Research progress on the relationship of overactive bladder syndrome and irritable bowel syndrome / 中国综合临床

Overactive bladder syndrome is a complex of lower urinary tract symptoms that disturbs people of all ages worldwide. The etiology and pathogenesis are unclear, and the treatment effect is often poor.In recent years, with the in-depth study of overactive bladder, it has been found that patients with overactive bladder are often accompanied by intestinal functional changes such as irritable bowel, which presents high comorbidities with irritable bowel syndrome. This article will discuss the relationship of overactive bladder and irritable bowel syndrome from three aspects of comorbidities,pathogenesis and treatment,in order to find similarities between overactive bladder and irritable bowel syndrome.It provides new clues and methods for the pathogenesis and treatment of overactive bladder and irritable bowel syndrome.

Comparação entre oxibutinina, eletroestimulação do nervo tibial posterior e exercícios perineais no tratamento da síndrome da bexiga hiperativa / Comparación entre oxibutinina, electroestimulación del nervio tibial posterior y ejercicios perineales en el tratamiento del síndrome de la vejiga hiperactiva / Comparison of oxybutynin, electrostimulation of the posterior tibial nerve and perineal exercises in the treatment of overactive bladder syndrome

RESUMO Objetivou-se avaliar a eficácia dos exercícios perineais, da eletroestimulação transcutânea do nervo tibial posterior (ETNTP) e da oxibutinina em mulheres com síndrome da bexiga hiperativa, que é a segunda causa mais comum de incontinência urinária, com sintomas urinários extremamente incômodos que prejudicam a qualidade de vida. Foram randomizadas 65 mulheres, das quais 57 completaram o tratamento. Formaram-se três grupos: o de exercícios perineais, ETNTP e o grupo controle, que utilizou oxibutinina. Os exercícios foram realizados em grupo, nas posições em pé, supino e sentado, duas vezes por semana, com duração de 30 minutos cada sessão, totalizando 12 sessões. Na ETNTP utilizou-se eletrodo transcutâneo posicionado em maléolo medial e outro 10cm acima, com frequência de 10Hz e largura de pulso de 200 microssegundos, por 30 minutos, duas vezes por semana, totalizando 12 sessões. Na medicação as pacientes receberam oxibutinina de 10mg/dia de liberação imediata divididos e duas doses de 5mg/dia, durante 12 semanas consecutivas. Antes e depois dos tratamentos, as pacientes passaram por uma avaliação composta pela análise do diário miccional, avaliação funcional do assoalho pélvico e aplicação de questionário de qualidade de vida OAB-V8. Houve redução da incontinência de urgência em 50%, 70,5% e 41% nos grupos de exercício, ETNTP e oxibutinina, respectivamente, com significância estatística somente da eletroestimulação. As três modalidades de tratamento foram eficazes na melhora da qualidade de vida para a terapêutica em curto prazo, estatisticamente semelhantes entre si.

RESUMEN Se evaluó la eficacia de los ejercicios perineales, de la electroestimulación transcutánea del nervio tibial posterior (ETNTP) y de la oxibutinina en mujeres con síndrome de la vejiga hiperactiva, la segunda causa más común de incontinencia urinaria, con síntomas muy incómodos, que perjudican la calidad de vida. Sesenta y cinco mujeres, de las cuales 57 completaron el tratamiento, formaron tres grupos: el de ejercicios perineales, ETNTP y el grupo de control, que utilizó oxibutinina. Los ejercicios se realizaron en grupo, en las posiciones en pie, supino y sentado, dos veces por semana, con duración de 30 minutos cada sesión, totalizando 12 sesiones. En la ETNTP se utilizó electrodo transcutáneo posicionado en el maléolo medial y otro 10 cm arriba, con frecuencia de 10Hz y ancho de pulso de 200 microsegundos, por 30 minutos, dos veces por semana, totalizando 12 sesiones. En la medicación las pacientes recibieron oxibutinina de 10 mg/día de liberación inmediata, divididos en dos dosis de 5mg/día, durante 12 semanas consecutivas. Antes y después de los tratamientos, las pacientes pasaron por una evaluación compuesta por el análisis del diario miccional, la evaluación funcional del piso pélvico y la aplicación del cuestionario de calidad de vida OAB-V8. Se observó una reducción de la incontinencia de urgencia en un 50%, 70,5% y 41% en los grupos de ejercicio, ETNTP y oxibutinina, respectivamente, con significancia estadística solamente de la electroestimulación. Las tres modalidades de tratamiento fueron eficaces en la mejora de la calidad de vida para la terapéutica a corto plazo y estadísticamente similares.

ABSTRACT The objective of this study was to evaluate the efficacy of perineal exercises, transcutaneous electrostimulation of the posterior tibial nerve (TPTNS) and oxybutynin in women with overactive bladder syndrome, which is the second most common cause of urinary incontinence, with extremely uncomfortable urinary symptoms which impair their quality of life. A total of 65 women were randomized, of whom 57 completed treatment. Three groups were formed: the perineal exercises group, the TPTNS group and the control group, which used oxybutynin. The exercises were performed in groups, in the standing, supine and sitting positions, twice a week in 30-minute sessions, totaling 12 sessions. In the TPTNS group, carried out with 10Hz frequency and 200 microsecond pulse width, a transcutaneous electrode was positioned on the patients' medial malleolus, and another was positioned 10cm above it. The patients of the control group received 10 mg/day doses of immediate release oxybutynin, divided into two 5mg/day doses for 12 consecutive weeks. Before and after the treatments, the patients' voiding diary was analyzed, their pelvic floor was functionally evaluated and they were asked to fill in an OAB-V8 quality of life questionnaire. Urge incontinence was reduced by 50%, 70.5% and 41% in the exercises, TPTNS and oxybutynin groups, respectively, and statistical significance was detected for stimulation only. The three treatment modalities were effective for improving quality of life in the short-term therapy, and were statistically similar to each other.

