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Overactive Bladder During Childhood: When and How It Should Be Treated

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Overactive Bladder During Childhood: When and How It Should Be Treated Incont Pelvic Floor Dysfunct 2010; 4(1):13-17 Review Overactive Bladder during Childhood: When and How It Should Be Treated Yi-Sheng Chen, M.D.1, Stephen Shei-Dei Yang, M.D.2, Shang-Jen Chang, M.D.2 Department of Urology1, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan; Division of Urology2, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan and School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan fkqolar`qflk ê~íÉ=çÑ=ÉåìêÉëáë=ÇÉÅêÉ~ëÉÇ=ïáíÜ=~ÖÉI=áí=åÉîÉê=êÉ~ÅÜÉÇ=MBK=qÜÉ=êÉëìäíë çÑ=íÜÉ=ëíìÇó=Äó=h~êàáï~ê~=Éí=~ä=~äëç=ëÜçïÉÇ=íÜÉ=ë~ãÉ=íêÉåÇ=xVzK=få=íÜÉ m~íáÉåíë=ïáíÜ=çîÉê~ÅíáîÉ=Ää~ÇÇÉê=El^_F=ïÉêÉ=~ëëìãÉÇ=íç=Ü~îÉ é~íáÉåíë=ïáíÜ=Ç~óíáãÉ=ìêáå~êó=áåÅçåíáåÉåÅÉI=ìêÖÉåÅó=~äçåÉ=ï~ë=íÜÉ=ãçëí ÇÉíêìëçê=çîÉê~ÅíáîáíóI=ìêÖÉ=ëóåÇêçãÉI=ÜóéÉê~ÅíáîÉ=Ää~ÇÇÉêI=éÉêëáëíÉåí Åçããçå=ÅÜ~ê~ÅíÉêáëíáÅ=áå=ÄçíÜ=ëÉñÉëK áåÑ~åíáäÉ=Ää~ÇÇÉêI=~åÇ=ÇÉíêìëçê=ÜóéÉêíçåá~K=`ÜáäÇêÉå=ïáíÜ=l^_=ã~ó 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áë=îÉêó=ÅçãéäÉñK=^åó=áãÄ~ä~åÅÉ=ÄÉíïÉÉå=íÜÉã=ã~ó=äÉ~Ç=íç=l^_K=qÜÉ Received: July 30, 2009 Accepted: August 11, 2009 Éñ~Åí=é~íÜçéÜóëáçäçÖó=çÑ=l^_=ëíáää=åÉÉÇë=íç=ÄÉ=áåîÉëíáÖ~íÉÇK Address correspondence to: Dr. Shang-Jen Chang, Division of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch, 289, Jianguo Road, Sindian, Taipei, Taiwan E-mail: [email protected] NP Review qfjfkd=lc=qob^qjbkq áåÖ=åÉìêçäçÖáÅ~ä=ÇáëçêÇÉê=ëÜçìäÇ=ÄÉ=ÉñÅäìÇÉÇI=~åÇ=ÑìêíÜÉê=Çá~ÖåçëíáÅ ãçÇ~äáíáÉë=ëÜçìäÇ=ÄÉ=~êê~åÖÉÇK eÉ~äíÜó=ÅÜáäÇêÉå=ìëì~ääó=~íí~áå=Ç~óíáãÉ=~åÇ=åáÖÜííáãÉ=ÅçåíáåÉåÅÉ ~í=íÜÉ=~ÖÉë=çÑ=P=~åÇ=S=óÉ~êëI=êÉëéÉÅíáîÉäóK=få=~=ëíìÇó=çÑ=g~é~åÉëÉ Laboratory investigation éêáã~êó=ëÅÜççä=ÅÜáäÇêÉåI=íÜÉ=Ç~óíáãÉ=îçáÇáåÖ=ÑêÉèìÉåÅó=ï~ë=SKNOKM qÜÉ=ä~Äçê~íçêó=ëíìÇáÉë=Å~å=ÄÉ=Åä~ëëáÑáÉÇ=áåíç=ÉëëÉåíá~ä=~åÇ=ÅçåÇáJ íáãÉë=éÉê=Ç~ó=xVzK==`ÜáäÇêÉå=ïáíÜ=îçáÇáåÖ=ÑêÉèìÉåÅó=ãçêÉ=íÜ~å=U=íáãÉë íáçåáåÖ=íÉëíëK çê=ìêÖÉåÅó=~í=ëã~ää=Ää~ÇÇÉê=Å~é~Åáíó=~åÇLçê=áåÅçåíáåÉåÅÉ=Ç~ó=Å~å=ÄÉ NK=bëëÉåíá~ä=íÉëíëW 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  • Urinary Incontinence Embarrassing but Treatable 2015 Rev
    This information provides a general overview on this topic and may not apply to Health Notes everyone. To find out if this information applies to you and to get more information on From Your Family Doctor this subject, talk to your family doctor. Urinary incontinence Embarrassing but treatable 2015 rev. What is urinary incontinence? Are there different types Urinary incontinence means that you can’t always of incontinence? control when you urinate, or pee. The amount of leakage Yes. There are five types of urinary incontinence. can be small—when you sneeze, cough, or laugh—or large, due to very strong urges to urinate that are hard to Stress incontinence is when urine leaks because of control. This