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Overactive bladder is a condition, especially observed in older adults and is associated with a sudden and uncontrollable need to pass urine (urinary urgency), urge incontinence (leakage of urine before the woman has a chance to reach the toilet) and increased frequency of micturition (Rovner, & Walls, 2007). An overactive bladder is a condition that results from sudden, involuntary contraction of the muscles in the wall of the urinary bladder.
Another type of urinary continence is known as stress incontinence which is associated with involuntary loss of urine when the woman gets involved in activities, like coughing, sneezing, laughing etc, which cause only a slight increase in intra-abdominal pressure. Vaginal childbirth is often cited as a big risk factor for development of problems related to urinary incontinence by causing weakening of the pelvic tissues and structures around the urethra which can prevent it from holding back urine even when a mild physical activity causes slightest increase in intra-abdominal pressure.
Vaginal childbirth can also causes weakness of various tissues and ligaments supporting the uterus, resulting in prolapse of uterus out of vaginal opening. All these problems associated with the weakness of pelvic floor structures may cause significant social, psychological, occupational, domestic, physical, and sexual problems for the woman. Thus overactive bladder can be considered as an important problem which can significantly influence the health related quality of life of affected women.
In this essay, a comparison would be done between what the public reads about the problem of overactive bladder in the written media, and the way medical community supports or refutes the information that has been presented by the media. This would be done by presenting the summary and main points of the two articles, one after the other, followed by the comparison of two articles.
The article by Sheehan (2008) titled, “Your most embarrassing ‘female’ problem solved” describes the symptoms of the various pelvic-floor disorders including bladder incontinence, (both stress incontinence and urge incontinence) and uterine prolapse. The article describes the problem in simple language, which even a layperson can understand. It helps in alleviating fears out of the mind of lay person by explaining that these disorders occur commonly, affecting almost one in every three women under the age of 54 years.
One of the main reasons for development of stress incontinence is the weakening of the tissues and structures around the urethra, which can prevent it from holding back urine whenever there is even the slightest increase in intra-abdominal pressure related to minor degree physical activities like coughing, laughing etc as well as with more-energetic activities like sexual intercourse or exercise. Pelvic-organ prolapse, can be defined as protrusion of the pelvic organs through the vaginal opening.
Though the main risk factor associated with weakening of pelvic floor tissues is vaginal delivery particularly that associated with a large baby, prolonged labor and the use of forceps or vacuum extraction, other risk factors which can contribute to the risk of development of pelvic tissue weakness include obesity, hysterectomy, estrogen deficiency (e. g. menopause), constipation etc. Uterine prolapse can result in significant distress to the women by causing pelvic and back discomfort, increased frequency of urinary tract infections, and problems related to emptying the bladder or bowel.
Besides explaining the symptoms and pathophysiology related to the development of various pelvic floor disorders, this article also highlights various treatment options for these disorders. Kegel exercises or the exercise which aim at strengthening the muscles of pelvic floor by regularly squeezing-and-holding the pelvic floor muscles can especially prove to be helpful both for problems related to incontinence and uterine prolapse. For overactive bladder, kegel exercises can prove to be really helpful if combined with behavior modification strategies.
Behavior modification aims at re-training the bladder by helping the patient schedule her bathroom trips, helping her resist the urge to urinate between trips, thereby gradually increasing the intervals between trips. Prescription medicines like Detrol (tolterodine) and Ditropan (oxybutynin) can help by reducing the activity of hyperactive tissues. For overactive bladder use of botox injection, though yet not approved by the FDA, is also being commonly used. It is thought to provide relief from overactive bladder by paralyzing the overactive bladder muscles.
Stress incontinence symptoms can also be relieved through the use of a small diaphragm like device known as pessary, which is placed inside the vagina in order to support the uterus and other pelvic structures. Surgical procedures involving the use of a synthethic mesh or sling to support the utrethra also help in providing relief. Though the vaginal delivery is more likely to be associated with development of incontinence and prolapse, having a caesarean section may not necessarily prevent their development.
Besides, caesarean sections are associated with their own share of complications including bleeding, scarring, prolonged recovery, risk of development of infections etc. Summary of Professional Article (Journal of the American Academy of Nurse Practitioners) This review article by Bradway et al (2008) titled, “Lower urinary tract symptoms in women—A common but neglected problem” is a review article which focuses primarily towards providing the nurse practitioners (NPs) an understanding of female lower urinary tract symptoms (LUTS).
