Overactive Bladder Syndrome

Definition/diagnostic criteria Overactive bladder syndrome (OAB) is characterised by urinary urgency, often accompanied by frequency and nocturia, with or without urge incontinence, in the absence of urinary tract infection or other obvious pathology.

Epidemiology OAB is a common condition affecting men and women, with increasing incidence in older age groups. In the UK, approximately 12-17% of the population experience OAB symptoms. The condition’s prevalence is higher in women and the elderly.

Diagnosis
Clinical features: Diagnosis primarily relies on patient history and symptom identification. Key symptoms include:

• Urinary urgency, increased daytime frequency (typically more than eight times in 24 hours), nocturia, and urgency incontinence.
• These symptoms must be chronic, persisting for at least six months.

Investigations: Investigations are aimed mainly at underlying pathologies that can cause similar symptoms, such as urinary infection, and bladder stones or tumour – clearly, urinalysis is helpful in this situation, though further investigation or referral might be necessary.

• In men, consideration would be given to assessment of the prostate.
• In women, a CA125 should be considered to exclude significant ovarian pathology.
• Urodynamic studies may be helpful to confirm the diagnosis in complex cases.

Treatment Treatment follows a stepwise approach:

• Lifestyle interventions:
  – Fluid management, bladder training, and weight loss if indicated’.
• Medication:
  – Antimuscarinics (e.g., oxybutynin, tolterodine) or beta-3 agonists (e.g., mirabegron) are first-line pharmacological treatments. They should be used with caution in elderly patients due to the risk of cognitive side-effects.
  – Adjustments or alternatives should be considered if side-effects are intolerable or if treatment is ineffective after 4-6 weeks.
• Referral to specialist:
  – Consider referral in refractory cases, in which case other treatments such as Botox or even surgery might be considered.

Prognosis OAB is a chronic condition that significantly impacts quality of life. While symptoms can be managed effectively in many cases, complete symptom resolution is uncommon. Long-term management often requires a combination of lifestyle modifications, pharmacotherapy, and, in some cases, more invasive treatments. Patient education and support are crucial for effective management and improving patient outcomes.