Overactive bladder - What is this?

A overactive bladder was defined by the International Continence Society in 2002 as a syndrome characterized by the association of irritating urinary symptoms. THE urgency it is the most significant symptom. However, there may or may not be urgent urinary incontinence (involuntary loss of imperative urine), usually accompanied by increased urinary frequency during the day and also at night (nocturia - waking up at night to urinate). However, there are no concomitant infections or other common lower urinary tract diseases. Generally, the overactive bladder has a longer evolution, but the patient does not report dysuria, that is, burning when urinating. In the overactive bladder there is no painful phenomenon.

Os lower urinary tract symptoms guarantee clinical evaluation, both for men and women, at any age. Thus, their understanding facilitates the decision on how to treat the patient individually. Therefore, the physician must clearly state to his patients the steps that will be taken during the diagnosis and treatment, whether medication or surgical.

Importance of understanding signs and symptoms

Lower urinary tract symptoms (LUTS), overactive bladder, urinary incontinence and obstruction of the bladder neck to exit the urine (BOO) are common, with an estimated worldwide prevalence of 45%, 11%, 8% and 22%, respectively. Thus, the clinical understanding of these signs and symptoms is essential for treatment planning, sometimes independent of clinical and imaging tests.

The prevalence rates of overactive bladder vary from 7% to 27% in men and 9% to 43% in women. Some studies report higher prevalence rates in women than men, while others have found similar rates between the sexes.

Treatment by BPH surgery

Patients with lush obstructive symptoms of the lower urinary tract they are best treated by surgery when correctly indicated. Therefore, these expressions of chronic impairment can be demonstrated by anatomical changes in the lower urinary tract, whether in the urethra, prostate, bladder and / or upper urinary tract (kidney injury). Thus, imaging tests, IPSS questionnaires, laboratory tests, urofluxometry and voiding diary can identify these abnormalities. Therefore, in these circumstances, surgery to unblock the lower urinary tract (urethra and / or prostate) is always necessary.

A urinary urgency it is the complaint of a sudden and uncontrollable urge to urinate. Thus, the increase in daytime and nighttime urinary frequency causes the patient to realize that something has suddenly changed in their urinary habit. In addition, it usually occurs urinary incontinence associated with urinary urgency. Furthermore, they do not say that their urine is smelly or has suspended sediment.

Important sign of overactive bladder

The diagnosis of overactive bladder is performed based on the symptoms presented by the patient, being essential the presence of urinary urgency, that is, complaints of sudden urge to urinate with difficulty in retaining urine. Its carriers do not report dysuria.

The syndrome of overactive bladder differs from detrusor hyperactivity, due to the presence of involuntary contractions of the detrusor, during the bladder filling phase. This, therefore, is demonstrated through investigation of the urodynamic study.

The signs and symptoms of the lower urinary tract (LUTS) are divided into three groups of symptoms:

• Signs and symptoms that occur during urine storage
• Symptoms and signs that occur during urination, observed in the urinary stream
• Signs and symptoms observed after the end of urination

Storage and its symptoms

• Polaciuria. Increased frequency. Thus, the person urinates many times during the day
• Nocturia. The person wakes up at night to urinate
• Urgency. It is the complaint of a sudden urge to urinate and that is difficult to postpone.
• Urinary incontinence. Therefore, any type of involuntary urine loss
• Stress urinary incontinence (when doing some physical effort, from mild to intense)

Signs and symptoms during the jet

• Weak jet. The jet got weaker than before or compared to other people.
• Jet split or spread during urination.
• Jet interrupted or intermittent. Thus, it stops and increases, or decreases and increases during urination.
• Hesitancy. That is, difficulty to start the jet and even with voiding effort.
• Voiding effort. Describes the muscular effort used to initiate, maintain or improve urinary flow.

Symptoms after the end of urination

• Feeling of incomplete bladder emptying
• Terminal drip. The final part of urination is prolonged. Thus, the flow has decreased and ends in a drip.
• Loss of drops of urine after running out of urine. Therefore, involuntary loss of urine may occur after you have finished urination, usually after leaving the bathroom.