can be embarrassing, but it can be treated. sudden pressure on your lower stomach muscles, such as when you cough, sneeze, laugh, rise from a Millions of adults in North America have urinary chair, lift something, or exercise. Stress incontinence incontinence. It’s most common in women over 50 years usually occurs when the pelvic muscles are weakened, of age, but it can also affect younger people, especially sometimes by childbirth, or by prostate or other pelvic women who have just given birth. surgery. Stress incontinence is common in women. Be sure to talk to your doctor if you have this problem. Urge incontinence is when the need to urinate comes on If you hide your incontinence, you risk getting rashes, too fast—before you can get to a toilet. Your body may only sores, and skin and urinary tract (bladder) infections.
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  • Interstitial Cystitis/Painful Bladder Syndrome
    What I need to know about Interstitial Cystitis/Painful Bladder Syndrome U.S. Department of Health and Human Services National Kidney and Urologic Diseases NATIONAL INSTITUTES OF HEALTH Information Clearinghouse What I need to know about Interstitial Cystitis/Painful Bladder Syndrome U.S. Department of Health and Human Services National Kidney and Urologic Diseases NATIONAL INSTITUTES OF HEALTH Information Clearinghouse Contents What is interstitial cystitis/painful bladder syndrome (IC/PBS)? ............................................... 1 What are the signs of a bladder problem? ............ 2 What causes bladder problems? ............................ 3 Who gets IC/PBS? ................................................... 4 What tests will my doctor use for diagnosis of IC/PBS? ............................................................... 5 What treatments can help IC/PBS? ....................... 7 Points to Remember ............................................. 14 Hope through Research........................................ 15 Pronunciation Guide ............................................. 16 For More Information .......................................... 17 Acknowledgments ................................................. 18 What is interstitial cystitis/painful bladder syndrome (IC/PBS)? Interstitial cystitis*/painful bladder syndrome (IC/PBS) is one of several conditions that causes bladder pain and a need to urinate frequently and urgently. Some doctors have started using the term bladder pain syndrome (BPS) to describe this condition. Your bladder is a balloon-shaped organ where your body holds urine. When you have a bladder problem, you may notice certain signs or symptoms. *See page 16 for tips on how to say the words in bold type. 1 What are the signs of a bladder problem? Signs of bladder problems include ● Urgency. The feeling that you need to go right now! Urgency is normal if you haven’t been near a bathroom for a few hours or if you have been drinking a lot of fluids.
