Wednesday, September 12, 2007

Overactive Bladder Part 3

There are multiple treatments for OAB. They include medical therapies (medication), behavioral modification, and neuromodulation (electrical stimulation).

Medical treatment:
There are a wide variety of medications approved by the FDA for urgency, frequency and urge incontinence. These include:
Ditropan (oxybutynin)
Detrol (tolterodine)
Oxytrol patch (oxybutynin)
Enablex (darifenacin)
Vesicare (solifenacin)
Santura (trospium)

All are effective, and all cause dry mouth and constipation to varying degrees. Some individuals may respond better to one versus another.
They cannot be taken with certain types of glaucoma, and gastric outlet obstruction. They may or may not be appropriate depending on patient situation.

Medication works best with behavior modification. Behavior modification itself works best with medical therapy. Common bladder retraining exercises include: Kegel muscle contraction and delaying voiding.

Next installment: Neuromodulation

Monday, September 10, 2007

Overactive Bladder Part II

Overactive Bladder Stats: 21 million adults in US (10% of adult pop.) will have OAB-Dry, while 12 million adults in the US (6% of adult pop.) will have OAB-Wet.

OAB with or without incontinence can present coincidentally with Stress Incontinence- this is known as Mixed Incontinence.

OAB can be the result of:
Normal aging
Neurological causes
learned habit
overconsumption of fluids
pelvic trauma

Conditions that can be confused with OAB:

polyuria: large urine volume production
"irritable bladder syndrome"- food/caffiene/spice intolerance
interstitial cystitis
radiation cystitis
bladder tumor
bladder infection

An inventory of urinary symptoms and lifestyle as well as physical exam should be performed.
A "voiding diary" should be kept:

This is a log of how much fluid is consumed over 24-48 hours, in addition to the time and frequency of when an urge or leakage is experienced, as well as the volume of urine voided.

A urine analysis or blood and infection is performed usually.

residual urine can be checked as well.

Tuesday, September 4, 2007

Overactive Bladder

Overactive Bladder (OAB) is quite a prevalent problem in both the female and male population. It can exist both with and without urinary incontinence. OAB is defined as having frequency and urgency of urination that is abnormal. Frequency of urination is abnormal if it occurs more than 8 times a day during waking hours, while urgency is abnormal if it is uncontrollable or painful. It can occur with and without incontinence, known as urge incontinence.

OAB with incontinence is also known as OAB-Wet, while simple OAB without incontinence is known as OAB-Dry. About 1/3 of women with OAB have OAB-wet. 85% of women with OAB will present with frequency, while 50% will have urgency.

Approx. 21 million adults in the US (10%) will have OAB-Dry, while 6.1 million (12% of the adult pop.) will have OAB-Wet.

Because of embarrassment only about 1/2 of all patients bring it up with their physician.