OAB remains a “closet disorder.” The exact origin of the term “overactive bladder” is unknown but it became widely utilized and popularized in the medical lexicon in the latter half of the 1990s. It is interesting that although much argument was engendered by use of the term overactive bladder, this term was not actually defined or described by the International Continence Society until 2001. Overactive bladder syndrome, urge syndrome, or urgency– frequency syndrome is now defined as “urgency with or without urge incontinence, usually with frequency and nocturia”[1]. Although this definition indicates that these symptoms are suggestive of detrusor overactivity (a term later defined in this document as the observation of involuntary detrusor contractions during the filling phase of cystometry), a urodynamic demonstration of detrusor overactivity is not necessary in all cases. Furthermore, the definition allows that a variety of other conditions of urethro-vesical dysfunction may result in a similar symptom complex. Finally, it is important to note that the use of the term overactive bladder is restricted to those situations in which local pathology, such as infection, and malignancy have been ruled out. Typical symptoms of the OAB include an increased number of micturitions (urinary frequency, usually > 8 times/day), a strong and sudden desire to void that is difficult to defer (urinary urgency), and if the urgency cannot be suppressed, urinary urge incontinence [2]. People suffering from bladder overactivity typically have to empty their bladders frequently, and when they experience a sensation of urgency they may leak urine if they are unable to reach the toilet quickly. The amount of urine lost may be large, as the bladder may empty completely and involuntarily. Sleep may be disturbed, as the need to void may awaken the patient. Nighttime frequency and nocturnal enuresis (bedwetting) is often particularly disruptive. Urinary incontinence occurring shortly after or in concert with the sensation of impending leakage is called urge incontinence. CASE STUDY Initial Presentation A healthy 58-year-old woman presents to her family doctor with a primary complaint of urinary frequency and incontinence.