Urinary incontinence overactive bladder. Overactive bladder in women: symptoms and treatment. Examination and diagnostics

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 bladder;
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. The daily rate of urination for an adult is 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 features - 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. This is:

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.
Restrict total income liquids, 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 exercise

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. This is:

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.

This is not so much a disease as a complex of symptoms that develop against the background of the underlying pathology. A symptom complex is manifested by imperative urge to urinate, urgent urinary incontinence, increased frequency of urination, nocturia.

The mechanism of hyperactivity is based on the increased sensitivity of the bladder receptors to stretching and increasing the contractile activity of the detrusor, the hyperactivity of which will be the root cause. Detrusor overactivity is a urodynamic phenomenon that includes a sequence of involuntary spontaneous or after provocation detrusor contractions, the suppression of which does not depend on volitional effort.

The frequency of hyperactivity, as well as the features of its etiology, are not well understood, since patients rarely seek medical help. Presumably, dysfunction occurs in 10-15% of the population, among men it is more common, as well as among persons of mature and elderly age.

Among causes of hyperactivity bladder, either neurological diseases occur, and then it is called neurogenic, or an unambiguous cause is not distinguished, and then we are talking about idiopathic hyperactivity. Damage to the central nervous system above the sacral center of urination (S 2 -S 4) leads to the development of neurogenic overactivity of the bladder. The most common causes of such lesions are multiple sclerosis, traumatic brain and spinal injuries, myelomeningocele, spina bifida.

Although the causes of idiopathic hyperactivity cannot be considered known, a number of factors have been identified that determine the development of this kind of disorder:

genetic predisposition;
childhood enuresis in history;
infravesical obstruction - subvesical blockage of the urinary tract, preventing the free outflow of urine at the level of the bladder neck or urethra;
cystitis;
ischemia of the bladder wall.

Among the indirect causes of overactive bladder are:

a large amount of urine produced due to the consumption of large amounts of fluid;
renal dysfunction, as well as diabetes;
acute urinary tract infections causing similar symptoms;
inflammation localized near the bladder;
bladder pathologies, such as tumors or stones;
factors leading to a violation of the flow of urine, for example, prostate enlargement, constipation, previous surgery;
excessive consumption of caffeine and alcohol;
the use of drugs that cause a rapid increase in urine output or excessive fluid intake.

The symptoms of an overactive bladder are obviously worrisome, although they are not always the reason for seeking qualified help. The clinical picture includes:

pollakiuria - frequent urination of small portions of urine, which in total per day forms an average norm;
imperative urge to urinate - an irresistible urge to urinate, the result of which is incontinence;
urge incontinence - an involuntary act of urination due to the inability to control the process of emptying the bladder;
it is noteworthy that pain in the suprapubic or lumbar region is absolutely not typical for this disorder.

How to treat an overactive bladder?

occurs either in combination with the treatment of the underlying disease, or independently, if hyperactivity is recognized as idiopathic. An overactive bladder undergoes medical and non-drug, as well as surgical treatment. When determining the strategy, the doctor focuses on the initial use of minimally traumatic procedures, that is, a combination of drug and non-drug methods is much preferable to surgery. The latter is produced with unsuccessful conservative therapy.

Non-drug treatment is as follows:

bladder training - patient compliance with the urination plan agreed with the doctor, it is important to urinate at certain intervals, which corrects the formed pathological stereotype of urination;
exercises for the pelvic muscles - the effect is felt in the presence of anal-detrusor and urethral-detrusor reflexes, it consists in inhibition of the contractile activity of the detrusor during arbitrary contractions of the external anal and urethral sphincters;
physiotherapeutic methods - electrical stimulation of the sacral dermatomes and peripheral tibial electrical stimulation, which reduces the contractile activity and sensitivity of the bladder.

Kegel exercises are considered to be a popular set of exercises for the pelvic floor muscles:

slow contractions - tighten your muscles, as if urination stops, slowly count to three and relax;
contractions - strain and relax the same muscles, but as quickly as possible;
pushing out - to push (as during defecation or childbirth), which causes the necessary tension of the perineal and some abdominal muscles;

Non-drug methods have such obvious advantages as harmlessness and the absence of side effects, the possibility of a variety of combinations with other types of treatment (including medication).

Medical treatment is deservedly considered the main treatment for overactive bladder. Medical treatment has several goals at once:

decrease in the contractile activity of the detrusor;
increase in the functional capacity of the bladder;
decreased urination and intensity of imperative urges
elimination of urgency urinary incontinence.

