Response to SHU- Overactive bladder.

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Over 50 percent women age 65 and older have reported urinary incontinence and urgency. However, aging is not the only risk factor for urinary incontinence. This problem remains underdiagnosed and undertreated that only 25% of affected women seek care, and of those, less than half receive treatment (Lukacz, et al., 2017). The factors that implicated the mechanisms underlying stress and urgency incontinence include damage to the endopelvic fascia and pelvic floor muscles that support the urethra, decreased function of the striated urinary sphincter, changes in the compliance and innervation of the detrusor muscle, changes in the urothelium, changes in the urine composition and the changes in the central nervous system (Lukacz, et al., 2017). One-thirds of women who are suffering from urinary incontinence has overactive bladder syndrome (White & Iglesia, 2016).

Overactive bladder syndrome is formally defined as urinary urgency, with or without urgency incontinence, usually with urinary frequency and nocturia, in the absence of a urinary tract infection or other obvious pathology (Aoki, et al., 2017).

The diagnosis of overactive bladder syndrome

Taking a thorough medical and surgical history and a complete review of system as well as medications are important of diagnosing. The parity, obesity, the mode of delivery should also be considered for diagnosis.

The review of system should include the signs and symptoms of urinary tract infection (UTI) that the burning sensation of urination, change of mental status. Besides, the voiding diary is helpful of assessing the potential modifiable factors associated with incontinence episodes (Lukacz, et al., 2017). The urinary analysis should be done to rule out the UTI and chronic irritative bladder conditions. Measurement of postvoid residual volume (typically <150ml) can help rule out overflow incontinence (White & Iglesia, 2016).

The management of overactive bladder syndrome

The assessment of how the condition impacts the patient’s daily life determine the treatment plan. When the urinary UTI is ruled out, the first-line treatment for symptoms is the pelvic floor muscle therapy (White & Iglesia, 2016). The pharmacological interventions like oxybutynin and myrbetriq are commonly used. However, the oxybutynin is a formulation of anticholinergic with adverse effects of dry mouth, constipation, and blurred vision, which induce the discontinue therapy. While the Myrbetriq with generic name of Mirabegron is much newer than oxybutynin relax the bladder wall muscle. The side effect of Myrbetriq includes hypertension, UTI, headache, nasopharyngitis (White & Iglesia, 2016). It is important to educate the patients the adverse effect of the medications before the pharmacological therapy.

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