Overactive bladder - causes, symptoms and treatment

Overactive bladder is a pathological condition in which a person suffers from frequent urge to defecate, and in some cases, patients even develop urinary incontinence. The organ that accumulates biological fluid consists of muscle fibers, and when they are in a relaxed state, it is impossible to independently control urination.

With this pathology of the bladder, it starts the process of bowel movements even with minimal filling, so the urge becomes too frequent. In most cases, this disorder is detected in the fairer sex, which is due to the anatomical structure of the genitourinary system. Let's take a closer look at why overactive bladder occurs in women and men.

Etiology

The causes of overactive bladder syndrome in men and women can be various diseases, including:

benign neoplasm of the prostate gland (this causes narrowing of the urinary channel);
a wide variety of disorders of the brain structure, for example, traumatic brain injuries, hemorrhages, oncology;
spinal cord disorders - tumors, intervertebral hernias, injuries and bruises, complications after surgery;
diabetes;
mental retardation;
strokes;
nervous system disorders;
various poisonings of the body with toxic chemicals, alcohol, drug overdose;
congenital pathologies in the structure of the urinary canal;
hormonal changes in women, especially during the period of cessation of menstruation. That is why female representatives are more susceptible to this disease.

In addition, prolonged exposure to stressful situations, communication with unpleasant people, and harmful working conditions can serve as factors for the manifestation of an overactive bladder. Pregnancy in women can cause this disease, as well as urinary incontinence, since the fetus puts strong pressure on the bladder. Age category plays an important role - cases of such a disorder in young people are extremely rare. But in some cases, bladder overactivity is observed in children, but the reasons for this are completely different features:

increased activity of the child;
excessive fluid intake;
severe stress;
unexpected and severe fear;
congenital pathologies of the urethra.

It is these factors that become the causes of this disease in the younger age category. But we must not forget that for children under three years of age, uncontrolled urination is quite typical. When symptoms of overactive bladder are observed in adolescents, it is necessary to immediately seek help from specialists, because it may be associated with mental disorders, which are best treated in the initial stages.

Normal organ functioning

The kidneys produce urine, which then drains into the bladder. When you go to the bathroom, urine leaves 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 head of the penis.

As the bladder fills, signals from nerves are sent to the brain, which eventually trigger the need to stool. When urinating, nerve signals coordinate the relaxation of the pelvic floor and urethral muscles (the latter are called the urinary sphincter muscles). The muscles of the organ tense (contract), pushing urine out.

Varieties

Overactive Bladder

Overactive bladder can manifest itself in several forms:

idiopathic – in which it is impossible to determine the factors of occurrence;
neurogenic - the main causes of manifestation are associated with disorders of the central nervous system.

Despite the delicate connection between the bladder and the nervous system, in most cases the basis for the appearance of urinary incontinence disorder arises precisely because of various infections and diseases.

Relevance of the problem

The disease is detected in 20% of the population on Earth. However, there is considerable suspicion that the real figure is higher, since not all patients go to the doctor.

This applies to a greater extent to men. Hence the misconception that women are more likely to suffer from OAB.

Most patients are around 40 years old, give or take a couple of years, when the disease is diagnosed. Among patients from 40 to 60 years old, women are more common. After 60 years, men are more likely to get sick.

Despite the high prevalence of OAB, there are certain problems with diagnosis and treatment. Not all people (especially men) seek medical help in a timely manner due to shyness or various matters.

Treatment of overactive bladder in women begins at the age of 25, in men - from the age of 20. The disease can also occur in old age.

Many patients are interested in whether overactive bladder can be cured without surgery or medication.

Symptoms

In addition to the main symptom of overactive bladder - urinary incontinence, there are several symptoms characteristic of this disorder:

repeated urge to pass urine. Despite the feeling of a full bladder, a small amount of fluid is released;
strong urge to urinate (often so strong that a person does not have time to get to the toilet);
passing urine at night or during sleep. In the normal state of the bladder muscles, a person does not get up at night to relieve the need;
involuntary release of a few drops of liquid;
excretion of urine in several stages, i.e. after the first process has ended, after straining, a second wave of urine excretion occurs.

