Overactive bladder causes. Overactive bladder: symptoms and signs. Complications and consequences

An overactive bladder is a syndrome that presents with symptoms such as an urgent need to urinate, increased frequency of urination, and sometimes urinary incontinence.

But what are the reasons? What are the treatment options and what natural remedies can alleviate the condition?

What is overactive bladder syndrome

Overactive Bladder Syndrome is a disorder characterized by increased frequency of urination and urgent need do this, in the absence of urinary tract disease.

From the latest data it follows that:

This disease affects 15-17% of the population;
40% men and 60% women;
In general, about 50 million people in the world suffer from overactive bladder.

However, the disorder may be much more common, and the reported data may be grossly underreported, as shame or fear of being judged by others causes many patients to avoid seeking medical attention.

Mechanism of overactive bladder syndrome

The pathophysiology of overactive bladder syndrome is associated with bladder detrusor muscle changes. Under normal conditions, this muscle is controlled by a neural network located at the level of the brain. In particular, the urinary control center is located at the level of the frontal cortex. In general, the mechanism of urination is under the control of this network.

For various reasons, some of which are not yet known, this control network is causing involuntary and frequent contractions of the detrusor muscle leading to an urgent need to urinate.

Overactive bladder can be divided into two forms:

Wet overactive bladder when, along with the need to urgently urinate, involuntary loss of urine (incontinence) occurs.
Dry overactive bladder occurs when there is an urgent need to urinate and increased frequency of urination, but there is no involuntary loss of urine.

In addition, a distinction can be made based on association with neurological disease:

Bladder overactivity in neurological diseases: associated with causes that affect the nervous system.
Bladder overactivity without neurological disease: when proven that the causes lie outside nervous system.

Symptoms can be confused with other diseases

The symptoms of an overactive bladder are not entirely specific, and can sometimes be confused with other conditions that have similar symptoms.

Among the symptoms of this syndrome, we note:

Urgent need to urinate: a characteristic feature of this syndrome. The patient experiences an urgent urge to urinate, and this symptom can manifest itself at any time of the day: on its own, after exertion, during coughing, or during emotional events.
Urinary incontinence: Some patients suffering from overactive bladder syndrome have urinary incontinence.
Increased frequency of urination: A subject suffering from overactive bladder syndrome may go to the toilet many times a day, many times above the normal threshold, in particular 8 or more times a day.
nocturia: People with this syndrome have an urgent urge to urinate not only during the day, but also at night, this leads to frequent awakenings and poor quality sleep. On average, nocturia is characterized by two episodes of urination per night, but sometimes it can be many more.

Several Causes of an Overactive Bladder

Overactive bladder syndrome can be caused by certain medical conditions, sometimes associated with neurological problems. The latter can be both the determining cause and one of the reasons for the aggravation of the symptoms of the syndrome.

Among causes of a pathological nature, we will highlight:

Bladder anomalies: This includes both tumors or stones in the bladder, which can interfere with normal urinary function, and benign prostatic hyperplasia, which puts pressure on the urethra, causing urinary problems.
Neurological disorders: The most severe form of overactive bladder is associated with changes in the central or peripheral nervous system. Among these diseases we have sclerosis, stroke and Parkinson's disease (typical of the elderly).
Increased urine production: A metabolic disorder such as diabetes mellitus or kidney failure can lead to increased urine production.
Obesity: Excessive weight gain leads to increased pressure on the lower abdomen, and, accordingly, bladder contraction. This can lead to an overactive bladder with excessive tension on the urethral sphincter, leading to incontinence.

All non-pathological causes, as a rule, are derived from disorders of a psychological nature or are associated, for example, with lifestyle or personality characteristics:

Pregnancy and childbirth: is one of the main causes of overactive bladder in women. For pregnancy and childbirth lead to a weakening of the pelvic floor muscles and a decrease in contractile strength.
Age: most often the phenomenon of overactive bladder is observed in the elderly. This is because all the control mechanisms (neurological) of urination weaken with age.
stress and anxiety: sometimes an overactive bladder can be associated with stress or excessive anxiety, which causes an increase in the frequency of urges.
Surgery: operations that may affect the spinal nerve (for example, in the case of repair of a herniated disc), or that concern the gastro-urogenital area, may lead to disturbances in the transmission of nerve control over urination.
Menopause: The lack of estrogen in menopausal women is usually associated with frequent urge to urinate and urinary incontinence.
Medications: Those who take drugs that increase urine production, such as diuretics, may suffer from overactive bladder due to excessive urine production.
smoking and diet: although there is no proven correlation with overactive bladder, it seems that those who smoke cigarettes and consume alcohol and caffeine in large quantities are more likely to suffer from this disorder.

Correct diagnosis improves quality of life

Diagnosing the causes of overactive bladder is critical to a patient's quality of life.

To make a correct diagnosis, the doctor uses the following methods:

Anamnesis: includes a conversation with the patient about the clinical history of the disease. The patient is asked whether he has had episodes of urinary incontinence, how many times he gets up at night, whether he often feels an urgent need to urinate, whether he manages to get to the toilet or involuntary losses occur.
Survey: carried out by examining the abdominal cavity and genitourinary apparatus. In women, a pelvic exam is performed to see the condition of the pelvic floor muscles, in men, a prostate exam.
Level 1 analyzes: necessary for differential diagnosis with diseases such as cystitis, irritable bowel syndrome, urinary tract infections and the presence of stones in the bladder or kidneys.
Urodynamic test: used to evaluate the process of filling and emptying the bladder to rule out urinary stasis (i.e., the bladder does not empty completely during urination), which can lead to symptoms similar to overactive bladder syndrome. This test can be combined with uroflowmetry, which evaluates the volume and speed of urine flow.
Other level 2 examinations: to exclude dangerous diseases such as tumors in the bladder or changes in muscle contractility. These studies include cystometry, electromyography, and urethrocystoscopy.