Medical treatment lasts an average of 3 months, after which a tangible effect will remain for several months. If at this stage the use of non-drug methods is not stopped, or if they are just started, the effect will be fixed. It is absolutely acceptable to conduct repeated courses of drugs after a few months with insufficient effectiveness of the first course or the development of relapses.

Treatment of an overactive bladder in women during menopause can be supplemented with hormone replacement therapy with a mandatory consultation with a gynecologist.

To surgical treatment an overactive bladder is rarely used, even if other methods of treatment are ineffective. The types of surgery used include detrusor myectomy and enterocystoplasty. Detrusor myectomy is the excision of the detrusor from the fornix of the bladder, provided that the intact mucous layer is preserved. This reduces the contractility of the detrusor. Enterocystoplasty is appropriate if it is necessary to significantly reduce the distensibility and reduce the capacity of the bladder with the ineffectiveness of conservative therapy, as well as at the risk of developing ureterohydronephrosis. A clear advantage in choice is such a technique as cystoplasty, it replaces the bladder with a section of the ileum.

What diseases can be associated

An overactive bladder is diagnosed in people who are caused by other diseases. Often these are neurological disorders:

- a chronic autoimmune disease in which the myelin sheath of the nerve fibers of the brain and spinal cord is affected; determines not so much the loss of memory or absent-mindedness, but the multiple scarring of the nervous tissue and the gradual replacement of its connective tissue;
- a decrease in the number of blood cells formed in the bone marrow;
- a malformation of the spine (spinal dysraphism or rachischis), often combined with a hernia of the membranes (meningocele or meningomyelocele), protruding through a bone defect.

Bladder overactivity is associated with such abnormalities:

and - performance of urination acts without volitional control over them;
nocturia - frequent nighttime urination (more than 2 times, often reaching 5-6), significantly affecting the quality of sleep and life in general;
pollakiuria - frequent urination of small portions of urine, which in the total amount per day forms an average rate.

Treatment of overactive bladder at home

The occurrence of disturbing symptoms should certainly become a reason for contacting a urologist, and not a motivation for self-treatment. The doctor, based on diagnostic procedures, will exclude the possibility of complex urological, neurological or gynecological pathologies, and will determine the treatment regimen for overactive bladder. If the suspicions of the underlying disease are confirmed, the treatment will be comprehensive, but certainly professional.

People who are faced with this problem definitely feel the need for social isolation, restrictions on their work and communication. Even under favorable circumstances, when the patient can get to the toilet on time, frequent urge to urinate, including at night, can disrupt social adaptation. It is important to note that after a brief assessment and diagnostic procedures, the doctor determines the appropriate treatment, and it significantly alleviates the manifestations of hyperactivity and contributes to the normalization of the quality of life.

In addition to the fact that at home it is important to comply with all medical prescriptions, it is necessary to adhere to very simple rules organization of everyday life to facilitate the course of the syndrome for the period of its elimination:

avoiding caffeinated drinks (coffee, tea) and carbonated drinks;
during the day, consume a normal amount of fluid, but refuse it at night, in particular when you suffer from nocturia;
after emptying the bladder due to the urge, it is recommended to constantly relax for a few seconds, and then try again;
it is advisable to have a portable toilet next to the bed in case you cannot get to the toilet at night.

Lifestyle change should include giving up bad habits and normalization of weight (if necessary).

What medications can be used to treat overactive bladder?

As part of the medical treatment of overactive bladder the following categories of drugs are used

anticholinergics - eg (Tolterodine), (Solifenacin);
antispasmodics with anticholinergic activity - for example,;
tricyclic antidepressants - for example,.

It is permissible, but not recommended, to use drugs from other groups, however, their insufficient effect is noted with very pronounced side effects. Among them, there is usually a feeling of dryness in the mouth and mucous membranes of the eyes, which is reduced by the use of sugar-free chewing gum and eye drops.

If a particular case of the disease is accompanied or develops against the background of infravesical obstruction, then it is better to find an opportunity to refuse to prescribe drugs with anticholinergic properties, since these reduce the contractile activity of the detrusor, and hence the speed of urination. In the presence of severe infravesical obstruction, it is first necessary to restore the outflow of urine from the bladder, and then to carry out drug treatment of overactive bladder.