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  • Overactive Bladder: What You Need to Know Whiteboard Animation Transcript with Shawna Johnston, MD and Emily Stern, MD
    Obstetrics and Gynecology – Overactive Bladder: What You Need to Know Whiteboard Animation Transcript with Shawna Johnston, MD and Emily Stern, MD Overactive bladder (OAB) is a symptom-based disease state, which includes urinary frequency, nocturia, and urgency, with or without urgency incontinence. Symptoms of a urinary tract infection (UTI) are similar but additionally include dysuria (painful voiding) and hematuria. OAB tends to be a chronic progressive condition, while UTI symptoms are acute and may be associated with fever and malaise. In patients whose symptoms are unclear, urinalysis and urine culture may help rule out infection. If symptoms point to OAB, you should rule out: 1. Neurological disorders, such as multiple sclerosis, dementia, parkinson’s disease, and stroke. 2. Medical disorders such as diabetes, and 3. Prolapse, as women with obstructed voiding, usually from advanced prolapse, can have symptoms that mimic those of OAB. It is important to delineate how OAB symptoms affect a patient’s quality of life. Women with OAB are often socially isolated and sleep poorly. On history, pay attention to lifestyle factors such as caffeine and fluid intake, environmental triggers, and medications that may worsen symptoms like diuretics. Cognitive impairment and diabetes can influence OAB symptoms. Estrogen deficiency worsens OAB symptoms, so menopausal status and hormone use are important to note. Physical exam includes a screening sacral neurologic exam, an assessment for pelvic organ prolapse and a cough stress test to rule out stress urinary incontinence. On pelvic exam, look for signs of estrogen deficiency. Investigations include urinalysis, urine culture, and a post-void residual volume measurement.
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  • Review of Systems
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  • Overactive Bladder
    Overactive Bladder Introduction Symptoms You Might Notice “Overactive bladder” (OAB) or “unstable bladder” • A strong urge to urinate with little warning. refers to the feeling of needing to urinate much more • More frequent urination. often than is average. Since a medical name for the • Possible dribbling or loss of a large amount of urine. bladder muscle is the “detrusor,” you may also hear this • Difficulty postponing urination. This becomes a major condition called names like “detrusor overactivity” or issue for people with OAB, and can limit activities and “detrusor instability.” travel. OAB is a complex problem, but generally, the • Usually, no physical pain is associated with this bladder may contract/squeeze prematurely and hard problem, but it can be very emotionally and socially enough to make urine leak out before you can make it to disturbing. the bathroom. This type of urine loss is called “urge • Need to get up more than once at night to urinate. incontinence.” • Some people may experience an uncomfortable OAB can occur at any age. Some people are born sensation of urgency. with conditions that affect nerve and muscle signals, resulting in frequent urination, accidents, and bed Possible Causes Your Health Care Provider wetting in children. Other people may not develop OAB May Look For until they are older. The body and its muscles change • Usually no outward physical signs of OAB. with aging, making OAB quite common in older adults. • In older men, this type of bladder problem may be Additionally, certain disease processes or treatments associated with prostate enlargement. may change the bladder to be more sensitive, leading to • In older women, OAB may be related to skin, blood OAB symptoms.
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  • Urinary System
    Urinary system Urinary system terms Nephr/o, Kidney Nephritis, renal artery ren/o Hydronephrosis (abnormal condition involving back Hydro/o Water up of urine into the kidney Cystitis, cystectomy (inflammation of, removal of Cyst/o Bladder bladder) Pyel/o Renal collecting ducts Pyelogram (X-ray of the collecting ducts) Polyuria, anuria (frequent urination, no urine Ur/o, -uria Urine formation) Olig/o Scanty, less than normal Oliguria (reduced urine formation) To surgically reattach, fix in Nephropexy (surgically attach kidney in normal -pexy normal position anatomical position) Urinary system diseases Nephrosis – a noninflammatory disease of kidneys. Nephrolith – a kidney stone. Urethritis – inflammation of the urethra, the final pathway for urine in both sexes, and the common pathway for urine and semen in the male. Nocturia – frequently getting up and urinating during the night. Enuresis – involuntary release of urine, most often in reference to “bedwetting.” Urinary system procedures Nephrologist – I am hoping by now, you would know this is a physician specializing in kidney diseases. Urologist – a physician specializing in the genitourinary tract, which includes kidneys, urinary bladder and urethra of both men and women and the prostate and testes in men. Cystoscopy – looking into the urinary bladder with a fiberoptic instrument. Intravenous pyelogram – special X-rays showing the drainage pattern of the kidneys. A dye opaque to X-rays is injected into a vein. After a waiting period for the blood and dye to pass through the kidneys, X-rays can be taken of the collecting system of the kidney, ureter and bladder. Retrograde pyelogram – personally, I prefer the former procedure! In this procedure a dye opaque to X-rays is flushed backwards up the urethra and bladder and up the ureters to the kidneys.
