Journal of Kidney

Overactive Bladder and Symptoms of the Lower Urinary Tract

Gaurav Singh Dangi^{* *}Correspondence: Gaurav Singh Dangi, Department of Biotechnology, Graphic Era Deemed University, Dehradun, India, Email:

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Introduction

The quality of life is significantly affected by the chronic medical illness known as Overactive Bladder (OAB) syndrome in both men and women. OAB influences how well people execute social and daily tasks like working, traveling, exercising, sleeping, and having sex. OAB is defined as a condition with the defining symptoms of "urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence, in the absence of urinary tract infection or other obvious pathology,". In the absence of a urinary tract infection, metabolic conditions that impact urination, or urinary stress incontinence, OAB is diagnosed (generated by effort or overexertion). Only one-third of people with OAB exhibit urge incontinence, often known as wet OAB. This is distinct from incontinence caused by the pelvic floor and urethra's inability to endure stomach pressure, which typically does not involve "urgency." Some patients may experience symptoms of both urine stress incontinence and OAB, leading to the diagnosis of mixed urinary symptoms. According to studies, this syndrome affects 12%–17% of the population in Europe and America, and large funds have been set aside for medical care. OAB can affect adolescents and young adults, however, it most frequently affects those over the age of 40. Elderly patients must be more carefully assessed for pertinent complaints because of the incidence and severity of OAB in this cohort. This is a difficult disorder to treat because some of the risk factors are still unknown, and more research is needed to find effective cures. This review discusses several facets of the OAB syndrome's clinical management and diagnosis. The simplest and most crucial initial diagnostic tool is a bladder diary that details daily bladder routines and patterns related to urination. Finding out the frequency, volume, and pattern of voiding might be very beneficial. A bladder diary for three days offers a steady and accurate way to gauge how frequently incontinence episodes occur.

Patients with OAB may experience urge incontinence, urgency, frequency (more than 8 voids per 24 hours), or nocturia (one or more voids after falling asleep and a return to sleep after voiding). Urine analysis, urinary culture, and blood tests to check levels of electrolytes, glycozilated haemoglobin (HbA1C), and creatinine to assess kidney function are all advised in the evaluation of OAB. Using an ultrasonic probe or a straight catheter, post-void residual urine can be quantified. If the patient's previous void was more than 30 minutes ago, they should urinate right away before this test (residual volume measured should be less than 50 ml). If available, perform the post-void residual urine test first, followed by the uroflowmetry. A maximum urine flow of at least 15 ml/s and at least 150 ml of voiding should be present. The patient's actual maximum flow may not be correctly reflected by values under 150 ml. Non-pharmacological therapy aims to inform patients about OAB and assist them in creating management plans for urge and urge incontinence. To achieve long-term changes, it is crucial to let the patient know that treatment calls for perseverance and motivation. Smoking cessation, weight loss, dietary and fluid consumption adjustments (avoiding coffee, acidic foods, and alcohol), bowel control, and exercise are all examples of changes in lifestyle that have been proven to be successful. Urination at regular intervals while ignoring the natural urge to evacuate is a part of bladder retraining. The voiding intervals may be as brief as 30 minutes at first, but with training, they may gradually lengthen until the patient can maintain control for periods of three hours to four hours. The bladder's capacity could gradually expand as a result of this surgery. Pelvic floor muscle training is another therapy used to treat urge and urgency incontinence. It works by inhibiting detrusor contractions by relaxing the pelvic floor. Patients are instructed to contract their pelvic floor muscles when they feel an involuntary contraction, when they sit up from a prone posture, and when they stand up from a seated position during the training. The use of anticholinergic medications is the most cutting-edge pharmacological treatment for OAB. The goal of these medications is to relax the detrusor muscle a little bit, which will help the patient's discomfort. Two mechanisms in this medication family work together to reduce OAB symptoms. The first method of action inhibits detrusor muscle contractions by competitively inhibiting the process by which parasympathetic stimulation causes them at the level of the neuromuscular junction on cholinergic-muscarinic receptors. Additionally, a second method of action may suppress afferent nerve activity by acting on urothelial sensory receptors. Today's anticholinergic medications can be found and prescribed all over the world, and the International Consultation on Incontinence suggests using several of them. The most frequent and troublesome side effects of antimuscarinic medications are dry mouth and constipation. Additionally, due to the impact of having too much stool in the rectal ampulla, constipation may exacerbate symptoms. This can reduce bladder capacity, therefore if constipation develops, it's advised to utilize fiber and stool softeners as soon as possible. Due to their anticholinergic effects on the gut, antimuscarinic drugs are contraindicated in individuals with closedangle glaucoma, myasthenia gravis, severe ulcerative colitis, toxic megacolon, or intestinal blockage. However, each patient's case should be taken into account while making treatment options, and the clinician treating these diseases may need to approve their prescription. There is a transdermal formulation of oxybutynin. Patients should be made aware of typical side effects and that a dose-dependent effect can exist. Given that timing might affect the occurrence and severity of side effects while concurrently increasing the therapeutic benefit following the patients' specific symptoms, precise instructions should be given on timing and dosing. Anti-muscarinic medicine's failure to produce clinical improvement is problematic for the patient and difficult for the doctor. We feel that referral to a urogynecologist or urologist shouldn't be postponed when conservative non-pharmacological treatment hasn't worked, when a patient has received the full dose of one or two antimuscarinic medications without seeing enough improvement in their condition, or when a patient has discontinued medical therapy because of side effects