Treatment of overactive bladder folk methods

Alternative methods can be an addition to traditional, doctor-controlled treatment. Independent use of such funds is unlikely to provide the desired result. The following herbal infusions are popular in the treatment of overactive bladder:

St. John's wort- 40 grams of dried St. John's wort pour a liter of boiling water, insist for a day, stirring occasionally, strain; take instead of tea or to quench your thirst, especially towards the end of the day;
St. John's wort and centaury- combine 20 grams of dried herbs, pour a liter of boiling water, insist for a day, stirring occasionally, strain; take instead of tea or to quench thirst, especially closer to the night;
plantain- 1 tbsp dried plantain leaves pour a glass of boiling water, wrap, insist for an hour (you can use a thermos), strain; take 1 tbsp. before meals 3-4 times a day;
cowberry- 2 tablespoons brew dried lingonberry leaves with a liter of boiling water, insist for an hour, strain; take during the day instead of water;
dill- 1 tbsp dill seeds brew a glass of boiling water, insist for 2 hours, strain; drink in one go; repeat daily until symptoms are relieved;
elecampane- 1 tbsp grind elecampane rhizomes, pour a glass of water and boil over low heat for 10-15 minutes; insist a few more hours, strain, and flavor with a little honey before use; take 2-3 tbsp half an hour before meals.

It should be noted that it is not recommended to prepare decoctions in advance; they have maximum efficiency on the first day after preparation.

The following recipes can be an alternative to herbal remedies:

honey- 1 tsp it is recommended to consume natural honey before going to bed, if desired, drinking a sip of water, this has a calming effect;
onion and honey- Finely chop 1 medium-sized onion, add 1 tsp. chalk and ½ grated apple, mix; take in full half an hour before meals once a day.

Treatment of overactive bladder during pregnancy

Treatment of overactive bladder during pregnancy is very common due to the fact that anatomical and hormonal changes in the body of the expectant mother cause this dysfunction. Therapy should be supervised by a gynecologist, and carried out by a urologist. Self-medication is highly inappropriate. Surgical intervention is avoided in every possible way, preference is given to folk remedies and lifestyle adjustments. Usually the condition is normalized after delivery, otherwise the therapy described above is carried out.

Which doctors to contact if you have an overactive bladder

Neurologist
Urologist

Diagnosis of bladder overactivity is a multicomponent procedure, it is a set of measures that can be conditionally divided into basic, additional, urodynamic.

A set of basic diagnostic procedures:

collection of anamnesis and fixation of patient complaints, incl. compiling a diary of urination and carefully detailing the symptoms, a detailed analysis of the diseases suffered by the patient and the treatment being carried out;
physical examination (including examination of the pelvic organs in women and rectal examination of men).
laboratory research - analysis of urine and blood.

A set of additional diagnostic procedures:

endoscopic methods of examination,
x-ray methods of examination,
ultrasound methods of examination - to assess the safety of the parenchyma of the kidney and determine the state of its pyelocaliceal system, you can also detect stones, diverticula, tumors.
excretory urography - to detect ureterohydronephrosis, which is especially often complicated by neurogenic dysfunctions of the lower urinary tract;
cystourethroscopy - to identify organic causes of dysuria, such as stones and tumors of the bladder.

Complex of urodynamic diagnostic procedures:

uroflowmetry - indicators are usually normal; sometimes there may be difficulties in carrying out due to the small capacity of the bladder and the impossibility of accumulating the volume of urine necessary for the study;
cystometry - to detect involuntary detrusor activity, increase the sensitivity of the bladder and reduce its extensibility.
video urodynamic study - for a comprehensive assessment of the state of the lower urinary tract and the identification of complex dysfunctions of the lower urinary tract.

Treatment of other diseases with the letter - g

Treatment of sinusitis

Treatment of galactorrhea

Treatment of lung hamartoma

Treatment of gangrene of the lung

Treatment of gastritis

Treatment of gastroesophageal reflux disease

Treatment of hemolytic leukopenia

Treatment of hemorrhagic stroke

An overactive bladder in women, which requires treatment immediately after a problem is discovered, is a violation of the function of storing urine and the appearance of a sharp desire to empty the bladder. This need is often acute and results in the involuntary release of some urine (incontinence).

Traditional therapy begins with the use of strategies - doctors recommend drinking water and other drinks on a regular basis, going to the toilet every day at a certain time, and controlling sudden urges with the help of the pelvic floor muscles. If these measures do not help, there are other methods of treating the pathology.

