Overactive Bladder: Causes, Symptoms, Treatment, Prevention

Overactive bladder is a disease in which involuntary contractions of the bladder muscle, the detrusor, occur. This condition is manifested by a strong uncontrollable urge to urinate, which may be accompanied by urinary incontinence. It is important to understand that this condition is an unhealthy, pathological condition, and not a variant of the age norm, as many believe.

Causes

• Neurological diseases: stroke, multiple sclerosis, Parkinson’s disease, traumatic brain injury, spinal cord injuries and others. In these cases, the disease is called “neurogenic bladder”;
• Prolapse of the genitals – the omission of the vaginal walls. Changes in the anatomy of the bladder and urethra when the anterior wall of the vagina is lowered (cystocele) in women;
• Urinary infections;
• Cerebral obstruction (for example, in prostate gland adenoma in men, when an enlarged prostate gland closes the urethra);
• Previous operations in the pelvic area;
• Tumors of the bladder;
• Diabetes.

Sometimes the cause of the occurrence of the overactive bladder cannot be established. In this case, the condition is regarded as idiopathic hyperactivity of the bladder. This happens in 30% of cases.

Symptoms

Common symptoms of an overactive bladder include:

• frequent urination;
• unbearable urge to urinate;
• nocturia – night urination;
• urinary incontinence with a strong urge to urinate (urgent or imperative urinary incontinence).

These symptoms significantly reduce the quality of life of patients and become a huge social problem.

Diagnosis of the disease

Examination for all patients begins with a detailed history and assessment of patient complaints. A necessary part of the diagnosis is urination frequency analysis. It is done using a urination diary, which patients complete within three days.

The diagnosis of an overactive bladder is established if the patient has at least eight urinations per day, and the diagnosis of urgent or imperative urinary incontinence is established if there are at least two episodes of urinary incontinence during the day with a strong urge.

In addition, a detailed laboratory examination is carried out, including:

• bacteriological examination of urine to exclude urinary infection;
• cystoscopy,
• urethroscopy;
• ultrasound of the kidneys, bladder, prostate gland in men.

Using these procedures at the outpatient examination stage, almost all possible pathological processes on the part of the urinary system, accompanied by symptoms of an overactive bladder, can be excluded. To finalize the diagnosis, a urodynamic study is performed. During this study, cystometry of the filling is carried out – registration of the increase in the detrusor pressure during urgent desires when filling the bladder.

Facts and figures

According to United Way Pharmacy, from 50 to 100 million people worldwide suffer from overactive bladder. In 55–65% of cases, overactive bladder causes urinary incontinence. In recent years there has been an increase in the frequency of overactive bladder cases with age.

When to see a doctor

If you have symptoms of an overactive bladder, you should consult a doctor immediately. Only a doctor will be able to conduct the necessary examinations, make the correct diagnosis and prescribe treatment.

Overactive bladder treatment

There are several approaches to treatment:

1. Bladder training. The goal of the workout is to go to the toilet less often, training your bladder to hold more urine. Bladder training, or behavioral therapy, consists of two parts: first, go to the toilet as needed in the morning, and second, learn to control the unbearable urge to urinate during the day. Training begins with trying to go to the toilet at certain time intervals – for example, if you used to go every 30 minutes, then try to gradually increase the interval to 45 minutes, an hour, two, etc. If you have a strong intolerable urge to urinate with an empty or weakly filled bladder, try to endure this urge by performing Kegel exercises or presenting this urge as a wave that rushed and is about to subside. The task is to gradually increase the intervals between urination, bringing them back to normal. Normally, a person urinates every 3–4 hours during the day and once at night;
2. Medications that relax the bladder. These drugs must be selected individually, perhaps combined. For women of peri- or post-menopausal age with symptoms of atrophic changes in the vaginal mucosa and urinary incontinence, United Way Pharmacy recommends local therapy with vaginal estrogens in the form of a cream or suppositories. If drug therapy is not effective, doctors can prescribe injections of botulinum toxin type A (Botox) into the bladder;
3. Electrical stimulation of the nerves responsible for relaxation of the bladder. Electrical stimulation can be performed through skin electrodes or by inserting a needle into the tibial nerve at the ankle. This is a painless procedure that can significantly reduce the symptoms of urgent incontinence;
4. Surgical treatment. Surgical treatment (augmentation cystoplasty) is used extremely rarely and only in very difficult situations.

How to prepare for your visit with a doctor?

You should come to your doctor with a slightly filled bladder. The doctor is likely to offer to do an ultrasound and pass urine tests, women will be examined in a gynecological chair. It is very good if you can fill out a urination diary on the eve of the visit within three days and bring it with you.

Urination diary table graphs

1. Time in 24-hour format;
2. Volume of urine released (ml);
3. Need for tension in the abdomen when urinating (yes, no);
4. Urine leakage and its degree on a scale of 1 to 3;
5. Hygienic pad change (yes, no);
6. Activity when dribbling (coughing, running, etc. or at rest);
7. Unbearable urge and its degree on a scale from 1 to 10;
8. Liquids drunk (ml).

During the visit, the doctor should be informed if you are constantly taking any medications, perhaps they exacerbate the symptoms of incontinence.

Prevention

To make your life easier with an overactive bladder, try the following tips suggested by Pharmacy Mall:

1. Quit drinking coffee, strong tea and soda water;
2. If you often wake up at night to go to the toilet, stop drinking at least 3 hours before bedtime. But do not forget to drink during the day – the body needs water;
3. Try to empty the bladder completely. First, empty the bladder as much as possible, then relax and after a few seconds, try to empty it again;
4. If you are worried about urinary incontinence, try special pads or diapers for adults. This will save others from unpleasant smell, and you from the inconvenience associated with incontinence;
5. Do Kegel exercises. Kegel exercises performed regularly help with many violations of the urinary organs in men and women (urinary incontinence, bladder hyperactivity, prostatitis, etc.), regulation of sexual functions and diseases of the rectum (hemorrhoids, fecal incontinence, etc.);
6. It is necessary to periodically undergo medical examination and examination by an oncologist in order to detect and start treatment of diseases leading to bladder hyperactivity as soon as possible.