Treatment for an overactive bladder

Overactive bladder medications are used to control the malfunction.

Among the drugs used are:

Antimuscarinic: these drugs act on muscarinic receptors, thus regulating detrusor muscle contractions and reducing their intensity and frequency. The most commonly used are oxybutynin, darifenacin and tolterodine.
Adrenoreceptor agonists: act on different categories of beta-3 adrenergic receptors, due to which they cause relaxation of the detrusor muscles and, therefore, increase the capacity of the bladder. This category includes one of the new drugs for the treatment of overactive bladder - mirabegron.

one more possible option treatment is medico-surgical therapy if medications have not given the expected results.

Among these methods are:

Botox: to influence the contraction of the detrusor muscle, botulinum toxin can be injected directly into the tissues of the bladder. This causes numbness in muscle tissue, which reduces the frequency and intensity of contractions. Used mainly in patients who suffer from overactive bladder associated with neurological diseases such as multiple sclerosis. The effect of the injection lasts from 6 to 9 months, after which the introduction of the toxin is repeated.
Bladder expansion surgery: also known as enterocystoplasty. This operation aims to expand the bladder surgically so that it becomes larger and can hold more urine. Used rarely and only in severe cases where all other treatments have failed.
Cystectomy: used in very severe cases or in the presence of a bladder tumor. It consists in the complete removal of the bladder and the performance of a ureterostomy with the installation of an external bag to collect urine.

Lifestyle with overactive bladder

With proper therapy, overactive bladder syndrome can be completely cured. However, you should know some behaviors that will, if not get rid of the disorder, then minimize the symptoms.

Avoid certain foods eg caffeine-rich foods such as coffee, alcohol and those that can irritate the urinary tract such as spices and highly acidic foods (such as citrus fruits). Instead, fiber-rich foods such as whole grains and vegetables should be consumed to help avoid constipation that causes straining during bowel movements. In addition, reducing your intake of fats and processed foods will be helpful to keep your weight under control.
To give up smoking, as nicotine can irritate the tissues of the bladder and cause recurrent coughing episodes that lead to urinary incontinence.
Do any gymnastic exercises designed to strengthen the pelvic floor muscles. The most famous are Kegel exercises.
double urination, after you have finished urinating, wait a few minutes and try to urinate again to remove any remaining urine.
Keep a urinary diary, in which to note how many times they went to the toilet during the day and at night, whether there were episodes of urinary incontinence. It should be noted how much time passes between urination and how much urine is produced.
Train your bladder or trying to resist the urge to urinate. Once you feel the urge, wait a few minutes before heading to the bathroom, gradually increasing your waiting time from a few minutes to several hours.

Bladder overactivity is a disease that is manifested by disturbances in the initiation of urges, urinary incontinence, and a significant increase in small trips. According to statistics, such a pathology overtakes every fifth inhabitant of the planet, regardless of the country of residence. An overactive bladder is more common in middle-aged women than in men. After 60 years, the statistics are equalized.

Not everyone who suffers from it knows about overactive bladder (OAB) as a disease. Most patients hide the problem, considering it shameful. Since urination disorders increase gradually, a person explains them by personal characteristics, inevitable age-related changes. As the problem grows, a person isolates himself, reduces contacts to a minimum. So the medical problem develops into a social one. A non-life-threatening disease reduces the patient's quality of life to nothing.

A person is born without being able to control the acts of urination. A newborn urinates unconsciously (involuntarily). But already by the age of 6 months, the baby begins to show anxiety before peeing. By the age of two, a small person learns (with the patient work of the mother) to restrain the act of urination for a short time. He begins to urinate consciously (voluntarily). The developing syndrome of an overactive bladder is a rollback of the body to involuntary urination.

The bladder has two "working muscles":

detrusor - the initiator of the release of the bubble;
sphincter - holds urine, allowing it to accumulate.

The average urinary of a healthy person has a rounded shape, is able to hold up to 300 ml of urine. Daily rate urination for an adult about 8 times during the day and 1-2 times per night.

A healthy urination process is a coordinated work of nerve receptors, conductive fibers, and muscle groups. When the organ is empty, the detrusor is relaxed, the sphincter is tense, compressed. As urine accumulates, signals about the state of the bladder are transmitted to special sections of the spinal cord and brain. A person feels the initial urge to go to the toilet when the bladder is half filled. Normally, the detrusor initiates urination when the organ is 2/3 full. A healthy person at this time, if he is away from home, is actively looking for a toilet, holding the beginning of the process with muscle effort.

With GAMP, the mechanism breaks down. Irresistible (urgent) urges occur with small volumes of urine, sometimes a few drops. characteristic feature OAB is the impossibility of volitional effort to control the beginning of the process of urination - it becomes involuntary, independent of the patient's consciousness.

Causes and factors for the development of pathology

Hyperactivity develops for various reasons. Among urologists, there is no consensus on whether this is an independent disease or a characteristic symptomatology that accompanies other diseases.

It is customary to single out the nature of the causes that cause OAB. They are divided into:

idiopathic - not exactly established (fixed in 65% of patients);
neurological - uncontrolled initiation of the detrusor is caused by neurological pathologies (24% of patients).

Neurogenic hyperactivity has no selectivity for sex or age. It develops when the chain that conducts nerve impulses from the bladder to the spinal cord and further to the higher parts of the brain is damaged. The cause is traumatic injuries of the brain, spinal cord, atherosclerotic changes in the vessels of the brain, Parkinson's disease, malignant tumors in the brain, spinal cord, cerebral hemorrhages.

