Overactive bladder (OAB)

Overview Overactive bladder (OAB) is a syndrome characterized by urgency symptoms, often accompanied by frequent urination and nocturia symptoms, with or without urge incontinence, which significantly affects patients' daily life and social activities. Has become a major disease that plagues people. In recent years, with the entry of China into an aging society, as well as the growth of diabetes and neurological damaging diseases, the incidence of bladder-related overactive diseases, which is secondary to this, has increased year by year. "Guidelines for the diagnosis and treatment of overactive bladder" pointed out that OAB is a syndrome characterized by urgency symptoms, often accompanied by frequent urination and nocturia symptoms, with or without urge incontinence; urodynamics It manifests as detrusor overactivity and can also be other forms of urinary tract and bladder dysfunction. Does not include symptoms caused by acute urinary tract infections or other forms of local lesions of the bladder and urethra. The cause of the disease is still unclear. It is believed that the following four factors may be related: 1. Detrusor instability is caused by non-neurogenic factors, and the abnormal contraction of the detrusor during storage of the urine causes the corresponding clinical symptoms. 2. Bladder hypersensitivity urination occurs when the bladder capacity is small. 3. The urinary tract and pelvic floor muscles are abnormal. 4. Other causes such as abnormal mental behavior, hormonal metabolic disorders, etc. Typical clinical symptoms include urgency, frequent urination, nocturia, and urge incontinence. 1. Urinary urgency refers to a sudden, intense desire to urinate, and it is difficult to be subjectively inhibited and delay urination. 2. Urge incontinence refers to urinary incontinence that occurs immediately after urgency or after urgency. 3. Frequent urination is a complaint, which means that the patient consciously urinates too often every day. On the basis of subjective feelings, the number of adult urination reaches: no less than 8 times during the day, no less than 2 times during the night, and urinary frequency is considered when the urine volume is less than 200ml. 4. Nocturia refers to the patient's complaint of urinating due to urinary sensation twice a night. Examination 1. Screening examination refers to the examination items that should be completed in general patients, including: (1) Medical history OAB is a symptom diagnosis, so the inquiry of medical history is very important, and should cover the typical symptoms of the disease, related symptoms and related The medical history should be evaluated at the same time as the urination diary. (2) Physical examination includes male genitourinary system, female reproductive system and nervous system examination to understand whether there is a primary factor causing OAB. For elderly men with OAB symptoms, rectal examination should be performed to understand whether there is prostate. Related diseases, etc. (3) Laboratory examination 0AB diagnosis should first exclude infectious factors, so routine urine examination is essential. (4) special examination of urology such as urine flow rate, measurement of residual urine and transrectal prostate color ultrasonography, etc., to understand the functional status of the lower urinary tract. 2. Selective examination refers to the selective examination of patients suspected of having a certain urinary or reproductive system, including urological or reproductive system pathogens, urine cytology, etc., if necessary, depending on the situation, KUB, IVU Or MRI check. The diagnosis of overactive bladder disease (OAB) is based on clinical symptoms as the primary diagnosis. Because the pathogenesis of OAB is not clear, it involves many factors such as bladder sensory nerve, urinary center, motor nerve, detrusor and other forms, and other forms of storage and urinary dysfunction can also cause non-inhibitory contraction of the detrusor. Therefore, the correct diagnosis of OAB depends on screening and selective testing. Treatment 1. Behavioral therapy (1) Bladder training The efficacy of bladder training in the treatment of OAB is positive. Through bladder training, bladder contraction is inhibited and bladder capacity is increased. Training points are to drink plenty of water during the day, try to endure the urine, prolong the interval between urination; no longer drink water after the night, do not drink irritating, excitable drinks, at night, take appropriate sedative sleeping pills to sleep quietly. Record the urination diary during treatment to enhance the confidence of the cure. (2) Biofeedback treatment People consciously urinate and control urination due to the existence of certain biological information in the body. Biofeedback therapy is the application of a biofeedback therapy device that amplifies these in vivo information for use by patients, learns to incorporate these unattended information into the control of consciousness, and actively urinates or controls urination. The feedback therapy device placed in the anus or vagina records the activity of the bladder in the form of sound, light, image, etc. When the patient has uninhibited contraction or unstable contraction of the detrusor, the instrument emits specific sound, light, and image. Such information enables the patient to directly sense bladder activity and consciously learn to self-control gradually, to achieve the purpose of inhibiting bladder contraction. (3) Pelvic floor muscle training Through biofeedback or other guidance methods, patients can learn to inhibit bladder contraction and other strategies to suppress urgency by contracting the pelvic floor muscles. (4) Other behavioral treatments such as hypnotherapy. 2. Drug therapy (1) M receptor antagonist Drug therapy is easily accepted by most OAB patients and is therefore the most important and basic treatment for OAB. Detrusor contraction is mediated by agonistic cholinergic (M receptor), which inhibits detrusor contraction by antagonizing M receptors, improves bladder sensory function, and inhibits detrusor instability. Therefore, it is widely used in the treatment of OAB. The first-line drugs include tolterodine, tromethamine, solifenacin, etc. Other drugs include oxybutynin, propifenline, and profenozin. (2) sedative, anti-anxiety drugs Read more...