Overactive Bladder

Management of Overactive Bladder

Bladder Retraining

It constitutes a program of scheduled voiding with progressive increase in the interval between each void. The cure rate of 80% has been reported. A 12-week program is anticipated.

Electrical Stimulation

It stimulates the pelvic floor and urethral muscles, and inhibits detrusor muscle contractility. A 50% cure rate has been reported. The main difficulty is with patient acceptance.

Drug Therapy

It is the most popular mode of treatment in patients with overactive bladder. However, the response is often dose-related and side effects are common at effective doses. In general, drugs improve detrusor instability by inhibiting the contractile activity of the bladder.

The maximum dose is usually determined by patient tolerance to the side effects.

Anticholinergic Agents

• Oxybutynin chloride: It is the probably the most effective drug. The side effects are common and include dry mouth, constipation, blurred vision, dizziness that can be unbearable and cause some patients to discontinue its use. Symptomatic improvement can be seen in about two-thirds of patients.
• Tolterodine: It causes a 20% or more reduction of frequency of micturition and a 45% reduction in incontinence episodes. Because of bladder selectivity, it has less systemic side effects, particularly dry mouth as compared to oxybutyin.

Tricyclic Antidepressant

Imipramine hydrochloride: It improves bladder storage significantly. It appears to improve bladder hypertonicity or compliance rather than uninhibited contractions. It is useful in patients with enuresis. The side effects are anticholinergic, as well as tremor and fatigue. It can also cause orthostatic hypotension.

Synthetic Vasopressin

DDAVP: It decreases urine production. It is helpful in patients with troublesome nocturnal urinary symptoms. However, its use in the elderly and patients with heart problem is limited.

Important Points To Remember In Drug Therapy

• Each drug should be given for at least 6 weeks before deeming it a failure, as the onset of benefit may be delayed
• Each drug must be titrated, based on subjective response and its side effects
• If one drug is not beneficial, it is worth trying other drugs with different modes of action or combining drugs
• Overactive bladder is a relapsing and remitting condition

Surgical Treatment

It is only used as a last resort in the management of overactive bladder.

Mixed Incontinence

Overactive bladder can co-exist with stress urinary incontinence / urodynamics stress incontinence in up to 30% of patients. Medical management of the overactive bladder reduces the need for bladder continence surgery. If patients fail medical treatment, bladder neck surgery may be recommended. However, patients should understand that the post-operative course of detrusor instability is somewhat unpredictable. They may need to continue medical treatment for their overactive bladder.