Overactive bladder and its most important symptoms

Patients with overactive bladder exhibit the most exacerbated storage symptoms. Even more, it is noteworthy that these symptoms are the ones that most disturb the quality of life of patients and are the ones that most seek the help of the urologist. In addition, clinical studies of more than 14.000 patients show that almost 50% of people who urinate poorly have symptoms related to urine storage.

Symptoms do not worsen with aging, both in men and women. When patients also have symptoms that indicate weakened jet, are considered to have mixed symptoms, that is, to have obstructive and irritative symptoms.

Worse quality of life

Irritating urinary symptoms, isolated or associated, greatly compromise people's quality of life. Thus, they are responsible for the appearance or worsening of social, psychological, emotional, physical and sexual problems. Therefore, these patients can have such a significant interference in their quality of life that they commonly experience depression and anxiety. On the other hand, the discomfort appears socially, when they have to stop a meeting to urinate.

The International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) is a short questionnaire with a high capacity to specifically assess the overactive bladder, both in men and women. Therefore, your response can clearly quantify whether symptoms related to bladder storage and emptying are occurring.

How often do you urinate during the day?
() 1 to 6 times	0
() 7 to 8 times	1
() 9 to 10 times	2
() 11 to 12 times	3
() 13 times or more	4
During the night, how many times, on average, do you have to get up to urinate?
( ) Not once	0
() 1 time	1
( ) 2 times	2
( ) 3 times	3
() 4 times or more	4
Do you need to hurry to get to the bathroom to urinate?
( ) Never	0
( ) Few times	1
( ) Sometimes	2
( ) Mostly	3
( ) Ever	4
Do you lose urine before reaching the bathroom?
( ) Never	0
( ) Few times	1
( ) Sometimes	2
( ) Mostly	3
( ) Ever	4

Therefore, responses can range from 0 to 16 points. Therefore, the higher it is, the greater its storage symptoms. When indicated, medications that act on storage should be prescribed, as they cause an important improvement in quality of life.

Importance of correct diagnosis

Therefore, a good diagnosis of LUTS / HPB can greatly improve the patient's quality of life, and when caused by mixed symptoms, the introduction of drugs that act directly on storage can greatly improve the clinical situation of patients. In addition, life change, such as encouraging physical activities, social gatherings, leisure planning, improving the quality of the diet, weight loss, psychotherapy, yoga, etc.

Important differential diagnoses

• Acute cystitis. Recent onset and dysuria.
• Postmenopausal cystitis. History of months or years and genital atrophy.
• Carcinoma on-site. It is caused by flat bladder carcinoma. Most common in smokers
• HPB. Urgency in men accompanied by weak jet and voiding effort, but may report urgency and urge-incontinence

The doctor's clinical view should be global and not just regarding urological complaints. Therefore, unveiling other diagnoses and actively participating in this search will make all the difference to the success of the therapy. As is known, aging causes the natural appearance of symptoms related to common illnesses that may be happening. Therefore, the clinical view must be global.

The patient is not only the urinary tract and certainly, many symptoms can worsen the quality of urinary symptoms, and can even worsen them. Therefore, treating uncontrolled diabetes, obesity, metabolic syndrome, testosterone deficiency, depression, cardiovascular disease, high blood pressure, etc.

Finally, in Medicine, correct diagnosis is the best medicine for successful treatment.

However, if you would like to know more about this and other diseases of the genitourinary tract, access our content area for patients to understand and gain knowledge. Are more than 135 articles on various urological subjects available for your reading. Culture always makes a difference. You will be surprised!

Reference

http://www.auanet.org/guidelines/surgical-management-of-lower-urinary-tract-symptoms-attributed-to-benign-prostatic-hyperplasia-(2018)

https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/

https://www.drfranciscofonseca.com.br/sinais-e-sintomas-da-hiperplasia-begnina-da-prostata/