Symptoms

If you're having trouble urinating, it's not certain that an overactive bladder is the cause. Symptoms in women are manifested as follows:

the appearance of a sudden need to visit the toilet, and this need is extremely difficult to control;
that is, its involuntary release immediately after the desire to empty the bladder;
usually more than eight times a day;
nocturnal polyuria (nocturia) - nocturnal urge to go to the toilet, repeated more than twice during sleep.

Although many patients manage to get to the toilet as soon as there is an urgent need, almost all those suffering from this pathology experience the stress of having to empty their bladder many times a day.

Normal functioning of the body

The kidneys produce urine, which then flows into the bladder. When visiting the toilet, urine exits the storage organ through an opening at the bottom and flows out through a tube called the urethra. In women, the opening of the urethra is located directly above the vagina, in men - at the tip of the glans penis.

As the bladder fills, the brain receives signals from the nerves, which, in the end, cause the need to empty. During urination, nerve signals coordinate the relaxation of the muscles of the pelvic floor and urethra (the latter are called urinary sphincter muscles). The muscles of the organ tense (contract), pushing the urine out.

Causes of pathology

When the muscles of the organ begin to suddenly tighten (even if the volume of urine in it is still small), doctors diagnose an overactive bladder. Symptoms in women include, first of all, a sharp onset of need and may be accompanied by signs of diseases that serve as prerequisites for the development of this ailment. However, chronic diseases are not the only cause of the problem. Frequent toileting and incontinence may be due to:

neurological disorders, including Parkinson's disease, strokes, multiple (multiple) sclerosis;
excessive urine production as a result of high fluid intake, poor kidney function, or diabetes;
taking medications that speed up urine production or require drinking plenty of fluids;
sharp infectious diseases urethra, causing symptoms similar to those of an ailment such as an overactive bladder in women;
organ pathologies (tumors, stones);
factors preventing normal urination (in men, this may be an enlarged prostate, in women, constipation or past operations to treat other forms of incontinence);
excessive consumption of caffeine or alcoholic beverages;
depression of the cognitive function of the brain due to aging of the body, as a result of which the bladder hardly recognizes incoming signals;
difficulty walking, due to which not all patients can get to the restroom in a timely manner;
incomplete emptying of the bladder, which can lead to symptoms of overactivity due to reduced space for new urine coming from the kidneys.

Often, however, even experts cannot say for sure what caused the development of the organ hyperactivity syndrome.

Diagnostics

If you suffer from an unbearable urge to go to the toilet too often, your doctor will first test your urine for blood or infection. It is also necessary to establish whether you empty your bladder completely. A complete diagnosis is likely to include the following activities:

studying the history of diseases;
initial medical examination with special attention to the organs of the abdominal cavity and groin;
urine tests to check for infections, traces of blood and other signs of pathology;
Focused neurological exam to look for sensory disturbances or problems with reflexes.

Special Studies

First, the doctor will establish an accurate diagnosis and presumptive prerequisites for the development of such an unpleasant condition as an overactive bladder in women. Treatment will depend on many factors, but first of all - on the quality of the functioning of the organ. The ability of the bladder to empty regularly and completely is checked by the urodynamic study, which consists of several different tests.

What is included in the concept of urodynamic analysis

Measurement of the residual volume of urine. This analysis is especially important if the organ does not empty completely when urinating, or if you suffer from incontinence. Residual urine causes symptoms similar to those of hyperactivity. To measure the remaining fluid after emptying, the doctor will prescribe an ultrasound examination of the bladder or put a special catheter (thin tube) to withdraw and study the remainder.
Measurement of urine flow rate. If it is necessary to assess the volume and speed of urination, the doctor will ask you to empty your bladder into a uroflowmeter - a device that measures these parameters and converts them into a graph of changes in the rate of emptying.
Determination of intravesical pressure. The cystometry method helps to measure the pressure in the organ and its surrounding tissues when filled with liquid. During this test, the doctor uses a thin tube (catheter) to slowly fill the bladder with warm water. Another catheter with a pressure sensitive sensor is placed in the vagina. This procedure helps to understand why an overactive bladder occurs in women. Treatment will depend on what the analysis shows: there will be either involuntary contractions of the walls of the organ, or its rigidity, due to which the bladder becomes unable to store urine at low pressure. You may be asked to have a bowel movement during the exam to measure the pressure needed to empty the organ and determine if there is a possible blockage (obstruction) or not. Obstruction due to pelvic organ prolapse can lead to symptoms that are characteristic of such a common ailment as an overactive bladder in women. Causes (treatment, as you know, can only be prescribed by a qualified specialist) in this case almost always involve neurological diseases affecting the spinal cord.