If a person has the urge to stool more than nine times during the day, and at least three times at night, these are the first symptoms that he is susceptible to a disease such as overactive bladder. But this amount may vary depending on the amount of fluid consumed, alcoholic beverages or diuretics. Under normal conditions, this process occurs less than ten times a day and is generally not observed at night. Both women and men may experience one or more of the above symptoms.

Drug treatment for overactive bladder

Overactive bladder (OAB) is a clinical syndrome with symptoms of frequent and urgent urination with (or without) urgency urinary incontinence and nocturia (urination between falling asleep and waking up). OAB is based on detrusor hyperactivity of a neurogenic or idiopathic nature. is a consequence of neurological diseases. indicates that the cause of involuntary detrusor contractions is unknown. When frequent, urgent urination is not accompanied by detrusor overactivity in the absence of other causes of these symptoms, the term is used [5]. Thus, the term OAB is a general term to refer to all of the above urination disorders. However, the term OAB does not purport to replace the well-known terminology of the International Continence Society, which is used by a narrow circle of urologists. Figure 1 and Table 1 present urodynamic and clinical terms for frequent and urgent urination.

Rice. 1. Clinical and urodynamic terms for frequent and urgent urination

An analysis of the medical literature in recent years shows an increased interest among doctors in the problem of OAB, which was greatly facilitated by the results of epidemiological studies on the prevalence of OAB. According to the International Continence Society, OAB occurs in approximately 100 million people worldwide. In the United States, the diagnosis of OAB is more common than that of diabetes mellitus, gastric and duodenal ulcers, and is included in the 10 most common diseases. There is reason to believe that 17% of the European adult population have symptoms of OAB [14]. It is believed that imperative urination is observed in 16% of Russian women [3].

Despite the fact that OAB is more often noted in old age, symptoms of OAB are quite common in other age groups. According to our data, the largest number of patients was observed over the age of 40 years, while in men over 60 years of age there is a clear tendency towards an increase in incidence, while in women, on the contrary, a decrease [2]. The data presented clearly demonstrate that OAB is a very common clinical syndrome, occurring in various age groups and leading to physical and social maladaptation of such patients.

Clinically, patients with OAB more often have idiopathic detrusor hyperactivity, less often neurogenic, and even more rarely OAB without detrusor hyperactivity (according to our data, in 64%, 23.5% and 12.5%, respectively). If idiopathic detrusor hyperactivity is observed 2 times more often, and OAB without detrusor hyperactivity is 6 times more often in women, then neurogenic detrusor hyperactivity occurs almost equally often in both women and men [2].

Etiology and pathogenesis

It has been reliably established that OAB can be a consequence of neurogenic and non-neurogenic lesions. The first are disorders at the level of the supraspinal centers of the nervous system and the spinal cord pathways, the second are a consequence of age-related changes in the detrusor, bladder outlet obstruction and anatomical changes in the position of the urethra and bladder.

Some morphological changes in the detrusor are known due to its hyperactivity

. Thus, in most patients with OAB, a decrease in the density of cholinergic nerve fibers is detected, which, in turn, have increased sensitivity to acetylcholine. These changes are defined as “postsynaptic cholinergic detrusor denervation” [12]. In addition, using electron microscopy, it was possible to establish violations of normal intercellular connections in the detrusor of the GMF in the form of protrusion of intercellular connections and protrusion of the cell membrane of one myocyte into another neighboring myocyte with the convergence of intercellular boundaries - “a tight connection of two parallel planes of adjacent myocytes” [11,18] . Based on these morphological changes, which are believed to be characteristic of OAB, Brading and Turner in 1994 proposed a theory of the pathogenesis of the development of detrusor hyperactivity, which is based on the increased excitability of myocytes that are in close connection with each other in places of denervation [9,10].