The mechanism of development of idiopathic hyperactivity is associated with a decrease in blood circulation (ischemia) of the detrusor tissues and impaired conduction of nerve impulses. This provokes overexcitation in the detrusor tissue cells - a violation of the nervous regulation of the urination process develops. A slight stretching of the muscle tissue in the center of overexcitation is transmitted to the entire bladder, it contracts.

The remaining 11% of patients are women in whom the pathology develops without disturbances in the work of the detrusor. In this group, as a rule, women are post-menopausal. They have a violation of the urinary system, urinary incontinence develops against the background of a weakening of the sphincter.

Factors leading to the development of OAB

Factors provoking the development of pathology of the bladder are:

Belonging to the female sex.
Age-related changes in the body.
Depression, chronic stress.
organic diseases.
Excessive fluid intake, especially at night.

In women, the predisposition to urination disorders is explained by physiological characteristics - a short urethra, post-natal trauma, prolapse or displacement of the genitourinary organs. In addition, women naturally have a low level of serotonin, which decreases with age, in stressful situations, and with hormonal disruptions.

Senile OAB is associated with impaired blood circulation in the pelvic organs, proliferation of connective tissue. This is reflected in the work of the nerve endings of the urinary system - the contraction of the detrusor becomes uncontrollable.

Diseases in which OAB develops:

obesity;
mental retardation, dementia;
diabetes;
stroke;
spinal hernia;
frequent cystitis.

An overactive bladder in men develops mainly after 60 years, with the development of pathologies in the prostate gland. Adenoma, prostatitis, surgical interventions, in addition to urinary retention, can provoke its uncontrolled, frequent outflow.

Unfavorable working conditions (cold, chemical pollution), weight lifting contribute to the development of frequent, uncontrolled urination.

An overactive bladder in children can be due to the following reasons:

after a strong fright;
in unfavorable conditions in the family;
as a reaction to a strong fright, stress;
congenital overexcitability of the nervous system;
congenital malformations of the urinary system;
the habit of drinking at night.

Periodic urinary incontinence in a child is considered normal until the age of 5. However, frequent episodes should encourage parents to visit a doctor.

Clinical picture

Urinary hyperactivity is diagnosed with the following criteria:

the patient urinates more than 10 times a day;
drip leakage;
at least 2 times a day there are sudden, irresistible urges;
incontinence is fixed;
nocturnal diuresis exceeds daytime (nocturia).

The most common symptom of an overactive bladder is frequent trips to the bathroom. Characterized by sudden episodic urges of such strength that the patient does not have time to run to the toilet. Systematic incontinence is less common, it is typical for age-related patients (both men and women).

With neurogenic disorders, a violation of the process of urination is noted. It:

presence of residual urine;
jet interruption;
difficulty initiating the process with strong urges.

Adolescents and young women may complain of urine leakage while standing, during physical exertion, while laughing, coughing.

Symptoms may vary. If you regularly experience two of these symptoms, then you should consult a urologist.

Establishing diagnosis

Diagnosis of OAB begins with a questioning of the patient, studying his anamnesis and life characteristics. Gynecological or urological pathologies, surgical interventions, injuries, the presence of hormonal pathologies, diabetes mellitus, and obesity are especially noted.

The next step will be a urination diary. The patient is offered to record all trips "in a small way" with fixation of time, urge strength, urgency, features and volume of excreted urine. Separately fix all consumed liquid.

Instrumental studies include ultrasound of the bladder, urinary tract, kidneys, uterus, or prostate. Conduct laboratory tests of urine. According to indications, MRI, urodynamic examination, internal examination with a cystoscope can be performed.

If necessary, the patient is referred for a consultation with a neurologist, endocrinologist.

Treatment

Before proceeding with the treatment of OAB, the identified pathologies of the urinary and reproductive systems are treated. The leader among inflammatory diseases that cause symptoms of an overactive bladder is cystitis.

There is no single approach to the treatment of pathology. Each patient requires individual therapy depending on age, sex, history, living conditions. There are three methods:

Non-drug. Includes behavioral, nutritional, physical correction.
Surgical.
Medical.

The first method is successfully combined with drug treatment.

Non-drug therapy

The safest, most affordable is behavioral therapy. Treatment comes down to streamlining the patient's food and drink regimen, to "accustoming" him to go to the toilet not at the "dictation of the senses", but at regular intervals.

This mode of life makes the patient control the filling and emptying of the bladder. Gradually, the bladder "learns" to hold an increasing volume of urine, and the patient adapts to empty it beforehand, before the onset of "critical" moments. Psychotherapeutic tactics give the best results in young patients.

Behavioral therapy is developed for each patient individually, which helps to improve the quality of life. Every fifth patient manages to return to the usual daily routine.

Power correction

From the menu of the patient exclude or sharply limit:

Foods and drinks that have a diuretic effect. Completely exclude strong tea, coffee, carbonated drinks and any kind of alcohol.
Limit the total intake of fluid, given soups, watery fruits.
Prohibit drinking at night, The last meal and drink should be 3 hours before bedtime.

It is recommended to increase the amount of fresh and cooked vegetables. Bread is allowed with bran, coarse grinding. The menu is adjusted to increase the fiber in it. Prevention of constipation effectively restores the sensitivity of the bladder. A crowded intestine squeezes it and provokes premature stimulation of urination.