Behavioral Therapy Treatment

Behavioral therapy, or the acquisition of good habits necessary to fight the disease, is the first and most effective measure on the road to recovery. The undoubted advantage of this method is the complete absence of side effects. If you have no idea how to treat an overactive bladder in women, try the following techniques.

Best Troubleshooting Methods

Exercises for the muscles of the pelvic floor. No wonder they gained worldwide fame and unprecedented popularity: perhaps there is no more natural way to strengthen the muscles of the pelvic floor and urinary sphincter. Stronger muscles can permanently save you from involuntary contractions of the walls of the bladder. The doctor will give detailed advice on the correct implementation of the famous gymnastics. Follow the recommendations of a professional and be patient: it often takes quite a long time (six to eight weeks) for a noticeable improvement in well-being.
Maintaining normal weight. If you're obese, returning to a healthy weight can help tame an overactive bladder in women. Treatment (reviews can be found on thematic forums if desired) in this case involves a diet based on the principles of proper nutrition.
Fluid intake control. Your doctor may recommend limiting your fluid intake and help you create a comfortable schedule for drinking your favorite beverages.
Double emptying. To completely empty the bladder, you must wait a couple of minutes after the first emptying and then try again to relieve a small need.
Scheduled urination. The scheduling method is useful not only in terms of drinking liquids, but also for going to the toilet. If you follow a planned schedule (for example, going to the bathroom every 2-4 hours), then the body will get used to the same regimen, and you will no longer experience unnecessary stress from a sudden need.

What else can be done?

intermittent catheterization. When an overactive bladder is diagnosed in women, treatment and feedback on the prescribed therapy largely depend on the individual effectiveness of the prescribed method. However, there is a general, universal way to alleviate the symptoms of pathology, which involves the periodic use of a catheter to completely empty the organ. Check with your doctor before using this method.
Wearing urological pads. The use of urological pads or special absorbent underwear will help protect clothes from the effects of incontinence and eliminate the psychological stress associated with this. These pads and underwear come in all sizes and have different absorbency ratings.
Bladder training. This term refers to the development of one's own ability to restrain a small need. You need to start with small periods - for example, from 30 minutes, after which you can gradually increase the intervals until you start going to the toilet only once every three to four hours. An overactive bladder in women (treatment, causes, symptoms discussed above) can only be stabilized in this way if you are able to strain (contract) your pelvic floor muscles on your own.

Overactive bladder in women: treatment (drugs)

To reduce the hyperactivity syndrome, medications are used to help relax the walls of the organ. This is:

tolterodine ("Detrol");
oxybutynin in the form of a skin (transdermal) patch ("Oxytrol");
oxybutynin in;
trospium;
solifenacin;
darifenacin;
fesoterodine.

Be careful

The above medicines can cause side effects, including dry mouth and constipation, which can aggravate the symptoms of an overactive bladder in women. Treatment (tablets and other drugs for oral administration) should be prescribed by a doctor, but if you suffer from these side effects, it is better to consult a specialist about replacing tablets with gels and patches.

According to statistics, 17% of women and 16% of men suffer from bladder disease, but only 4% seek help from a specialist. Many simply do not realize that they have some kind of health problem. So how do you recognize the presence of bladder disease? First of all, it is necessary to clarify what is meant by this term.

What does an overactive bladder (OUB) mean?

The bladder is an organ made entirely of muscle tissue. Its task is the accumulation and excretion of urine through the urethra. It should be noted that the location, shape and size of the body vary depending on its content. Where is the bladder located? The filled organ has an ovoid shape and is located above the transitional connection between the bones of the skeleton (symphysis), adjacent to the abdominal wall, shifting the peritoneum upward. The empty bladder lies completely in the pelvic cavity.

GPM is a clinical syndrome in which there are frequent, unexpected and difficult to suppress urge to urinate (they can be both at night and during the daytime). The word "hyperactive" means that the muscles of the bladder work (contract) in an enhanced mode with a small amount of urine. This provokes frequent intolerable urges in the patient. Thus, the patient develops a false feeling that he constantly has a full bladder.

