Guidelines for over active bladder in older people
- Feb 02 , 2017 1
Natural changes in the urinary tract may account for some of the apparent increase in the lower urinary tract symptoms with increasing age. The sensation of bladder filling is reduced and bladder capacity falls, leading to an older person having less time to respond and perhaps explaining why many older people complain of severe urge, rather than urgency. The older who sufferers with OAB, bladder sensation appears to be heightened, bladder capacities much lower, and urethral resistance rises in association with the onset of the condition, although the mechanism underlying this is unknown.
Urinary urgency in older people may be a result of both bladder and intracerebral lesions. Severity of urinary urgency and of incontinence have been associated with increased white matter hyperintensities by MRI scanning of older people, suggesting that increasing ischemic insults in association with aging may impair higher centers of influence on the maintenance of continence, manifesting severe urge and urgency.
Guidelines for coping with OAB:
According to a study:
- First-line therapy: Behavioural therapies and education should be offered first; starting anti-muscarinic therapies at the same time as behaviour therapies may prove clinically beneficial
- Second-line therapy: Anti-muscarinic; extended-release preparations should be used instead of immediate-release preparations when possible; transdermal oxybutynin can also be used. Beta-3 adrenoceptor agonists are also second-line pharmacologic therapies for the management of OAB and may be used as the initial pharmacologic therapy or when anticholinergic agents have failed or are contraindicated.
- Third-line therapy: Sacral neuromodulation or peripheral tibial nerve stimulation (PTNS) for carefully selected patients with severe refractory OAB symptoms or those who are not candidates for second-line therapy and are willing to undergo a surgical procedure; intradetrusor injection of onabotulinumtoxinA is another option.
- Limiting bladder irritants for an example- caffeine, alcohol.
- Bladder training.
- Urgency suppression techniques, including pelvic floor muscle exercises.
- Wearing diapers.