Physical exercises

Physical exercises target specific pelvic floor muscles. Their strengthening and training help the sphincter to retain urine during urges. The Kegel complex is recommended, with which most women who have given birth are familiar. In the postpartum period, urination disorders often occur, there is no urge to it. In addition, this complex helps to fix the uterus in its natural position and does not allow it to move down.

The complex includes 4 types of exercises that are performed while sitting. Their specificity is such that it allows you to practice at any time and in any place where you can sit down.

Surgery

Surgical intervention can be indicated only after unsuccessful therapy with conservative methods. It is possible to treat urination disorders in hyperactivity syndrome by performing an operation according to individual indications. This method is rarely used.

Operations on the bladder are aimed at reducing the activity of the detrusor. It:

complete denervation - when the introduction of medicines into the walls of the bladder completely block the supply of nerve impulses to urination;
additional "suturing" of nerves;
removal of a part of the muscle tissue of the detrusor, without affecting the mucosa;
replacement of part of the detrusor tissue with tissues of the intestinal wall (it is not able to contract);
the introduction of a sterile solution into the bladder to increase its volume.

All three types of operations are difficult to perform, but can be shown to patients regardless of their gender and age.

Medical therapy

Medical treatment includes several areas:

decrease in the tone of the walls of the bladder;
blocking of nerve impulses of the detrusor;
improvement of pelvic blood supply.

To reduce muscle tone, drugs can be prescribed:

Trospium chloride.
Detrol.
Driptan.
Soliferacin.
Ditropan.
Tolterodine.
Oxytrol.
Dariferacin.
Sanctura.

The above anticholinergics have side effects in the form of dry mouth, visual disturbances, general lethargy, drowsiness.

Tablets effectively relieve irritable bladder syndrome. The therapeutic effect increases within 6-8 weeks. However, when the drugs are discontinued, the symptoms return.

The constant intake of pills that relax the walls of the bladder provokes insufficient emptying of it. Therapy is recommended to be carried out under the dynamic supervision of the presence / absence of residual urine. Why do periodic ultrasound examinations (ultrasounds). Uncontrolled intake of drugs of this series can provoke the development of renal failure.

With the neurogenic nature of hyperactivity, drugs Capsaicin, Resiniferotoxin are prescribed. Solutions are injected into the bladder, where they depress nerve receptors.

Vitamins, L-carnitine, succinic acid are shown to improve blood supply and nutrition to the tissues of the genitourinary organs.

In the treatment of children, medications are used in extreme cases. The focus is on working with parents to improve the psychological component of raising a child, adjusting nutrition and drinking regimen, and observing the daily routine.

Folk remedies and prevention

Folk remedies for the treatment of urination disorders are safe and can be recommended to patients with inflammatory diseases of the urogenital area. They improve the functioning of the kidneys and bladder.

Dill seeds.
Elecampane (rhizomes).
Lingonberries (leaves).
Plantain.
St. John's wort.

A decoction of any of the above raw materials is prepared as follows: a tablespoon of raw materials is poured into 200 ml of water, boiled for up to 10 minutes. After cooling, you can take it with the addition of honey. Treatment is for 3 weeks. After that, you should either take a 2-week break, or continue treatment with another component.

- a syndrome characterized by a sudden need to urinate, involuntary release of urine, frequent urge to urinate, including at night (nocturia). Sometimes symptoms occur in isolation. Diagnosis is based on data from ultrasound of the bladder, kidneys, cystoscopy, urodynamic studies; to exclude the infectious-inflammatory process, OAM, bakposev are prescribed. Treatment is based on a change in behavioral reactions, the use of pharmacological agents, less often - surgical interventions.

ICD-10

N31 Neuromuscular dysfunction of the bladder, not elsewhere classified

General information

Overactive bladder (OAB, detrusor overactivity/hyperreflexia) in women is a urinary disorder that impairs quality of life and prevents socialization. Pathology occurs in millions of patients worldwide, regardless of race. The prevalence increases with age, but urgency, frequent urination, and nocturia are not normal signs of aging. Women over 75 experience 30-50% vesical hyperactivity. It has been proven that the higher the body mass index, the greater the risk of developing the syndrome.

Causes of OAB

An overactive bladder is a neuromuscular dysfunction in which the detrusor contracts excessively during the filling phase with low urine volume. The idiopathic form is defined in the absence of underlying neurological, metabolic, or urological causes that may mimic the diagnosis, such as cancer, cystitis, or urethral obstruction. An overactive response is most often caused by:

Neurological conditions. Spinal cord injury, demyelinating diseases (multiple sclerosis), medullary lesions can lead to vesico-urinary dysfunction, cause incontinence. Similar changes occur in diabetic and alcoholic polyneuropathy.
Medication. Signs of urgent disorder cause some drugs. So, diuretics provoke incontinence due to the rapid filling of the reservoir. Taking the prokinetic bethanechol enhances intestinal motility, urinary tract, which in some cases is accompanied by hyperreflexia.
Other pathologies. Heart failure, peripheral vascular disease in the stage of decompensation are accompanied by symptoms of hyperactivity. During the day, in such patients, excess fluid is deposited in the tissues. At night, most of this fluid is mobilized, absorbed into the bloodstream, thereby increasing nocturnal diuresis.

Risk factors

Risk factors for developing an overactive bladder include:

complicated childbirth (forceps, muscle rupture)
urogynecological surgery
woman's age >75 years
the use of alcohol, caffeine (cause transient detrusor hyperreflexia due to irritant action).

In some women, characteristic symptoms develop during menopause, which is associated with estrogen deficiency. On the other hand, hormone replacement therapy for breast cancer in young patients increases the risk of detrusor hypersensitivity.