It is believed that the cause of denervation, in addition to nervous disorders, may be detrusor hypoxia

due to age-related ischemic changes or due to bladder outlet obstruction. In the latter case, this is confirmed by the presence of OAB in 40–60% of men with benign prostatic hyperplasia [8]. Thus, the pathogenesis of detrusor overactivity in OAB is presented as follows: hypoxia that occurs in the detrusor as a result of age-related arteriolosclerosis or as a result of IVO, leading to hypertrophy and infiltration of the detrusor connective tissue, leading to detrusor denervation (detected in detrusor biopsies for all types of detrusor hyperactivity), as a result, structural changes occur in myocytes (close contact between myocytes with increased nervous excitability and conductivity), as a compensatory reaction to a deficiency of nervous regulation. In this case, any spontaneous or provoked by stretching of the bladder wall (the period of urine accumulation) contraction of individual myocytes in the form of a “chain reaction” leads to involuntary contractions of the entire detrusor. The proposed theory of the development of detrusor hyperactivity in OAB is currently leading.

Clinical course and examination tactics

Frequent daytime and night urination, as the predominant symptoms of OAB, we observed approximately 2 times more often without urgent urination and 3 times more often without urgent urinary incontinence, which is undoubtedly the most severe manifestation of OAB, since it causes incomparably significant suffering for patients. A feature of the course of OAB is the dynamics of its symptoms. During a 3-year follow-up period, in almost a third of patients, urge urinary incontinence spontaneously regresses without treatment and recurs again at different times. The most persistent symptom is frequent urination, which often reaches such a level that it makes patients completely unable to work and pushes them to make rash decisions.

In addition to collecting anamnesis and physical examination, all patients with frequent and urgent urination are assessed for urination frequency (based on a 72-hour urination diary), urine sediment examination and urine culture for sterility, ultrasound scanning of the kidneys, bladder, prostate, with determination of residual urine. The results of the urination diary are most important: having assessed them, one can largely assume OAB and, based on this, quickly decide on the initiation of treatment and its methods. OAB is eligible for diagnosis if there are at least 8 urinations and/or at least 2 episodes of urge urinary incontinence during the day

. It is important that the results of such an initial examination, which is carried out at the outpatient stage, often make it possible to identify diseases that are accompanied by symptoms of frequent and urgent urination, but are not related to OAB.

When OAB is detected, treatment can be started immediately to improve the patient’s quality of life by stopping frequent and urgent urination. In case of ineffectiveness of treatment or at the request of the patient, to clarify the form of OAB (idiopathic or neurogenic detrusor hyperactivity, OAB without detrusor hyperactivity), cystometry and special tests with cold water and lidocaine are performed, which allow one to suspect neurological disorders underlying the development of detrusor hyperactivity. In all cases, when detrusor overactivity is detected, a detailed neurological examination is indicated.

Treatment

Treatment of patients with OAB is aimed primarily at restoring lost control over the storage capacity of the bladder. For all forms of OAB, the main treatment method is medication. Anticholinergics

