Overactive Bladder Syndrome

Introduction

Overactive bladder (OAB) Syndrome has been defined by the International Continence Society (ICS) as “urgency, with or without urge incontinence, usually with frequency and nocturia.” Urgency is the defining characteristic of OAB and involves the sudden, compelling desire to urinate, even when the bladder isn’t full, which is often difficult to defer. Urgency can occur even when the bladder isn’t full and greatly impact one’s quality of life.

While the underlying mechanisms for OAB are not fully understood, it is often associated with various other conditions:

Pathophysiology

Relevant Anatomy

The pelvic floor musculature acts as a hammock to support the pelvic viscera, which includes the bladder, rectum and reproductive organs. Within this musculature are openings for the urethra, vagina and rectum. Normally the PFM are contracted to tighten these passages and relax when urine or faeces needs to be released. (ref)

Normally, when the urinary reflex occurs, the detrusor muscle begins to contract, which sends the necessary signals to the brain to cue the need to urinate. However, with OAB, urinary urgency is difficult to control and reflex occurs even when the bladder is not full, giving a false sense to urinate. The mechanism behind this faulty reflex is not fully understood.

Epidemiology

Treatment

Conservative treatment is recommended by the ICS as the first line of defence for OAB symptoms. Conservative treatment is tailored to the individual and their symptom characteristics, but often consists behavioural and/or lifestyle modifications, vesical training, pelvic floor muscle training (PFMT), electrical stimulation or medications. Surgical {medical?} treatment is available, but is only recommended when conservative treatment has failed.

[Add in options] https://www.brighamandwomens.org/obgyn/urogynecology/overactive-bladder

Nonsurgical: Surgical: