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DEFINITION:
Overactive bladder (OAB) is a condition caused by
sudden involuntary contraction (overactivity) of the
bladder detrusor muscles. According to the International
Continence Society (ICS), OAB is characterized as urinary
urgency, with or without urge incontinence, usually with
frequency and nocturia, in the absence of causative
infection or pathological conditions.
Other terms used include detrusor instability and detrusor
hyperreflexia.
Urge incontinence is characterized by a strong sudden
need to urinate, immediately followed by bladder
contraction, resulting in an involuntary loss of urine. Urge
incontinence is one of the most common types of urinary
incontinence.
ETIOLOGY:
1.Neurological causes:
a. Neurologic injuries
Spinal cord injury
Stroke
b.Neurologic diseases
Multiple sclerosis
Dementia
Parkinson disease
Medullary lesions
Diabetic neuropathy
2.Nonneurogenic causes:
Detrusor hyperactivity can also occur in the
absence of a neurogenic etiology.
Contractions can be spontaneous or induced by
rapid filling of the bladder, postural changes, or
even walking or coughing.
Nonneurogenic origins of detrusor hyperactivity
include
local genitourinary conditions such as infection,
bladder cancer, bladder stones, bladder
inflammation,
or bladder outlet obstruction .
3.Medications:
Diuretics can cause symptoms of urge
incontinence because of increased bladder
filling, stimulating the detrusor.
Bethanecol can also cause urge incontinence
through its stimulation of bladder smooth-
muscle contraction.
4.Idiopathic:
A specific cause cannot be identified in only rare
cases.
5.Cardiologic:
Heart failure or peripheral venous and vascular
disease can also contribute to OAB. During the day,
such individuals have excess fluid collect in
dependent positions (feet and ankles). When they
recline to go to sleep, much of this fluid becomes
mobilized and increases renal output, thereby
increasing urine output. Many of these patients
describe increased nocturia that manifests as OAB.
Pathophysiology
A normal bladder operates through a complex
coordination of musculoskeletal, neurologic,
and psychological functions that allow filling
and voiding of the bladder contents. The prime
effector of continence is the synergic
relaxation of detrusor muscles and contraction
of bladder neck and pelvic floor muscles.
.
In bladder filling, sympathetic nerve fibers
that originate from the Th11 to L2 segments
of the spinal cord, which innervate smooth-
muscle fibers around the bladder neck and
proximal urethra, cause these fibers to
contract, allowing the bladder to fill. As the
bladder fills, sensory stretch receptors in the
bladder wall trigger a CNS response
The parasympathetic nervous system (PNS) causes
contraction of the detrusor, while the muscles of
the pelvic floor and external sphincter relax.
Apply 2-4 g qd
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