(M-anticholinergics)
are standard drugs for such treatment
.
These drugs are used both as monotherapy and in combination with other drugs (Table 2). Below we will report which anticholinergic drugs are advisable to use in the modern treatment of OAB symptoms. Typically, medications are combined with behavioral therapy, biofeedback, or neuromodulation. The mechanism of action of anticholinergic drugs is the blockade of postsynaptic (M2, M3) muscarinic cholinergic receptors of the detrusor. This reduces or prevents the effect of acetylcholine on the detrusor, reducing its hyperactivity. In humans, five types of muscarinic receptors are known, of which the detrusor contains two - M2 and M3. The latter make up only 20% of all muscarinic receptors in the bladder, but they are responsible for the contractile activity of the detrusor. Location of M2 – heart, hindbrain, smooth muscle, potassium channels; M3 – smooth muscles, glands including salivary glands, brain. The cellular response to M2 stimulation is negative, isotropic, decreased presynaptic release of transmitters; M3 – contraction of smooth muscles, secretion of glands, decrease in presynaptic release of transmitters. It has been proven that activation of M2 receptors leads to inhibition of the sympathetic activity of the detrusor, which increases its contractile activity. Thus, blockade of M2 cholinergic receptors is essential along with blockade of M3 in suppressing detrusor hyperactivity. It is believed that M2 cholinergic receptors are largely responsible for the development of detrusor hyperactivity in neurological diseases and in elderly patients. M receptors are the main target of drug treatment for OAB
. M3 anticholinergic medications remain the drugs of choice, among which highly selective ones play a special role. According to their chemical structure, anticholinergic drugs are divided into secondary, tertiary (oxybutynin hydrochloride, tolterodine tartrate) and quaternary (trospium chloride) amines. From a practical point of view, this division allows us to assume the development of side effects depending on the chemical structure of the drug. In particular, it is believed that quaternary amines, compared to secondary and tertiary amines, penetrate the blood-brain barrier to a lesser extent and, therefore, are less likely to develop side effects from the central nervous system. This point of view has not yet been fully confirmed in clinical practice, since the development of side effects is also determined by other features of anticholinergic drugs (organ specificity, drug pharmacokinetics, drug metabolites, type of receptors blocked).

The use of anticholinergic drugs was limited due to the severity of systemic side effects, primarily dry mouth, which developed with blockade of M receptors of the salivary glands, often forcing patients to refuse treatment.
When using the immediate-release form of oxybutynin (used since 1960 and remains the standard for comparison with other anticholinergic drugs), only 18% of patients continue treatment during the first 6 months due to side effects [13]. Side effects include not only dry mouth, but also impaired vision clarity, decreased tone of smooth muscle organs and associated inhibition of intestinal motility and constipation, tachycardia, in some cases central effects (drowsiness, dizziness), etc. Side effects lead to the need for dose titration (for oxybutynin - from 2.5 to 5 mg 3 times a day). A significant step forward is the synthesis of a new anticholinergic drug, tolterodine.

, proposed specifically for the treatment of OAB.
Tolterodine is a mixed antagonist of M2 and M3 cholinergic receptors, which has a distinct organ specificity of action in relation to the detrusor. Unlike oxybutynin, which has pronounced selectivity for M1 and M3 receptors, tolterodine demonstrates almost identical sensitivity to different subtypes of M receptors. Our experience with the use of an immediate-release form of tolterodine at a dose of 2 mg 2 times a day in 43 patients with idiopathic detrusor overactivity indicates its high effectiveness. After 12 weeks of use, the number of urinations per day decreased on average from 13.5 ± 2.2 (9–24) to 7.9 ± 1.6 (6–17), and episodes of urge urinary incontinence from 3.6 ± 1. 7 (1–6) to 2.0±1.8 (0–3). The immediate-release form of tolterodine is relatively well tolerated, as evidenced by data from clinical trials in which 82% and 70% of patients completed 6- and 12-month courses of treatment, respectively, indicating that the effectiveness of therapy is maintained over the long term. The incidence of side effects with the immediate-release form of tolterodine was practically the same as in the placebo group, with the exception of dry mouth, which was observed in 39% of patients taking tolterodine and in 16% of the placebo group [6]. Our data also indicate good efficacy and tolerability of the immediate-release form of tolterodine
(4 mg) over 6 months. treatment in 16 patients with neurogenic detrusor hyperactivity. There was a decrease in the average number of daily urinations by 5.7/day, episodes of urgent urinary incontinence by 2.7/day and an increase in the average effective bladder volume by 104.5.

Clinical studies show that anticholinergic drugs lead to a reduction in the frequency of OAB symptoms within 1–2 weeks of treatment, with maximum effect achieved by 5–8 weeks. At the same time, treatment involves long courses. Despite this, in most cases of monotherapy with anticholinergic drugs, after their withdrawal, a relapse of OAB symptoms is observed, which makes it necessary to take them continuously in order to maintain an adequate therapeutic effect.