Development of the disease

Excessive activity of the bladder is caused by a decrease in the number of M-cholinergic receptors. Their number changes under the influence of various reasons. In response to the lack of nervous regulation, structural formations of close interconnections between neighboring cells are formed in the smooth muscle tissues of the organ. The result of this process is a sharp increase in the conduction of the nerve impulse in the muscular membrane of the bladder. Smooth muscle cells have a high spontaneous activity and begin to respond to a minor stimulus (a small amount of urine). Their reduction quickly spreads to the rest of the cell groups of the body, causing the syndrome of GPM (overactive bladder).

Factors of occurrence of GPM

1. Neurogenic:

Diseases of the central and peripheral nervous systems (for example, Parkinson's disease, Alzheimer's disease);

Stroke;

Multiple sclerosis;

Osteochondrosis;

Diabetes;

spinal cord injury;

Schmorl's hernia;

Consequences of surgical treatment of the spine;

Spondylarthrosis of the spine;

intoxication;

Myelomeningocele.

2. Non-neurogenic:

BPH;

Age;

Anatomical disorders of the vesicourethral region;

Sensory disturbances, mainly associated with a lack of estrogen in the post-menopausal period.

Forms of the disease

In medicine, two forms of GLM disease are distinguished:

Idiopathic GPM - the disease is caused by a change in the contractile activity of the bladder, the cause of the violations is unclear;

Neurogenic bladder - violations of the contractile function of the organ are characteristic of diseases of the nervous system.

Characteristic symptoms

An overactive bladder is defined by the following symptoms:

Frequent urge to urinate, while urine is excreted in a small amount;

Inability to hold urine - sudden urge to urinate of such strength that the patient does not have time to endure to the toilet;

Multiple nocturnal urination (a healthy person should not urinate at night);

Urinary incontinence is the uncontrolled leakage of urine.

GPM in women

2. Non-drug treatment.

Behavioral therapy consists in the formation of a urination regimen, lifestyle correction. During the treatment period, the patient must observe the daily regimen, avoid stressful situations, take daily walks in the fresh air, and monitor nutrition. People suffering from GLM should not eat spicy foods, carbonated and caffeinated drinks (tea, coffee, cola), chocolate, sugar substitutes and alcohol.

In addition, during the period of behavioral therapy, the patient needs to empty the bladder according to a certain schedule (depending on the frequency of urination). This method helps to exercise the muscles of the bladder and regain control over the urge to urinate.

Physiotherapy may consist of electrical stimulation, electrophoresis, etc.

Exercise therapy is a variety of exercises aimed at strengthening the pelvic muscles.

Treatment is based on biofeedback. The patient, using special devices (special sensors are installed that are inserted into the body of the bladder and rectum; the sensors are also connected to the monitor, it displays the volume of the bladder and records its contractile activity) observes at what volume of fluid the bladder contracts. At this time, the patient should volitional efforts by contracting the pelvic muscles, suppress the urge and restrain the desire to urinate.

3. Surgical treatment is used only in severe cases (denervation of the bladder, intestinal plastic to divert urine into the intestine, stimulation of the sacral nerve).

Complications of GPM

An overactive bladder impairs the patient's quality of life. The patient develops mental disorders: depression, sleep disturbances, constant anxiety. Social disadaptation also occurs - a person partially or completely loses the ability to adapt to environmental conditions.

Prevention

1. A visit to the urologist for the purpose of preventive examination once a year (passing the necessary tests, ultrasound of the bladder, if necessary, etc.).

2. There is no need to postpone a visit to the doctor if symptoms of urination disorders appear.

3. It is important to pay attention to the frequency of urination, the development of urge, the quality of the jet, if there are neurological diseases.

Also, as a preventive measure, you can perform Kegel exercises that will help strengthen the muscles of the bladder.

1. First you need to tighten the muscles, as when holding urination, slowly count to three and relax.

2. Then tighten and relax the muscles - it is important to try to do it as quickly as possible.

3. Women need to push down (as in childbirth or stool, but not as hard); men to push, as in stool or urination.

Frequent urination has a very negative impact on all areas of life. To avoid the development of psychological problems, it is necessary to seek help from a specialist in time.

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 Negative influence on the 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, while double urination is possible. 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 plan to go to the toilet 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 long 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

Medications that help relax the bladder can be effective for 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 sugar-free gum.
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 spinal cord and 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