Pathogenesis

The cerebral cortex, bridge, spinal centers with peripheral autonomic, somatic, afferent and efferent innervation ensure the normal functioning of the urinary tract due to the coordination of a number of processes. Changes (functional or morphological) at any level provoke urinary disorders.

This pathology is a multifactorial disorder, both in etiology and pathophysiology. It is based on detrusor hypersensitivity of neurogenic-muscular, myogenic or idiopathic genesis, which results in urgency and/or incontinence. A certain role in the development of an overactive detrusor against the background of obstruction and damage to the spinal cord belongs to M-2 receptors.

The interaction of acetylcholine with the M-3 receptor activates phospholipase C through binding to G proteins. This causes the release of calcium, smooth muscle contraction. Hypersensitivity to stimulation of muscarinic receptors causes hyperreflexia. Acetylcholine promotes detrusor contraction, activation of sensory afferent fibers, resulting in a hyperactive response in the form of pollakiuria, nocturia, urinary urgency.

Classification

The constant presence of pathogenic microflora contributes to recurrent infections of the urinary system. The bladder often loses its normal volume, i.e. a microcyst is formed, which in the most serious cases can lead to an organ-removing operation, disability.

Diagnostics

The diagnosis of "overactive bladder" is established by a urologist based on the data of a physical examination, anamnesis, laboratory and instrumental examination. The woman is asked to fill out a questionnaire (diary of urination). In some cases, a consultation with a neurologist, gynecologist is justified. The research algorithm includes:

Laboratory tests. If pathological changes (leukocyturia, bacteriuria) are detected in the OAM, culture is performed to identify pathogens and determine their sensitivity to drugs. Cytology is performed when a large number of erythrocytes is detected to exclude a neoplastic process. Glycosuria requires screening for diabetes mellitus.
Instrumental diagnostics. Ultrasound of the urinary organs with residual urine control, cystoscopy, complex urodynamic studies are indicated in cases of neurogenic etiology refractory to treatment, as well as in cases of suspected pathology that provokes symptoms of urgent incontinence - inflammation, tumor, blocking stone.

Differentiation is performed with other forms of incontinence, a tumor process, cystitis, atrophic vaginitis against the background of a decrease in estrogen levels. Similar symptoms are recorded with uterine prolapse, vesicovaginal fistula.

Treatment of an overactive bladder in women

If a specific cause of the pathology is determined, all measures are aimed at eliminating it. For example, the treatment of urinary tract infections involves the appointment of antibiotics, with atrophic urethritis, a cream containing estrogens is used. For the idiopathic form, there are three main therapeutic approaches: behavioral modification, medication, and surgery. Treatment depends on the severity of the symptoms and their impact on lifestyle.

Conservative therapy

With a mild to moderate degree, it is possible to carry out conservative measures. Their options are:

behavioral therapy. First-line treatment, sometimes combined with medication. It is recommended to stop taking liquids 3 hours before bedtime, to exclude alcohol, coffee, spicy foods, carbonated drinks. They develop a plan for urination: even if there is no desire, it is necessary to visit the toilet at a certain time. When urging, you should be patient for several minutes (against the background of taking medications, this is available), gradually the intervals between acts of urination increase.
Physiotherapy. Exercise therapy in the treatment of an overactive bladder involves doing exercises to strengthen the muscles of the pelvic floor. Gymnastics is effective when performed regularly, especially in young patients. It is also possible to use vaginal devices (cones). The woman contracts her pelvic muscles to hold the simulator transvaginally, gradually increasing its weight. Within 4-6 weeks, positive dynamics is noted in 70%.
Electrical stimulation of the pelvic floor. The procedure involves the supply of electrical impulses to cause contractions of a specific muscle group. The current is delivered using an anal or vaginal probe. Electrical stimulation is performed in combination with physiotherapy exercises, the duration of the course is several months.

Drug treatment of an overactive bladder in women is classified as a second line. As part of drug therapy, the following is prescribed:

Antimuscarinic/anticholinergic drugs: tropsium chloride, solifenacin, darifenacin, oxybutynin. They have a prolonged antispasmodic, anesthetic effect, block the sensitivity of M-cholinergic receptors of smooth muscle fibers.
Selective beta-3 adrenoreceptor agonists(mirabegron). They relax the muscles in the accumulation phase by acting on beta-3 adrenoreceptors, due to which the capacity of the organ is restored (increased). According to the results of the study, the combination of mirabegron and solifenacin is more effective than monotherapy.
Desmopressin and its analogues. It is prescribed for the neurological genesis of OAB, for which a decrease in the production of antidiuretic hormone and melatonin is typical, which causes nocturnal polyuria. Additionally, it is possible to prescribe anticholinergics.
Alpha-1-adrenergic blockers(tamsulosin, alfuzosin, silodosin, doxazosin). Applied with detrusor-sphincter dyssynergy to reduce intraurethral resistance and the amount of residual urine. Suppress the activity of postsynaptic alpha-1-adrenergic receptors of the neck, arteries, urethral sphincter.
Tricyclic antidepressants. Justified exclusively in combined schemes on the recommendation of a neurologist or psychiatrist.

Surgery

Surgical interventions are reserved for the most difficult cases, resistant to conservative therapy, or if there are contraindications to medication. Cystectomy is now rarely performed. Operations and manipulations with OAB:

augmentation cystoplasty: implies an increase in the capacity of the body through the use of its own tissues (replacement by the intestinal reservoir);
sacral and pudendal neurotomy: the intersection of nerves that provoke an overactive bladder is performed, their blockade with anesthetics;
pyelostomy, epicystostomy: performed for alternative diversion of urine, if there was a wrinkling of the bladder with the development / threat of accession of chronic renal failure;
sacral neuromodulation: the sacral nerve is stimulated with a weak high-frequency electric current using an implanted electrode connected to a pulse generator. This allows you to restore the coordination of the urination act.
injection of botulinum toxin A: normalizes muscle tone by inhibiting the release of acetylcholine from nerve endings, blocking signal transmission from the nerve cell to the muscle. The neurotoxin is injected into the sphincter or detrusor during cystoscopy. The disadvantages include the need for repeated manipulations after 8-12 months.