This article also highlights the present evidence regarding the prevalence, epidemiology, risk factors, symptoms, impact of these symptoms on the patient’s quality of life, diagnosis and treatment, and treatment barriers for LUTS in women. Though these symptoms are commonly present, they are often overlooked, and may not be adequately addressed in many women. This article emphasizes the fact that LUTS forms a global women’s health problem, which requires a stronger a nursing focus in order to fully understand its impact on the quality of woman’s life.
The nursing staff also needs to understand the likely barriers which might prevent them from giving adequate care to these individuals and to develop strategies for acceptable and effective evidence-based management. The article divides LUTS into seven categories, with the three main ones being related to storage, voiding, and postmicturition symptoms. Storage symptoms, which are related to bladder filling, include increased urinary frequency, urgency, nocturia, and urinary incontinence (UI). UI has been further subdivided into urge urinary incontinence (UUI), stress urinary incontinence (SUI), and mixed urinary incontinence (MUI).
This article has described overactive bladder (OAB) as a syndrome complex associated with LUTS mainly in relation to the storage symptoms, including urinary urgency, with or without UUI, along with increased frequency and nocturia. Voiding symptoms include slow stream, hesitancy, straining, and terminal dribbling etc. This article presents good evidence emphasizing how LUTS (and specifically OAB) can cause considerable emotional distress, have a negative impact on health related quality of life (HRQL), and can interfere with daily activities.
Women with overactive bladder often restrict their physical and social activities, due to the fear of embarrassment in public, leading to social isolation and depression. LUTS can also profoundly affect the woman’s sexual behavior and her sexual quality of life. Treatment strategies for LUTS and OAB include a combination of patient education; pelvic floor muscle training exercises (Kegel’s exercises); behavior modification (management of fluid intake, controlling the frequency of micturition etc); and pharmacotherapy with antimuscarinic agents (e. . , oxybutynin, tolterodine, trospium, darifenacin, solifenacin, etc).
Refractory cases may require surgery. The article highlights the importance of developing an awareness regarding the high prevalence of LUTS for the nursing professionals in clinical practice. Nurses also need to be aware that a large percentage of patients may not seek treatment, due to occurrence of embarrassing symptoms which may prevent them from discussing the problem with their health care provider.
The nursing staff needs to develop an empathetic attitude towards these individuals and discuss the various available therapeutic options with them. Comparison of the two articles The two articles are basically same in the sense they both describe the same problem i. e. symptoms related to lower urinary tract dysfunction resulting from the weakness of the muscles of the pelvic floor. The main problems described in both the articles include urge incontinence, stress incontinence and uterine prolapse.
However the two articles differ from each other based on the target audience they are meant to cater to. The article by Bradway et al (2008) is meant for the medical health professionals, especially the nursing staff. On the other hand, the article by Sheehan (2008) is meant for layperson, or a person who has no medical knowledge. This is the kind of article which may appear in woman’s magazine. It aims at making the layperson understand the problems commonly encountered in women, resulting from weakness of pelvic floor muscles.
Though this article also describes more or less same things as the article by Bradway et al (2008), the terminology used by Bradway et al is more difficult and is meant for a person who already has knowledge regarding this topic. The article by Sheehan (2008) highlights simple changes in lifestyle which the woman can make on her in order to prevent the occurrence of this problem. For e. g. according to Sheehan (2008), “Dietary changes are also helpful: Eat more fiber to normalize the stool and avoid caffeine, carbonated beverages, dairy, spicy foods, and acidic fruit (like oranges and pineapples), which can irritate the bladder.
On the other hand the article by Bradford et al (2008) highlights the interventions required on part of the nursing staff to prevent the occurrence of the disorders related to weakness of pelvic floor. According to Bradford et al (2008), “In terms of clinical practice, and given the large percentage of patients who do not seek treatment, increased attention is warranted as to the obstacles that prevent patients and healthcare providers from discussing the problem”.
Though the information provided by Bradford is well supported by good evidence, the article by Sheehan (2008) gives generalized information not supported with high quality research studies. Even though the names of few renowned gynecologists and physicians have been included, the exact sources from where these references were taken have not been mentioned. If a person wants to go into further details of the subject he/she can readily do it with the help of article by Bradford et al (2008) but not with the help of article by Sheehan (2008)