AAM; As described by the International Continence Association (ICS) in 2002, it is a sudden feeling of urgency, sometimes accompanied by increased frequency of night or daytime voiding and/or urge urinary incontinence. This is a definition of symptoms. There is no local pathological or metabolic cause to explain them. It is a feeling of urgency. Sudden urgency, known as urgency, is defined as a sudden and compelling urge to urinate that is difficult to delay. Night urination, known as nocturia, refers to getting up to urinate at least 2 times a night. Frequent urination indicates urinating at least 9 times a day. Urinary incontinence is one of the symptoms of OAB, and it can sometimes present as mixed-type urinary incontinence with stress-type urinary incontinence. Presence of stress-type urinary incontinence cannot rule out OAB, just as OAB symptoms can sometimes be a part of painful bladder syndrome.
OAB and Urinary Incontinence is a problem that affects not only the person but also his/her relatives, with social, hygienic and psychological effects. 13% overactive bladder was seen in 11 women. Urinary incontinence was detected in 1/2 of women in 1/3 of men with OAB. (Urinary incontinence was detected as 24% in Aydın, 26% in Eskişehir, and 46% in Elazığ.) The number of cases treated with anticonergics in Turkey in 2009 is close to 300,000.
Urinary Incontinence is a problem that is frequently observed in our society, but is rarely mentioned.
Risk factors for OAB are aging, pelvic ischemia due to atherosclerosis, which increases with age, hyperlipidemia, subclinical, cerebrovascular or other neurological diseases. Being a woman, this difference may be due to the difference in anatomy in women, vaginal birth trauma, pelvic floor relaxation or hormonal difference.3. the risk factor is psychosomatic disorders, stress and anxiety also affect OAB.
Behavioral and lifestyle changes and bladder and pelvic floor education are important in the first-line treatment options after the diagnosis of OAB.
1. Behavior and lifestyle changes:
A) Dietary habits:
Regulation of fluid intake; insufficient fluid intake increases the complaints. Fluid intake should be stopped 4 hours before going to sleep at night and the bladder should be emptied.
The effect of bladder irritants, caffeine increases the contraction of the detrusor, which is the bladder muscle. Alcohol, aspartame used as a sweetener, extremely spicy foods, citrus fruits, tomatoes, acidic foods increase irritation.
C) Smoking: Chronic cough and nicotine increase detrusor pressure.
D) Constipation: Fibrous foods should be added to the diet, liquid foods should be increased, and regular exercise should be done.
E) Bladder training: The purpose of this training is to establish normal bladder function with urination scheme and teaching techniques in order to suppress and control urgency. It is important to try to open the intervals between going to the toilet during the day, to increase this time gradually and to bring it in 3-4 hour intervals. .
2.Pelvic Floor Muscle Training:It allows to work the pelvic floor muscles, known as Kegel exercises. It is done 30 to 50 times a day in sets of 10, keeping the muscles tense for 3 seconds, 10 times at first, then 6 to 10 seconds and resting for 10 seconds. It is ideal to do it every day.
3. Providing Treatment with Antimuscarinic Drugs:The goal here is to reduce urinary urgency and urinary incontinence, to increase bladder capacity, voiding volume, and quality of life. 75%-80% success can be achieved with these drugs. Side effects: dry mouth, constipation, tachycardia, urticaria, accommodation paralysis and CNS effects. The reason for drug withdrawal is dry mouth. Patients who cannot use it are narrow-angle glaucoma (eye pressure), urinary retention (inability to urinate), intestinal obstruction (obstruction in the intestines), myasthenia gravis, cardiac rhythm disorders, incompatible patients and those who do not come to control.
In cases where these treatments are unsuccessful or discontinued due to side effects, second-line treatment options are applied.
A) Although the mechanism of action of neuromodulation is not fully understood, it is aimed to inhibit the voiding reflex by stimulating the nerves. Such as transcutaneous electrical nerve stimulation (TENS), sacral nerve neuromodulation.
B) Botulinum toxin injection into the bladder muscle called detrusor; It is the strongest known biological poison. 1 gram Botulinum toxin can kill 1 million people. With chemical denervation, it can last up to 9 months in the detrusor. It is currently the most promising minimally invasive treatment method in cases where first-line treatment is insufficient.
C) Surgical treatment is the last resort. Among these methods, the gold standard is augmentation cystoplasty (new bladder from the intestine).