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  • Frequently Asked Questions About Overactive Bladder
    ABOUT OAB Frequently Asked Questions about Overactive Bladder What is Overactive Bladder (OAB)? If you live with OAB, you may also: Overactive Bladder (OAB) isn’t a disease. It’s the u Leak urine (incontinence): Sometimes people name of a group of urinary symptoms. The most with OAB also have “urgency incontinence.” common symptom of OAB is a sudden urge to This means that urine leaks when you feel urinate that you can’t control. Some people will the sudden urge to go. This isn’t the same as leak urine when they feel this urge. Having to “stress urinary incontinence” or “SUI.” People urinate many times during the day and night is with SUI leak urine while sneezing, laughing or another symptom of OAB. doing other physical activities. (You can learn more about SUI at UrologyHealth.org/SUI.) How common is OAB? u Urinate frequently: You may also need to go OAB is common. It affects millions of Americans. to the bathroom many times during the day. As many as 30 percent of men and 40 percent The number of times someone urinates varies of women in the United States live with OAB from person to person. But many experts symptoms. agree that going to the bathroom more than eight times in 24 hours is “frequent urination.” Who is at risk for OAB? u Wake up at night to urinate: Waking from As you grow older, you’re at higher risk for sleep to go to the bathroom more than once a OAB. But no matter what your age, there are night is another symptom of OAB.
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  • Paediatric Urinary Incontinence
    VOLUME 37 : NUMBER 6 : DECEMBER 2014 ARTICLE Paediatric urinary incontinence Gail Nankivell Senior physiotherapist1 SUMMARY Patrina HY Caldwell Staff specialist Urinary incontinence, both in the day and at night, is common in school-aged children and can be paediatrician1,2 very distressing for children and their families. 1 The Children’s Hospital An accurate history together with a thorough physical examination is essential for assessing and Westmead diagnosing urinary incontinence. 2 Discipline of Paediatrics Conservative treatment should be offered to all children. If that fails, treatment with anticholinergic and Child Health University of Sydney drugs could be tried in those with daytime urinary incontinence and overactive bladder. After addressing any daytime bladder symptoms, treatment with alarm therapy is recommended Key words for children with nocturnal enuresis. Desmopressin is another option. bedwetting, nocturnal enuresis Introduction During the day, voiding occurs when children synchronously contract their detrusor muscle and relax Aust Prescr 2014;37:192–5 Urinary incontinence in the day and at night is their urinary sphincters and pelvic floor muscles (usually common in school-aged children. Its causes can be in response to the sensation of bladder fullness). multifactorial. Daytime urinary incontinence occurs This allows the free flow of urine until the bladder is in about 17–20% of children1-3 with a further 6.6% empty. At night, with adequate bladder storage and of those having problems at night as well.2 The urine concentration, children usually sleep through the prevalence of nocturnal enuresis is 8–20% at five night without needing to urinate, but have the ability years of age, with a spontaneous remission rate of to wake up to void when they sense bladder fullness.