Forecast and prevention

With timely treatment and diagnosis, it is possible to avoid complications. An overactive bladder affects women's quality of life. The combined approach is effective in 92%, the syndrome is considered as a chronic disorder requiring long-term medication.

Prevention includes an active lifestyle, avoiding nicotine and alcohol, controlling sugar levels, and eating a balanced diet. Drugs that can provoke symptoms of overactive urination disorder in a woman should be prescribed by a doctor. Timely consultation of a specialist at the first appearance of urological complaints, identification of the cause, adequate treatment are significant factors for a favorable prognosis.

Feeling like you need to be near the toilet all the time, afraid you won't be able to get there on time? Do you feel like you have social problems in connection with going to the restroom? This means that you may have an overactive bladder.

This is a dysfunction of the bladder, in which there is an urgent desire to urinate. The urge can be difficult to suppress, and an overactive bladder can lead to inadvertent loss of urine (incontinence).

If you have overactive bladder You may feel uncomfortable, isolate yourself from society, limit your work and social life. On the positive side, after a brief assessment and diagnostic procedures, you can receive appropriate treatment, which can greatly alleviate the manifestations of overactive bladder and improve your daily living conditions.

Symptoms of an overactive bladder

sudden strong urge to urinate
history of urinary incontinence, unintentional loss of urine immediately after an urgent urge to urinate.
frequent urination (usually eight or more times in 24 hours)
waking up 2 or more times at night to urinate (nocturia)

Although you may be able to get to the toilet in time, when you feel like urinating, you feel frequent urge to urinate, nighttime urination, which can disrupt social adaptation.

When is it necessary to see a doctor?

Less than half of women and less than a quarter of men who have ever experienced incontinence have seen a doctor, according to a study in the journal Urology. Although it can sometimes be difficult to discuss this with your doctor, especially if the symptoms of an overactive bladder interfere with your work, social activities, and daily activities.

Diagnosis and treatment should not be avoided, limited only to wearing panty liners and using hygiene products. There are treatments that can help you. Also, a visit to the doctor is necessary, as incontinence and hyperactivity can be the result of an underlying medical condition such as malignant tumor.

Causes of an overactive bladder

Filling and emptying your bladder is a complex interplay of kidney, nervous system, and muscle function. Violation of the function of one of these links can contribute to the occurrence of overactive bladder and urinary incontinence.

Bladder function is normal.

The kidneys secrete urine, which is then passed through the ureters to the bladder. Urine from the neck of the bladder passes into the urethra, which is a narrow tube. In women, the opening of the urethra is located above the entrance to the vagina, in men it is located on the glans penis.

Bladder expands like a balloon to correlate with the amount of urine. When it fills up to about half of its possible, nerve signals begin to arrive that tell it is ready to urinate, you get a feeling of filling the bladder. When it is three-quarters full, you feel the need to urinate. During urination, the pelvic muscles are coordinated with the muscles of the bladder neck and proximal urethra by nerve impulses. There is a contraction of the muscles of the bladder and the release of urine.

Involuntary contractions of the bladder

Signs of an overactive bladder occur in most cases due to inadvertent contraction of the bladder muscles. This contraction causes an urgent need to urinate.

The bladder sphincter may remain in a contracted state and prevent urine from flowing out of the bladder. If the contraction of the bladder exceeds the force of the sphincter, the person experiences an urgent urge to urinate.

Causes and contributing factors

In many cases, doctors cannot pinpoint the exact cause of an overactive bladder. Neurological pathologies such as Parkinson's disease, strokes, multiple sclerosis are often the causes of overactive bladder.

There are factors that contribute to the development overactive bladder Your doctor will try to rule them out during the examination, as they require other specialized treatment.

These factors include:

- a large amount of urine produced due to the consumption of large amounts of fluid, impaired kidney function, diabetes.
- acute urinary tract infections that cause symptoms similar to those of an overactive bladder.
- inflammation localized near the bladder.
- pathologies of the bladder, such as tumors, bladder stones.
- factors that interfere with the outflow of urine - prostate enlargement, constipation, previous surgery, which can cause other forms of incontinence.
- Excess consumption of caffeine and alcohol.
- drugs that cause a rapid increase in urine output or cause excessive fluid intake.

Risk Factors

As you get older, you are more likely to develop an overactive bladder, and you become more susceptible to diseases and disorders that can contribute to an overactive bladder. These diseases include prostate enlargement, diabetes mellitus. Although overactive bladder and incontinence are common in older people, they cannot be considered an integral part of aging.

Complications of an overactive bladder

As expected, incontinence affects quality of life, but both frequent urination and nocturia can have a negative impact on quality of life. People with overactive bladder symptoms are more susceptible to:

depression
emotional experiences

Some people may also have mixed incontinence disorders, where stress and urge incontinence occur.
Stress incontinence is the loss of urine during exercise when pressure builds up in the bladder if you cough or laugh.

Preparation for the procedure

You will probably see your family doctor or therapist initially.

However, they may refer you to a urologist or urogynecologist for diagnosis or treatment. When you first visit your doctor, ask if you need to keep a urinary diary for several days. You should record when, how much and what kind of liquid you drank, when you urinated, whether you felt the urge to urinate, urinary incontinence. Your diary can provide information that will help your doctor understand symptoms and triggers.

