{"id":1444,"date":"2026-05-07T10:40:36","date_gmt":"2026-05-07T07:40:36","guid":{"rendered":"https:\/\/gynaikologos-komotini.gr\/?p=1444"},"modified":"2026-05-07T10:49:51","modified_gmt":"2026-05-07T07:49:51","slug":"overactive-bladder","status":"publish","type":"post","link":"https:\/\/gynaikologos-komotini.gr\/en\/overactive-bladder\/","title":{"rendered":"Overactive Bladder"},"content":{"rendered":"\t\t
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Overactive bladder (OAB) is characterized by urinary urgency with increased frequency (urination episodes >8\/day) and nocturia (>1 nighttime urination episode), which may also be accompanied by urge urinary incontinence. Thus, it is classified into \u201cwet\u201d or \u201cdry\u201d forms<\/strong> depending on whether urinary incontinence is present or not. Diagnostic evaluation in suspected cases of overactive bladder is included within the assessment of mixed urinary incontinence.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Conservative Measures<\/strong><\/p>

Although there is no evidence supporting that improvement of other coexisting diseases improves OAB symptoms, reassessment of medications taken by the patient that may cause or worsen OAB is recommended. Incontinence pads help control urine leakage, as do intermittent self-catheterization or permanent catheterization when required in special cases.<\/p>

In many studies, reducing daily caffeine intake decreases symptoms, but the heterogeneity of studies does not provide strong evidence supporting such restriction.<\/p>

In a highly reliable randomized study, reducing daily fluid intake by 25% improved symptoms in patients with OAB, although it did not improve coexisting urge urinary incontinence.<\/p>

In general, reducing daily fluid intake to less than 2 liters\/day helps with urge urinary incontinence, and when nocturia coexists, the last fluid intake should be no later than late afternoon. Reduction of gas fluids (such as soda), which stimulate the bladder, and caffeine (<1\u20132 cups of coffee \/ 200 mg\/day), which acts as a diuretic and causes detrusor muscle instability and overactive bladder syndrome, is also recommended.<\/p>

Weight loss appears to help women with stress urinary incontinence more than those with OAB and urge incontinence, so results are probably limited.<\/p>

Smoking cessation has uncertain benefits.<\/p>

Bladder training to empty the bladder initially every 15\u201330 minutes until intervals reach 2\u20133 hours help reduce frequency and urge incontinence. Timed voiding helps keep the bladder empty for most of the day and reduces urine leakage during stress, as many women experience incontinence when bladder volume exceeds a certain threshold.<\/p>

Pelvic floor muscle exercises significantly reduce OAB symptoms (frequency and urge incontinence) in some studies, while in others they do not appear therapeutically effective. The contradiction is due to heterogeneity in exercise protocols used across studies.<\/p>

Posterior Tibial Nerve Stimulation<\/strong><\/p>

Posterior tibial nerve stimulation affects both afferent and efferent nerve fibers. The efferent stimulus causes flexion of the big toe, while the afferent stimulus creates a tingling sensation in the sole of the foot. The theory behind stimulation is based on neuromodulation resulting from cross-communication between sympathetic and parasympathetic nerve endings, leading to changes in neural signals associated with the urination reflex.<\/p>

A 34G needle is inserted three fingers above the medial malleolus, between the posterior surface of the tibia and the soleus muscle. The goal is for the needle tip to be near the posterior tibial nerve without touching it. Overall success (defined as improved quality of life and willingness to continue treatment) was seen in 56%\u201363% of patients. Objective success (defined as >50% reduction in urgency and urge incontinence episodes and 25% reduction in daytime and nighttime urination frequency) was seen in 33%\u201371% of patients overall. However, due to frequent relapses, treatment session protocols need better clarification to prevent recurrence.<\/p>

Sacral Nerve Stimulation<\/strong><\/p>

The sacral nerves are stimulated through implantation of a pacemaker in the sacral spine, which remains as a permanent implant after a temporary trial. It inhibits pathological filling and emptying reflexes of the bladder. Sacral nerve stimulation (SNS) has very good results (62%) in cases of combined urinary and fecal incontinence or in cases where sphincter deficiencies exist due to chronic nerve underfunction.<\/p>

Botulinum toxin A injections into<\/strong> the bladder wall are more effective than antimuscarinic drugs (27% vs 13%) and provide better urinary retention control (5% vs 0%).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Pharmacological Treatment<\/strong><\/p>

Anticholinergic (Antimuscarinic) Drugs<\/strong><\/p>

These are the drugs of choice, although cure rates are low; compared with placebo, however, they show much better results. These drugs block corresponding receptors, reducing bladder overactivity and thereby improving urge urinary incontinence symptoms.<\/p>

Drugs in this group include darifenacin, fesoterodine (Toviaz), flavoxate, oxybutynin (Ditropan), phenylpropanolamine, pilocarpine, propantheline, propiverine, solifenacin (Vesicare, Sivenacin), tolterodine (DETRUSITOL, DETRULET, DETRULON, CINTEROL), and trospium, for which studies demonstrate effectiveness in mixed urinary incontinence.<\/p>

However, two high-quality studies showed an association between long-term anticholinergic use and cognitive impairment.<\/p>

\u03b2<\/strong>3-Adrenergic Receptor Agonists<\/strong><\/p>

\u03b23-adrenergic receptor agonists work by activating \u03b23 receptors in the bladder detrusor muscle, leading to muscle relaxation and increased bladder capacity. This category includes mirabegron (Betmiga), a newer drug with very good results, as it improves urge incontinence episodes, urination volume, and nocturia episodes.<\/p>

It is as effective as anticholinergics, with the most common adverse effects being hypertension, nasopharyngitis, and urinary tract infections. Studies have shown that when treatment with solifenacin 5 mg (Vesicare) fails, combining it with mirabegron 50 mg is more effective than increasing the dose of solifenacin alone.<\/p>

Topical estrogen therapy is also useful for treating genitourinary syndrome of menopause, in which lower urinary tract symptoms coexist.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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\u00a0Conclusion<\/strong><\/p>

Overall, the treatment of choice is primarily conservative management, beginning with bladder training and lifestyle modification (coffee, weight, fluids). This is followed by pharmacological treatment with anticholinergics or mirabegron. If these fail, posterior tibial nerve stimulation or sacral nerve stimulation with implants may be useful, and later botulinum toxin A injections, while informing patients that repeat treatments are required, with increased risks of urinary tract infections and possibly bladder catheterization.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

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