RxPG - the perfect Rx for medical Post Graduate entrance blues!
Mobile Edition | Help/Newbie? | 24/7 Support
HOT | PrePG | MCQ | DNB | Careers | Books | Colleges | Dental | DocIndia | PLAB |  USMLE  | Australia | Canada | GLOBAL | OffBeat!
Articles | Forums | MCQ Crammer | Downloads | Mnemonics | Revision Tools | Recent Shouts | All Features

Overactive Bladder

Author: Akanksha, Posted on Friday, July 02 @ 18:07:18 IST by RxPG  

 FRIEND Add to My Pages   PRINTER Printer Friendly   FRIEND Email Story  FRIEND Download Story  Surgery alerts 


Overactive bladder (OAB) includes symptoms of urgency, frequency and urge incontinence.


Approximately 55% of individuals with OAB are women and 45% are men.
The prevalence of the condition increases with advancing age.


The prime effector of continence is the synergic relaxation of the bladder wall muscle (detrusor) and contraction of bladder neck and pelvic floor muscles.

The sympathetic nerve fibres originating from the T11 to L 2 segments of the spinal cord, which innervate smooth-muscle fibres around the bladder neck and proximal urethra, cause these fibres to contract, allowing the bladder to fill.

As the bladder fills, sensory stretch receptors in the bladder wall trigger a central nervous system (CNS) response.

The parasympathetic nervous system (PNS) causes contraction of the detrusor, while the muscles of the pelvic floor and external sphincter relax.

The PNS fibres, as well as those responsible for somatic (voluntary) control of micturition, originate from the sacral plexus from the S 2 to S 4 segment of the spinal cord.

The somatic fibers innervate the external sphincter and are responsible for the voluntary control of continence in the face of a pressing desire to void.

Causes & Risk Factors:

1. Idiopathic : The majority of cases are classified as without a demonstrable cause.

2.Neurological injuries, such as spinal cord injury or CVA.

3.Neurological diseases ,such as multiple sclerosis, dementia, Parkinson''s disease, medullary lesions.

4.Non-neurogenic causes :such as UTI, Ca bladder , bladder calculi, bladder inflammation, or bladder outlet obstruction(BOO).

5. Drug therapy : Diuretics can lead to symptoms of urge incontinence as result of increasing filling of the bladder, stimulating the detrusor.
Drugs used to treat urinary retention can also lead to increased contractions of detrusor leading to OAB.


. Sudden and urgent need to urinate

. Involuntary loss of urine

. Frequent urination, in the daytime and at night.

Types Of Urinary Incontinence:

Urge Incontinence

Urge Incontinence involves a strong, sudden need to urinate, immediately followed by a bladder contraction, resulting in an involuntary loss of urine.

Stress Incontinence

Stress incontinence is characterised by an involuntary loss of urine when the intra-abdominal pressure is suddenly increased, for example, during coughing, sneezing and laughing or during physical activity.

Overflow Incontinence

Overflow incontinence is the involuntary loss of urine associated with an overdistended bladder. It occurs when bladder filling exceeds the bladder functional capacity.

Functional Incontinence

Functional incontinence occurs in patients who would otherwise be continent but for whom physical and/or cognitive impairments interfere with the ability to reach a toilet in time.

Mixed Incontinence

Mixed incontinence involves a combination of different type of incontinence, typically stress and urge incontinence occurring simultaneously.


There are three main approaches to treatment: pharmacotherapy, bladder retraining, and surgery.

Pharmacotherapy options:


Since acetylcholine is the neurotransmitter that mediates detrusor contractions, medication with anticholinergics is used to inhibit the premature detrusor muscle contraction.

Consequently, the most frequently used drugs to treat this condition aim to reduce the involuntary contraction of the detrusor muscles by blocking the muscarinic receptors.


This was among the first anticholinergic agents to be used to treat detrusor overactivity and its efficacy in treating OAB is well documented. However, the effects of oxybutynin are not tissue specific and studies have shown that oxybutynin has a greater inhibitory effect on salivation than bladder contraction.


Tolterodine is the first major drug to address the problems of tolerability of treatment. Unlike oxybutynin, tolterodine has a greater inhibitory effect on bladder contraction than salivation. Therefore it has fewer side effects such as dryness of mouth, but with comparable efficacy.