Since the visit to the doctor can be short, it is good if you prepare for this:

write down any symptoms you experience, including any that may seem unrelated to the underlying cause.
make a list of all the medicines you get, including vitamins and supplements.
write down the questions you want to ask the doctor.

Your time with the doctor is limited, so making a list of questions will help you make the most of this opportunity.

List questions from most important to least important, just in case you run out of time.

With an overactive bladder, there are a few basic questions you should ask your doctor:

What is the most likely cause of my symptoms?
What could be other causes of these symptoms?
What kind of research do I need? Do they require any special training?
Is the disease likely to be acute or chronic?
What treatments are available for my disease?
What method can you recommend for me?
Are there dietary restrictions that I must follow?
Is there a need for a specialist consultation?
What are the alternatives?
Are there any brochures or any other products that I can consult at home?

In addition to asking questions, you can ask your doctor at any time if something is not clear.

What to expect from your Doctor?

Your doctor may offer you a questionnaire and a preliminary assessment of your symptoms. The doctor may pay attention to specific points, he may ask you:

Do you have sudden leakage of urine?
Do you have sudden urine leakage when coughing, sneezing, laughing?
Do you have urine leakage on the way to the toilet?
Do you use pads or special hygiene products for urinary incontinence?
When did you first experience symptoms of the disease?
Were your symptoms constant or intermittent?
What activities do your symptoms prevent you from doing?
What circumstances do you think improve your symptoms?
What circumstances do you think make your symptoms worse?

The doctor will be interested in whether these symptoms cause problems in your daily life, work, social interactions.

Examination and diagnostics

The main diagnostic points that your doctor uses will be the search for contributing factors. Research will likely include:

medical history
physical examination, which will mainly focus on your abdomen and genitals
a urinalysis to check for infection, blood, or other changes.
a thorough neurological examination that may reveal sensory problems

Specialized Research

Your doctor may order a urodynamic study to evaluate bladder function and its ability to fill and empty. This study usually requires additional consultation with a urologist or urogynecologist (specialist in urological problems in women).

Research includes:

Residual urine measurement.
When you urinate or leak urine, it is likely that your bladder is not emptying completely. The residual volume of urine can cause symptoms that are identical to those of an overactive bladder. To measure the amount of residual urine after emptying the bladder, it is necessary to measure the volume of residual urine after urination. This can be done with catheterization. An alternative method is an ultrasound examination of the contents of the bladder.

Uroflowmetry. A urofluometer is a device that you urinate into to measure the volume and speed of your urination. This device shows the graphic characteristics of your urination.

Cystometry and pressure-flow study. Cystometry measures the pressure in the bladder during filling. The pressure-flow study measures the pressure and flow rate of urine. A catheter is used to slowly fill the bladder with water. Another catheter with a pressure sensor is placed in the rectum or vagina in women. This procedure allows you to identify spontaneous contractions of the bladder, show the level of pressure at which incontinence occurs, the pressure at which the bladder is released.

Electromyography. Electromyography evaluates the coordination of impulses in the nerve endings of the bladder and sphincter. The sensor is placed on the skin or on the pelvic floor.

Video urodynamics. This test uses X-rays or ultrasound waves to see the bladder as it fills and empties. The bladder is filled with a catheter. You need to urinate to empty your bladder. The liquid contains a special dye, which is detected by X-ray examination.

Cystoscopy. A cystoscope is a thin tube with a small lens that allows the doctor to see the inside of the urethra and bladder. With this equipment, the doctor can check for diseases with symptoms of the lower urinary tract, such as tumors, bladder stones.

The doctor will analyze the results of these studies and suggest treatment options.

Treatment and drugs.

Behavioral Therapy

Behavioral therapy can help treat an overactive bladder. If you have stress incontinence, these interventions alone will not generally lead to complete continence, but they will reduce the number of incontinence episodes. The interventions your doctor will suggest are likely to be one of the following:

Change in fluid intake. Your doctor can advise you on timing and amount of fluid intake. Drinks with alcohol and caffeine can make your symptoms worse, so it's wise to avoid these drinks.

The use of dietary fiber. Eat foods rich in dietary fiber or dietary fiber alone if you have constipation, which is usually associated with bladder problems.

Bladder training. Sometimes your doctor may recommend that you exercise your bladder, training to delay emptying your bladder when you feel like urinating. Start with small delay episodes of about 10 minutes. , gradually this time can be increased to 2-5 hours.

Double emptying. Some people have trouble emptying their bladder. This is diagnosed with a significant increase in the volume of residual urine, with the possibility of double urination. After urinating, you must wait a few minutes, and then try again to empty your bladder completely.

Planning for toilet visits. Your doctor may recommend that you schedule your toilet visits so that you urinate every two to three hours at the same time every day.

Exercises for the muscles of the pelvic floor. These exercises are called Kegel exercises, they increase the strength of the pelvic floor and bladder sphincter muscles, these muscles are important for urination. These muscles can be considered strong enough if you can suppress unintentional bladder contractions. Your doctor and physiotherapist will help you learn how to do these exercises correctly. It may take a significant amount of time before you see a significant difference in your symptoms, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Intermittent catheterization. You can empty your bladder with intermittent catheterization to achieve complete bladder emptying. This is a very safe and convenient procedure. This procedure does not make the bladder less trained, contrary to what was previously believed. Your doctor will let you know if you need this procedure.

Use of daily absorbent pads. You can use absorbent pads and hygiene items to protect your clothes from getting wet and uncomfortable if you do have incontinence.

