**Part 2**

**The Overactive Bladder** 

160 Urinary Incontinence

[14] Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The

[15] Fowler, C.J., D. Griffiths, and W.C. de Groat, The neural control of micturition. Nat Rev

[18] Wein AJ, Rackley RR. Overactive bladder: a better understanding of pathophysiology,

[16] Benarroch, E.E., Neural control of the bladder. Neurology, 2010. 75(20): 1839-1846. [17] Miller J, Hoffman E. The causes and consequences of overactive bladder. *J Womens* 

diagnosis sand management. J Urol 2006; 175: S5–10

2003 Jan; 61(1):37-49.

Neurosci, 2008. 9(6): p. 453-466.

*Health* 2006; 15 (3): 251–60.

standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology

**10** 

*USA* 

**Diagnosis and Treatment of Overactive Bladder** 

Overactive bladder (OAB) is a disturbance of filling/storage and has been defined by the International Continence Society as "a symptom syndrome consisting of urgency with or without urge urinary incontinence, often associated with urinary frequency and nocturia." (Abrams et al., 2002) OAB has been divided into OAB without urinary incontinence (OABdry) and OAB with urinary incontinence (OABwet). The reported prevalence of OAB in women varies between 7.7 and 31.3%, and increases with age. (Irwin et al., 2006a; McGother

The symptoms of OAB include urinary urgency, urinary frequency, nocturia, and urinary urge incontinence. These symptoms often remain undetected and undertreated by both the woman and her providers, despite the substantial impact on a woman's quality of life. (Griffiths et al., 2006; Mardon et al., 2006) In a multiethnic survey, only 45 percent of women who reported weekly urinary incontinence sought care for their incontinence symptoms. (Harris et al., 2007) This leaves incontinent women with psychological morbidity and a

The normal micturition cycle includes inhibition and contraction of detrusor smooth muscle, afferent signaling from the urothelium, contraction and relaxation of the smooth and striated sphincter muscles, and the central, peripheral, and autonomic nervous systems.

Urine storage occurs secondary to afferent signals stimulated by bladder filling. These afferent signals activate sympathetic pathways in the hypogastric and pudendal nerves, which lead to contraction of the smooth and striated sphincters, and at the same time inhibit detrusor contraction. In addition, high cortical centers are activated, (Griffiths et al, 2007), and stimulate the storage center in the pons. (Fowler et al, 2008) When further bladder filling leads to increased afferent signaling from the bladder, spinobulbospinal reflex pathways are carried via the pelvic nerve and spinal cord to the pontine micturition center, which activates parasympathetic pathways that cause bladder contraction and inhibit

sympathetic and pudendal contraction of the sphincter (Fowler et al, 2008)

et al., 2006;Milsom, et al., 2001; Stewart et al., 2003; Wagg et al., 2007)

diminished quality of life. (Irwin et al., 2006b)

**1. Introduction** 

**2. Etiology** 

**2.1 Normal micturition** 

Howard A. Shaw1,2 and Julia A. Shaw2

*1Hospital of Saint Raphael* 

*2Yale University School of Medicine* 
