الفهرس 
Functional Anatomy of Female Pelvic Floor and Lower Urinary TractOnly 14 pages are availabe for public view
 |  | from | 190 |  |  |
| | | from | 190 | | |
Abstract
T
he International Continence Society (ICS) defines OAB as the presence of “urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of UTI or other obvious pathology (Haylen et al., 2010). Urgency, the hallmark of OAB, is defined as the sudden compelling desire to urinate, a sensation that is difficult to defer. Urinary frequency is defined as voiding 8 or more times in a 24-hour period. Nocturia is defined as the need to wake 1 or more times per night to void (Abrams P. et al., 2002).
The overall prevalence of overactive bladder is 13.9%, affecting men and women with equal frequency. Although it can happen at any age, overactive bladder is especially common in older adults. Overactive bladder should not be considered a normal part of aging. The prevalence under the age of 50 is < 10%. After age 60, the prevalence increases to 20%-30%. It is estimated that 60% of patients have dry OAB (no leakage) while 40% have wet OAB (Zorn et al., 2015).
Overactive bladder (OAB) appears to be multifactorial in both etiology and pathophysiology. The cause of detrusor overactivity is attributed to a lack of inhibition of the micturition reflex that is parasympathetic in nature, while sensory urgency has been attributed to increased afferent stimuli, especially noxious ones (Mundy, 1994). Common conditions such as urinary tract infection, kidney and bladder stones, or bladder tumors can all cause overactivity of the detrusor muscle, resulting in overactive bladder (Shaw et al., 2011).
Some nervous system conditions can increase the susceptibility to develop overactive bladder. These conditions include diabetic neuropathy, stroke, multiple sclerosis, spinal cord injury, dementia, and Parkinson’s disease. Sometimes no identifiable cause for overactive bladder can be found. This is termed idiopathic overactive bladder (Shaw et al., 2011).
Overactive bladder syndrome represents a great burden on the patients affecting their quality life, its cause is unknown in cases of idiopathic overactive bladder, so researchers care about identifying the exact etiology of this condition.
The aim of our study was to detect the possible association of subtle neurogenic affection in idiopathic overactive bladder and the role of biofeedback and electrical stimulation to pelvic floor muscles in the management of overactive bladder.
Our study included 30 female patients complaining of urinary urgency and/or urinary frequency with or without urinary incontinence diagnosed as overactive bladder without any suspected neurological disease (idiopathic overactive bladder) and 10 normal female persons serving as a control group. History taking and clinical examination were done, We tested pudendal nerve latency, sacral reflexes latency, and SSEP P1 latency in both patients and controls then we did needle EMG for EAS and EUS for patients only. We also gave 12 physical therapy sessions to our patients in the form of biofeedback therapy and electric stimulation to pelvic floor muscles.
The following were observed:
1) There was evidence of neuropathic affection in (86.7%) of our patients in the form of abnormalities in either multiple or all nerurophysiological studies.
2) There was a highly statistically significant increase in PNTML in patients than controls.(PNTML was prolonged in (73.3%) of our patients)
3) There was a highly statistically significant increase in sacral reflexes latency in patients than controls. (clitroanal reflex was prolonged in (83.3%), urethroanal reflex was prolonged in (76.6%) and bladder anal reflex was prolonged in (63.3%) of our patients)
4) There was non statistically significant difference between patients and controls regards PSSEP P1 latency.(t=-0.246, p=0.808 on the right side, t=-0.292, p=0.773 on the left side)
5) There was evidence of neuropathic affection on performing EMG for both EAS, EUS. (EMG abnormalities were detected in 73.3% of patients in EAS and in 76.6% of them in EUS).
6) There was a statistically high significant increase of the score of SSQ in our patients (improvement) after rehabilitation sessions (t=-26.217, p=0).
So we can conclude that:
1) There is element of neuropathic affection in patients with idiopathic overactive bladder.
2) The degree of neuropathic affection in overactive bladder patients is correlated to the severity of their symptoms.
3) Biofeedback therapy and electric stimulation to pelvic floor muscles are effective in improvement of symptoms of overactive bladder syndrome.