Normalization of body weight. If you are overweight, losing weight will ease your symptoms. Large body weight is associated with more severe symptoms of urge incontinence. They also have an increased risk of stress urinary incontinence.

Medications

Drugs that help relax the bladder can be effective in reducing bladder symptoms and reduce episodes of stress incontinence.

These drugs include tolterodine (Detrol), oxybutynin (Ditropan), oxybutynin (Oxytrol), trospium (Sanctura), solifenacin (Vesicare), and darifenacin (Enablex). Typically, the use of these drugs is combined with the behavioral treatments listed above.

Side effects of these drugs include dry eyes and mouth. Drinking too much fluid can exacerbate the symptoms of an overactive bladder. You can reduce these side effects.

If your mouth is dry, your doctor may recommend that you use sugar-free lozenges or chewing gum sugarless.
With dryness of the mucous membrane of the eyes, special eye drops can be used. Some over-the-counter medications can also be used to help alleviate the side effects.

Botulinum toxin

This drug, branded as Botox, is a protein from a bacterium that causes a disease called botulism. However, in small doses, when directly injected into tissues, this protein paralyzes muscles and can cause severe urge incontinence. Until this method is approved by the Food and Drug Administration, the treatment achieves a temporary effect of about 6 months. Also, under the influence of botulinum toxin, there is a risk of impaired bladder emptying, especially in the elderly group.

Surgery

Surgical treatment of an overactive bladder is used for severe pathology, when other methods of treatment are ineffective. The goal of treatment is to improve the reservoir capacity of the bladder and reduce pressure in the bladder.

Surgical operations include:

sacral nerve stimulation. The sacral nerves are the primary link between the spinal cord and the nerve fibers in the bladder tissue. Changing these nerve impulses can improve the symptoms of an overactive bladder. During this procedure, a thin wire is placed near the sacral nerves, which are located near the coccyx. With the help of a special device, impulses will be sent to your bladder, similar to the work of a pacemaker in the heart. If successful in reducing your symptoms, you may have a battery-operated subcutaneous device that sends pulses to your bladder.
augmentation cystoplasty. This is the main surgical treatment for increasing the capacity of the bladder by using a piece of your intestine to cover the area of the bladder. If you have this operation, you may need to use a catheter for the rest of your life to empty your bladder. Because this treatment has serious side effects, it is used in patients for whom all other treatments have failed.

Adaptation and support

Living with an overactive bladder can be quite difficult. Organizations such as the National Association for Continence can provide you with resources and information about joining an overactive bladder and incontinence support group. Support groups involve meetings with discussion of problems in order to learn how to control their condition and provide proper care.

Training can help you organize your own support network and alleviate the difficulties you are experiencing.

Prevention of an overactive bladder

A healthy lifestyle can help reduce the risk of developing an overactive bladder, which includes regular exercise, a high-protein diet, and limiting caffeine and alcohol intake.

The article is informational. For any health problems - do not self-diagnose and consult a doctor!

V.A. Shaderkina - urologist, oncologist, scientific editor

It will help determine if you need medical attention. It will take a minute!

Overactive bladder (OAB)- a pathological condition characterized by a sharp, difficult to control the urge to urinate, frequent urination, nocturnal urination, sometimes accompanied by an urgent urge to urinate (in the absence of a urinary tract infection).

Overactive Bladder Syndrome is not a life-threatening condition, but has a significant impact on the quality of life of patients. Interestingly, the prevalence of OAB is the same among men and women.

Causes of an overactive bladder

As a rule, the disease occurs independently, and it is not associated with other pathologies. Another cause of overactive bladder is neurological diseases: multiple sclerosis, Parkinson's disease, strokes, herniated discs and other spinal cord injuries.

Diagnosis of an overactive bladder

Before making a diagnosis of "overactive bladder", first of all, other pathological conditions that cause similar symptoms should be excluded: urinary tract infections, bladder tumors, urolithiasis, pelvic floor muscle dysfunction, diabetes mellitus, neurogenic bladder, interstitial cystitis.

Examination of a patient with symptoms of an overactive bladder must necessarily include b:

general urine analysis with sediment microscopy;

measurement of the amount of residual urine, especially in patients with neurological diseases and patients after surgery for urinary incontinence;

keeping a diary of urination for 72 hours (3 days);

In the case of neurogenic urination disorders, it is especially important, as it allows assessing not only the functional state of the lower urinary tract, but also the risk of damaging effects on the kidneys and choosing the most effective treatment;

examination on a gynecological chair (for women) - in order to assess the condition of the pelvic floor muscles, identify prolapse of the pelvic organs and atrophic changes in the genital organs.

Treatment for an overactive bladder

overactive bladder is a chronic, widespread pathological condition that has a significant impact on the quality of life. Luckily, modern medicine has a large arsenal of methods for the treatment of this disease. OAB treatment consists of several successive steps and is based on the principle "from simple to complex".

Medical therapy- includes drugs of the anticholinergic group that block muscarinic receptors on the smooth muscle of the bladder muscles. Side effects when taking this group of drugs include dryness of the mucous membranes of the mouth, eyes, constipation, and effects on the central nervous system.

Tibial neurostimulation- a method of treatment in which stimulation of the tibial nerve is carried out with a thin needle electrode, anatomically located in the ankle area. The procedure is performed on an outpatient basis once a week for 3 months, followed by a maintenance course once a month for a year.

Injection of botulinum toxin (Botox)- The essence of the method is to conduct cystoscopy and submucosal injection of the drug at certain points in the bladder wall. The average duration of the positive effect of the treatment is 6-9 months, after which repeated injections may be required.