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  • Gotta Gotta Go Right Now: a Comprehensive Assessment of Frequent Urination and Nocturnal Enuresis
    Gotta Go Right Now: A Comprehensive Assessment of Frequent Urination and Nocturnal Enuresis Kelly Haack, M.A., and William J. Warzak, Ph.D. Department of Psychology, Munroe-Meyer Institute at the University of Nebraska Medical Center INTRODUCTION METHOD RESULTS Participant Bartter’s Syndrome Baseline 2 Months Following BRT ¾ Bartter’s Syndrome is caused by a defect in the kidney’s ¾ The participant was a 14-year-old male with Bartter’s Syndrome. Fluid Intake and Output Fluid Intake and Output ability to reabsorb potassium. ¾ He presented with frequent daytime and nighttime voiding. 1000 1000 ¾ As a result, the kidneys remove too much potassium from ¾ Medical History: 900 900 the body. 4 years old: Renal Ultrasound showed normal kidneys and 800 800 ¾ Excessive loss of potassium leads to muscle cramping and hypokalemia (low potassium level) was ruled out. Intake weakness, constipation, increased frequency of urination, 700 700 Intake and growth failure. 11 years old: Ditropan XL 10 mg daily and Imipramine 35 mg 600 600 daily were prescribed to treat symptoms of overactive bladder, Nocturnal Enuresis 500 500 ML such as frequent urination. ML ¾ Nocturnal Enuresis is involuntary passing of urine while 12 years old: Neurological exam was normal and neurogenic 400 400 asleep. bladder was ruled out. 300 300 Output Bartter’s Syndrome Output • Continued taking Ditropan and Imipramine. 200 200 and • Prescribed DDAVP 0.6 mg each evening to increase urine 100 100 concentration and decrease urine production. Nocturnal Enuresis 0 0 ¾ Adolescents with Bartter’s Syndrome often have a problem • Started use of a urine alarm; however, it was a short trial and 3:00 6:00 7:45 9:45 1:00 2:30 4:00 5:00 6:20 8:00 9:30 1:00 2:45 5:00 7:00 9:00 2:00 4:00 5:00 7:00 9:00 1:45 4:00 7:00 4:00 7:05 9:45 2:00 4:00 5:45 7:00 9:30 2:30 5:00 7:45 2:30 4:30 7:00 9:30 1:45 5:00 12:00 11:00 11:00 10:45 12:00 10:00 12:00 concentrating urine and excrete an excessive volume of he slept through it and continued to wet 5 out of 7 nights.
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  • Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline
    Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline E. Ann Gormley, Deborah J. Lightner, Kathryn L. Burgio, Toby C. Chai, J. Quentin Clemens, Daniel J. Culkin, Anurag Kumar Das, Harris Emilio Foster, Jr., Harriette Miles Scarpero, Christopher D. Tessier, Sandip Prasan Vasavada From the American Urological Association Education and Research, Inc., Linthicum, Maryland, and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction Purpose: The purpose of this guideline is to provide a clinical framework for the Abbreviations diagnosis and treatment of non-neurogenic overactive bladder (OAB). and Acronyms Materials and Methods: The primary source of evidence for this guideline is the AE ϭ adverse event systematic review and data extraction conducted as part of the Agency for ER ϭ extended release Healthcare Research and Quality (AHRQ) Evidence Report/Technology Assess- ϭ ment Number 187 titled Treatment of Overactive Bladder in Women (2009). That FDA Food and Drug report searched PubMed, MEDLINE®, EMBASE and CINAHL for English- Administration language studies published from January 1966 to October 2008. The AUA IR ϭ immediate release conducted additional literature searches to capture treatments not covered in OAB ϭ overactive bladder detail by the AHRQ report and relevant articles published between October PTNS ϭ peripheral tibial nerve 2008 and December 2011. The review yielded an evidence base of 151 treat- stimulation ment articles after application of inclusion/exclusion criteria. When sufficient PVR ϭ post-void residual evidence existed, the body of evidence for a particular treatment was assigned QoL ϭ quality of life a strength rating of A (high), B (moderate) or C (low).
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