What is an Overactive Bladder (OAB)? OAB Symptoms, Diagnosis and Treatment

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What is an Overactive Bladder?

Overactive bladder (OAB) manifests itself with symptoms of overactive bladder such as urinating more frequently than usual, inability to delay urination.

Approximately 10-20% of people can experience OAB at a certain period of their life.

How many times a day is urinating considered normal?

It is considered normal to not urinate less than 8 times a day, 1 or no urination at night, depending on the amount of fluid intake. These numbers are increased in the case of an overactive bladder.

How Is Overactive Bladder Diagnosed?

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First of all, medical history and physical examination can give us very important clues.

Whether the complaints have increased over time, medications used, surgical procedures, chronic diseases such as diabetes, hypertension, COPD, and heart disease should be questioned very well.

While the whole body is evaluated in the examination, especially the urogenital area, that is, both the excretory and reproductive system should be reviewed in detail.

From all these evaluations, a voiding diary should be kept to show the frequency and amount of urination day and night.

After urinalysis and blood tests are performed, the diagnosis should be strengthened with ultrasound, uroflowmetry test, urodynamic test when necessary.

The uroflowmetry test is used to evaluate the urine flow rate. If there is a decrease in urine flow, more specific examinations can be performed.

Urodynamics test is performed to reveal possible causes affecting voiding such as bladder capacity, bladder compliance, contraction of the bladder, urination pressure, overactive stimulation.

In fact, the actual diagnosis of overactive bladder is made by urodimi. However, sometimes urodynamics may be completely normal in these patients, which does not exclude the diagnosis. Sometimes OAB occurs in urodynamics, but the patient has no complaints.

How to Treat Overactive Bladder?

After the diagnosis of overactive bladder is considered and other causes are excluded, evaluation is made according to the degree of complaint and the benefits of previous treatments.

  • Lifestyle change suggestions: Fluid restriction may be applied if excessive fluid intake. Losing weight with regular exercise and diet contributes to the reduction of complaints. Fluid restriction while traveling can contribute to less compression. It is important to restrict alcohol and caffeinated beverages and reduce the intake of certain foods. In addition, some exercises such as pelvic floor strengthening Kegel exercises may be recommended.
  • Drug Treatment: If the lifestyle changes suggestions are not sufficient in OAB, oral medication is suggested. The most commonly used of these treatments are muscarinic receptor antagonists or drugs with anticholinergic effect. These drugs with the active ingredients oxybutinin, tolteradin and solifenazine are the drugs that eliminate the need to urinate and prevent the sudden contraction of the bladder. They are generally well-tolerated drugs, but side effects such as dry mouth and eyes, blurred vision, dizziness, and difficulty urinating can be seen. The other drug group used is Beta3 agonist and desmopressin. While beta3 agonists reduce bladder contraction, desmopressin reduces water excretion and prevents urination, especially at night.
  • Botox (Botulinum toxin) injection into the bladder: Botox is generally used for cosmetic purposes. Recently, it has been widely used in the stomach, prostate and bladder to reduce the overactivity of organs. It is also common in overactive bladder. The aim is to temporarily prevent symptoms such as sudden urination and urinary incontinence by reducing the activity of the nerves that stimulate the bladder muscle. Botulinum toxin is administered to 30 foci of the bladder by cystoscope under local or general anesthesia. Its effect lasts about 6 months.
  • Other treatments: Bladder functions can be regulated as a result of tibial and sacral nerve stimulation. First, a temporary stimulating device is placed. If this treatment has benefited, a permanent device is placed.

If there is not enough response to all these treatments, bladder dilating surgeries can be performed if the bladder capacity is low.

Prof. Dr. Abdullah ArmağanUrology Specialist

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