Overactive bladder (OAB) is a condition with bothersome urinary symptoms including an increased need to urinate (urgency), increased frequency of urination, getting up at night to urinate, or involuntary urination.Cognitive approach to learning definition the key symptom of OAB is urinary urgency, which is defined by the american urological association (AUA) as "a sudden compelling desire to urinate that is difficult to defer." this should not be confused with a strong desire to urinate when the bladder is full.Cognitive approach to learning definition it is considered normal to urinate up to seven times during waking hours. The frequency of urination varies based on hours of sleep, fluid intake, and multiple medical conditions.Cognitive approach to learning definition nocturia is the interruption of sleep one or more times during the night because of the need to urinate. Involuntary urination, also known as urgency urine incontinence, is involuntary leakage of urine.Cognitive approach to learning definition

According to the AUA, OAB occurs in 7-27% of men and 9-43% of women. Many factors can increase the risk of developing OAB such as advanced age, diabetes, smoking, obesity, and gender.Cognitive approach to learning definition men have a higher probability of developing "overactive bladder syndrome dry," or urgency without urinary leakage, while women develop urgency urine incontinence consistently more than men.Cognitive approach to learning definition for women, the occurrence of OAB usually peaks around the age of menopause. Younger women who have given birth vaginally can also experience stress incontinence.Cognitive approach to learning definition studies have shown that OAB can reduce the number of social and personal activities, cause psychological distress, and decrease the quality of life.Cognitive approach to learning definition

During the diagnosis of OAB, it is important to rule out other disorders that could be causing similar symptoms. Healthcare providers will take a careful history, conduct a physical exam, and request a urine sample.Cognitive approach to learning definition they will ask about medications that can cause incontinence such as angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, and diuretics, all of which are common medications used to control high blood pressure.Cognitive approach to learning definition

Behavioral interventions are non-invasive, essentially have no risk to patients, and should be the first treatment for OAB. Interventions include lifestyle changes, bladder training, and pelvic floor training.Cognitive approach to learning definition lifestyle interventions include awareness of fluid intake, smoking cessation, dietary alteration (such as reducing caffeine intake), weight loss, and keeping a bladder diary.Cognitive approach to learning definition bladder training consists of learning urgency suppression strategies such as using relaxation and distraction techniques, self-monitoring, and use of reinforcement techniques.Cognitive approach to learning definition regular tightening of the pelvic floor muscle (kegel exercises) can be beneficial. Patients participating in behavioral interventions typically experience 50-80% reduction in the frequency of involuntary urination.Cognitive approach to learning definition

Drug therapy can be considered in patients with OAB symptoms that are not adequately controlled by behavioral interventions. Antimuscarinic drugs target receptors in the bladder and suppress premature contractions, thereby enhancing bladder storage.Cognitive approach to learning definition there are multiple antimuscarinic drugs and formulations available. For instance, oxybutynin comes in immediate-release (ditropan) and extended-release (ditropan XL) tablets, a patch (oxytrol), and a topical gel (gelnique).Cognitive approach to learning definition the immediate-release formulation is the oldest and least expensive option, but it causes substantial side effects; the extended-release formulation is often tried first.Cognitive approach to learning definition because the patch releases oxybutynin through the skin, it has a more tolerable side effect profile compared to medications taken by mouth. Some antimuscarinics such as tolterodine (detrol or detrol LA) should not be taken by people with liver or kidney disease.Cognitive approach to learning definition other medications like solifenacin (vesicare) should not be taken by those who are on certain medications because of drug interactions.

Antimuscarinic medications' side effects include dry mouth, constipation, dry or itchy eyes, blurred vision, indigestion, urinary tract infection, urinary retention, and drowsiness.Cognitive approach to learning definition rarely, people experience life-threatening symptoms such as irregular heart rhythms. Caution should be taken when starting antimuscarinic therapy in older adults with mild cognitive impairment or dementia as these drugs might worsen symptoms.Cognitive approach to learning definition antimuscarinics should not be used in patients with glaucoma.

Although antimuscarinics are used to treat children with OAB, as little as one oxybutynin tablet taken by a child, or extra doses in adults or children, can cause symptoms requiring medical evaluation.Cognitive approach to learning definition in severe toxicity, the concern is the effect antimuscarinics can have on the heart and nervous system. Severe effects include heart rhythm changes, hallucinations, seizures, and coma.Cognitive approach to learning definition

Mirabegron (myrbetriq), is a beta-3-adrenergic agonist that works in OAB by increasing bladder capacity through relaxing the bladder muscles.Cognitive approach to learning definition the most commonly reported side effects associated with mirabegron are high blood pressure, urinary tract infection, and headaches. It should be avoided in patients who have kidney or liver disease or uncontrolled high blood pressure.Cognitive approach to learning definition mirabegron works about as well as the antimuscarinic agents but with lower rates of dry mouth and constipation. However, it can cause rare effects such as heart palpitations, rash, abdominal pain, diarrhea, and constipation.Cognitive approach to learning definition