2.Tricyclic antidepressants:

Tricyclic antidepressants like imipramine or doxepin have also been used to treat OAB.

It is an extract from mexican red peppers and has been investigated for intravesical administration in OAB .

Bladder Training

Management of urge incontinence usually begins with a program of bladder retraining. Occasionally, electrical stimulation and biofeedback therapy may be used in conjunction with bladder retraining.

A program of bladder retraining involves becoming aware of patterns of incontinence episodes and relearning skills necessary for storage and proper emptying of the bladder. Bladder retraining alone is successful in 75% of people treated for urge incontinence

Pelvic Floor Exercises

Pelvic floor exercises, also known as pelvic muscle training exercises or Kegel exercises are primarily used to treat people with stress incontinence. However, these exercises may also be beneficial in relieving the symptoms of urge incontinence.


Surgery is rarely used to treat OAB . It is reserved for patients who are severely debilitated by their incontinence and who have an unstable bladder (severe inappropriate contraction) and poor ability to store urine.

The goal of any surgery to treat urge incontinence is aimed at increasing the storage ability of the bladder while decreasing the pressure within the bladder.
Augmentation cystoplasty is the most frequently performed surgical procedure for severe urge incontinence.
In this reconstructive surgery a segment of the bowel is removed and used to replace a portion of the bladder.

New Techniques


This technique is under development.

It requires the surgical implantation of a small device at the base of the spinal cord. It electrically or magnetically stimulates the sacral nerves that inhibit detrusor muscle contraction. akanksha

Note: Multiple Choice Test

1) Stress incontinence is initially treated by: (AI 94)

One answer only.
Bladder exercise
Long-term antibiotics

4 (Excellent) 3(Good) 2(Good) 1(Bad)   

Recommended Books for Surgery
 Books to read for Surgery by RxPG

Related Surgery articles
 Unravelling Neuroblastoma.
 Bailey & Love
 Benign breast disorders
 Fluids Of Choice!
 Overactive Bladder
 Frequent ejaculation fends off prostate cancer!
 Benign Colonic Polyps
 Suture Material
 Couinaud's nomenclature
 vexatious sites
 Surgery; Daily Free Online Mock Test 130 (PGI Pattern)
 Surgery; Daily Free Online Mock Test 125 (PGI Pattern)

Related Surgery Discussions

Other articles by Akanksha
 MRCPsych CASC EXAM STATIONS (3rd April 2009)
 Local Complications of Lung Cancer
 Paraneoplastic Syndromes
 Causes of Collapse and Confusion
 Pigmented lesions of the skin-2
 Pigmented Lesions of the Skin
 End of MRCS Examination
 SBAs introduced in MRCS Part 1 Paper
 PLAB Part 2 is not a difficult exam!!!
 Day Case Surgery
 JIPMER 2005 PG Courses notification
 SGPGI Lucknow 2005 MD MS session notification
 Books To Read For CET-NBE
 Overactive Bladder
 DNB: Information Vitae!
 New Revised Prospectus For Kerala PG
 vexatious sites
 The Devic's Devilry
 The Aching Heart!

 Surgery FAQ
  Browse all FAQs

Write an Article on Surgery
You can share your exam experiences, preparation strategies, books you have read or just any information about Surgery on RxPG website and we will publish it under your name.

Article Rating
Average Score: 4.71
Votes: 7

Most Read Article
Bailey & Love

Related Links
· Surgery Books at Amazon.com
· Surgery Forum
· RxPG Forums
· Discuss Past Papers


· Surgery section
· Articles by Akanksha
· Add to my pages
· Printer friendly version
· PDF version
· Email article
· Feedback on this article
· Medical tutorials
· Related forum posts
· Related articles
· Related downloads
· Submit article
· Surgery alerts
· Surgery books
· Surgery past papers

Most read story about Surgery:
Bailey & Love

Server Status: 188 pages served in last minute. Page generation time: 0.036 seconds

Site Maps: [Books] [News] [Forums] [Reviews] [Mnemonics]

sitemap - top30 - centuries - testimonials

About Us :: Disclaimer :: Contact Us :: Reporting abuse :: Terms of Services :: Privacy Policy

Advertise with RxPG!
Made in India by RxPG Medical Solutions Private Limited

"RxPG" is a Registered Trademark

Chrome Web Store YouTube Twitter LinkedIn Wikipedia Facebook