But what is an Overactive Bladder and how is UI diagnosed?
Overactive bladder (OAB) is a syndrome characterized by an urgency to urinate, usually accompanied by increased frequency and nocturia (frequent urge to urinate at night), with or without UI and in the absence of a urinary infection or other underlying pathology.
Although it is associated with an increase in mortality, it has a profound impact on the well-being and quality of life, especially for women, who often have concomitant diagnoses of depression or anxiety, accompanied by difficulties in a work context and social isolation.
The first step in approaching these patients includes collecting a detailed clinical history, in the case of women, which includes among others, the gynaecological and obstetric history.
The number of deliveries is a risk factor for UI, as well as pelvic organ prolapse. However, UI is described in nulliparous women (women without children) and can reach a prevalence of 32% between 55 and 64 years of age.
When comparing women who underwent a caesarean section delivery (who have a prevalence of UI similar to nulliparous women), with women who had a vaginal delivery, these have a higher risk of stress UI. The age of the mother at the first delivery and the new-born infant’s weight have also been implicated as obstetric risk factors for UI.
Pregnancy itself also predisposes to UI, with an increase throughout the different trimesters. However, primary prevention through pelvic floor training exercises during pregnancy has been shown to reduce the likelihood of having UI in late pregnancy by 62% and by 29% of experiencing it 3-6 months after delivery.
It is known that the prevalence of Overactive Bladder increases with age, and it is expected to increase in the coming years, due to population aging.
Physiological changes associated with aging, such as changes in muscle tone or decreased bladder capacity, favour the development of OAB, especially in the presence of precipitating factors. However, OAB should not be seen as an inevitable part of aging, and therefore deserves proper evaluation and treatment.
There is a wide spectrum of therapeutic options and the selection depends on the severity of symptoms and the impact they have on the patient's daily life.
The first approach is usually non-invasive and includes lifestyle adjustments (aiming to limit irritating agents to the bladder), bladder training, urge suppression techniques and pelvic floor physiotherapy.
The surgical treatment of stress UI has evolved over the last few decades towards minimally invasive approaches. This alternative is decided on when the other approaches do not have sufficiently satisfactory results, which is why it is reserved for a small percentage of patients.