Shahid Akhter, editor, ETHealthworld spoke to Prof. Christopher Chapple, Secretary General, European Association of urology (EAU), The Netherlands, to know more about the latest advancements and breakthroughs in the management of Over Active Bladder.
Female Urinary Incontinence: Contributing Factors and Prevalence
Incontinence is a major problem in the female population indeed. Upto 1 in 3 women following childbirth develop incontinence. Against the backdrop of the consequences of a child birth there is also a prevalence of the over active bladder symptom complex which is defined as frequency, urgency and continence which increases with increasing age. Unfortunately in women, as consequences of child birth which leads to pelvic flow weakness and an age related prevalence of increasing storage symptoms which are evident by over active bladder symptom complex. This is very common in most countries and particularly common in India because of the high incidence of child birth and many women will have a number of children and there would be a greater tendency towards the developments of these related problems.
Over Active Bladder: Prevalence and Symptoms
Over active bladder is a term while many think upon this as a condition but it is not. It relates to a non specific symptom complex. If you get that urgency then you need to frequently go to the bathrooms and if you don’t make it in time particularly if you are a female then you may develop urgency incontinence. Now many people think this is just a female condition but it also affects men, indeed these storage symptoms are the predominant reason why many men with benign prostatic hyperplasia leading to enlargement of the prostate…So these storage symptoms are very important factor that needs to be addressed.
Over Active Bladder: Breakthroughs
The symptoms of over active bladder which is a non specific symptom complex relate to failure to store urine and its no doubt that it increases with increasing age. Certainly by the age of 70 in both men and women, you have at least 60% prevalence of this storage symptom complex. Now in women because of the weak bladder outlet, incontinence does occur in a third of women with overactive bladder symptom complex but is relatively uncommon in men unless there is associated detrusor bladder activity. Many people feel that overactive bladder and detrusor activity are one of the same things but that is not correct because when you look at the evidence if you look at women, only 40-60% of women with overactive bladder have to choose over activity and the 40% have actually don’t have continence, 60% of those do have continence. So this is important healthcare issue because it interferes with quality of life to great extent.
Over active bladder: Advancement in addressing the issue
The problem here is misconception. The standard of care after you tried health modification, lifestyle modification, losing weight, reducing fluid intake if you got these symptoms is to actually use pharmacotherapy. The standard of care in the past has been use of drugs affecting the cholinergic neurotransmission circle-anticholinergic. Now most people including doctors think this is because the drug is reacting on the detrusor muscle but in fact that is incorrect because the target for all pharmacotherapy is actually a sensory system because at the end of the day it’s a sensory symptom urgency a compelling desire to pass urine which is difficult to differ which is what you are targeting. The same implies for anticholinergics which in fact act on the sensory nerves and the intestinal cells in the bladder…
