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overactive bladder (OAB)

A condition characterized by involuntary detrusor contractions during the bladder filling phase, which may be spontaneous or provoked & which the patient cannot suppress. It may result in urge incontinence. Etiology: 1) see urge incontinence 2) see disorders contributing to overactive bladder & urge incontinence 3) parasympathomimetics including cholinesterase inhibitors 4) idiopathic Epidemiology: affects men & women equally Pathology: 1) spastic contraction of the detrusor muscle 2) sustained high bladder pressure Clinical manifestations: 1) urgency at inconvenient & unpredictable time 2) urge incontinence Complications: urge incontinence Management: - behavioral therapy alone is reasonable 1st step [8] - pelvic-floor exercises & urge-suppression strategy - drug therapy consist of antimuscarinic agent + alpha blocker - antimuscarinic agents probably prevent a small number of urgency episodes & may improve quality of life [9] - multicomponent intervention including cognitive behavioral therapy improves quality of life for women with overactive bladder [10] - see urge incontinence

Related

disorders contributing to overactive bladder & urge incontinence

Specific

detrusor instability (unstable bladder, hyperactive bladder, irritable bladder)

General

urge incontinence

References

  1. Prescriber's Letter 12(2): 2005 Antimuscarinic Medications for Overactive Bladder Detail-Document#: 210209 (subscription needed) http://www.prescribersletter.com
  2. Prescriber's Letter 15(1): 2008 Chart: Antimuscarinic Medications for Overactive Bladder Detail-Document#: 240108 (subscription needed) http://www.prescribersletter.com
  3. Madhuvrata P, Cody JD, Ellis G, Herbison GP, Hay-Smith EJ. Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database Syst Rev. 2012 Jan 18;1:CD005429. PMID: 22258963
  4. Novara G, Galfano A, Secco S et al A systematic review and meta-analysis of randomized controlled trials with antimuscarinic drugs for overactive bladder. Eur Urol. 2008 Oct;54(4):740-63. Review. PMID: 18632201
  5. Anger JT, Weinberg A, Suttorp MJ et al. Outcomes of intravesical botulinum toxin for idiopathic overactive bladder symptoms: a systematic review of the literature. J Urol. 2010 Jun;183(6):2258-2264. PMID: 20400142
  6. Gormley EA, Lightner DJ, Faraday M et al Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015 May;193(5):1572-80. Review. PMID: 25623739 - Gormley EA, Lightner DJ, Burgio KL et al Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol. 2012 Dec;188(6 Suppl):2455-63. PMID: 23098785
  7. Maman K, Aballea S, Nazir J et al Comparative efficacy and safety of medical treatments for the management of overactive bladder: a systematic literature review and mixed treatment comparison. Eur Urol. 2014 Apr;65(4):755-65. Review. PMID: 24275310
  8. Burgio KL, Kraus SR, Johnson TM II et al Effectiveness of Combined Behavioral and Drug Therapy for Overactive Bladder Symptoms in Men. A Randomized Clinical Trial. JAMA Intern Med. Published online January 13, 2020. PMID: 31930360 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2758797
  9. Stoniute A, Madhuvrata P, Still M et al Effectiveness of anticholinergic drugs for treating people with overactive bladder syndrome. Cochrane Library. 2023. May 9 PMID: 37160297 https://www.cochrane.org/CD003781/INCONT_effectiveness-anticholinergic-drugs-treating-people-overactive-bladder-syndrome
  10. Funada S, Luo Y, Uozumi R et al Multicomponent Intervention for Overactive Bladder in Women: A Randomized Clinical Trial. JAMA Netw Open. 2024 Mar 4;7(3):e241784. doi: 10.1001/jamanetworkopen.2024.1784. PMID: 38477920 PMCID: PMC10938174 Free PMC article. Clinical Trial. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816032