Bexiga hiperativa / The overactive bladder

A Bexiga Hiperativa é uma condição frequente na população atual. A Urgência é o sintoma primário que leva aos demais simtomas dessa síndrome. A primeira lina do tratamento farmacológico, são os anticolinérgicos. A Oxibutinina, Telterodina, Darifenacia e Solifenacina, produzem resultados similares em relação a Urgência, po´rm com efeitos colaterais diferentes. O Mirabegron é a mais recente opção no tratamento farmacológico da Bexiga Hiperativa. Trata-se de uma nova classr terapêutica, os agonista Beta 3, que relaxa musculatura do detrusor. O tratamento de primeira linha é representada pela mudança estilo de vida e fisioterapia. Quando os sintomas presistem, o próximo passo é o tratamento farmacológico oral.O Mirabegron alivia os simpomas da Bexiga Hiperativa e por ter mecanismo de ação diferente é uma alternativa para os pacientes intolerantes ou refratários aos anticolinérgicos. A papel da terapia combinada dessas duas classes de drogas embora atraente, ainda não está validada.

Combination ofLingshao-Zaoren particle and Tolterodine Tartrate tablets for the treatment of overactive bladder in women / 国际中医中药杂志

Objective To evaluate the efficacy ofLingshao-Zaoren particle combined with Tolterodine Tartrate tablet in the treatment of overactive bladder in women.Methods A total of fifty female patients diagnosed with overactive bladder were randomized to receivingLingshao-Zaoren particle combined with Tolterodine Tartrate tablet group(treatment group,n=25) or only Tolterodine Tartrate tablet group(control group, n=25). Both groups were treated for 4 weeks. Changes of scores from the Overactive Bladder Symptom Scale (OBASS) and the Urgent Urination Scale were assessed.Results The scores from the OBASS improved significantly after treatment than those before treatment in both groups(in the treatment group: 3.24±0.61vs.12.16± 1.39,P<0.01; in the control group: 8.81±1.55vs.13.12±1.45,P<0.01) and so did the Urgent Urination Scale (in the treatment group: 1.04±0.72vs. 3.99±0.78,P<0.01; in the control group: 2.61±0.88vs.4.01±0.71,P<0.01) . There were significantly greater improvements in the scores from the OBASS and the Urgent Urination Scale in the treatment group than those in the control group(allP<0.01).ConclusionLingshao-Zaoren particle combined with Tolterodine Tartrate tablet was superior to only Tolterodine Tartrate tablet for the treatment of overactive bladder in women.

The Relating Factor and Quality of Life of Overactive Bladder in Adults / 가정의학회지

BACKGROUND: Overactive bladder syndrome (OAB) is a common disorder in primary care that affects negatively on the quality of life of outpatients. However, little information is available on related factors and the quality of life in adults with overactive bladder. The purpose of this study was to find related factors of overactive bladder and to measure the quality of life in adults with overactive bladder. METHODS: Among the people who visited a hospital in Seoul and Chung-ju for a health examination or primary care between October 1 and December 31, 2008, we selected 327 participants over 20 years old. We measured their Overactive Bladder Questionnaire (OAB-q), took medical history and reviewed their demographic data. The relationship between OAB, other independent variables and health related quality of life (HRQL) were analyzed. RESULTS: Of 327 respondents, the prevalence of OAB in adults was 38 (11.6%). The factors related to OAB were age (P = 0.007), history of prescription for congestive heart failure (P = 0.023), benign prostatic hyperplasia (BPH) (P = 0.002), and depression (P = 0.008). OAB was significantly associated with BPH medication (P = 0.042; OR = 8.757) and depression medication (P = 0.005; OR = 9.977) in multivariable logistic regression analysis. In each T-test analysis, OAB decreased in HRQL. CONCLUSION: OAB is a common disorder in adults, history of BPH medication and depression medication is more common in OAB. The symptoms that were suggestive of OAB were affected negatively on the quality of life in adults. Effective health care polices and prompt management of OAB should be implemented.

The Prevalence of Overactive Bladder Syndrome and Urinary Incontinence in Young and Middle Aged Women

PURPOSE: We performed a pilot survey via internet to assess the prevalence of overactive bladder syndrome (OABs) and urinary incontinence(UI) in young and middle aged women. MATERIALS AND METHODS: From 22 April 2002 to 5 May 2002, a total of 3,372(89.8%) women(mean age: 26.3+/-4.8 years) among 3,757 participants completed a questionnaire via internet web site. They were divided into 3 groups: those who had OABs(group 1), who had UI(group 2), and controls who had neither. The factors related to OABs and UI were analyzed by multiple logistic regression analysis. RESULTS: Of 3,372 respondents, the prevalence of OABs and UI in young women was 429(12.7%) and 707 (21%), respectively. The factors related to OABs were history of urinary tract infection and family history. The factors related to UI were age, occupation, history of urinary tract infection, family history, and parity. CONCLUSIONS: The symptoms suggestive of OABs and UI are highly prevalent in young and middle aged women. So, effective healthcare polices and prompt management about OABs and UI should be concerned.