The use of anticholinergic drugs, in particular tolterodine, requires careful monitoring and caution, especially in patients with neurogenic detrusor overactivity. The fact is that with prolonged uncontrolled use of these drugs, patients may experience a disturbance in the contractile activity of the detrusor, with the development of chronic urinary retention, urethrohydronephrosis and chronic renal failure. For timely monitoring of possible side effects, it is necessary to evaluate the amount of residual urine. We recommend that in the first three months after the prescription of anticholinergic drugs, the amount of residual urine is determined at least once every two weeks, and subsequently once a month. Patients should be warned about the possibility of such a complication and immediately inform the doctor if they experience incomplete emptying of the bladder.

It is known that, along with drugs, their metabolites are responsible for the development of side effects, the concentration of which in the blood and their affinity for M - cholinergic receptors often exceeds those of the original drugs. For example, the metabolism of oxybutynin leads to the formation of N-desityl oxybutynin, and tolterodine - to the active metabolite - 5-hydroxymethyl derivative. These data provided the basis for the use of anticholinergic drugs other than oral forms. In particular, intravesical administration of oxybutynin

or rectal suppositories.
Penetration of the drug directly into the blood, bypassing the liver, with such forms of administration is not accompanied by the formation of metabolites, which reduces the number of side effects. Since 1999, a slow-release form of oxybutynin
based on the OROS osmotic delivery system, which provides prolonged release of the drug and its constant concentration in the blood plasma over 24 hours. Clinical studies show that the slow-release form of oxybutynin is effective in reducing the symptoms of urinary urgency , comparable to the immediate-release form with fewer side effects (25% versus 46%). It is believed that this is why 60% of patients with OAB continue to take the slow-release form of oxybutynin for 12 months. at a dose of 15 mg per day [7].

Currently, the effectiveness and tolerability of the S-form of oxybutynin is being studied, and transdermal ( OXYtrol patch)

) and intravesical (
UROS
) forms of oxybutynin.

The slow-release form of tolterodine consists of many small beads made of polystyrene. The active substance is located on the surface of the beads and is covered with a special capsule. The drug is released when the capsule is destroyed by the acidic contents of the stomach. This delivery system ensures a constant level of the drug in the blood over 24 hours. The slow-release form of tolterodine has a more significant reduction in episodes of urge urinary incontinence and is better tolerated compared to the immediate-release form. Patients receiving slow-release tolterodine had 23% fewer cases of dry mouth [19].

Considering the insignificant number of side effects when using slow-release forms of anticholinergic drugs, the issue of increasing their dose in the treatment of patients with OAB has recently been discussed in the literature. This is due to the fact that most patients have a positive effect when using a standard dose of anticholinergic drugs and only some of them get rid of OAB symptoms completely. At the same time, despite good tolerability, doctors usually do not increase the dose of drugs to completely eliminate the symptoms of OAB. Clinical research and practice show that a significant number of patients with successful results of therapy with anticholinergic drugs may subsequently have clinical improvement in symptoms with increasing doses of these drugs [16].

A separate question arises about the possibility of using anticholinergic drugs in patients with OAB and bladder outlet obstruction.

. Despite the fact that anticholinergics reduce frequency and urgency of urination, doctors are wary of using them in patients with concomitant bladder outlet obstruction due to the risk of developing acute urinary retention. Only two randomized controlled trials have examined this issue. These studies showed that the immediate-release form of tolterodine, used alone or in combination with tamsulosin (a1-blocker), is safe against the potential development of acute urinary retention and improves quality of life in patients with detrusor overactivity in combination with mild to moderate bladder outlet obstruction and moderate amount of residual urine [4,8].

We used an immediate-release form of tolterodine (2 mg twice daily) in 12 patients with OAB in combination with benign prostatic hyperplasia [1]. In 2 patients, in the first 3 weeks of treatment, the appearance of residual urine in a volume of up to 100 ml was noted, which was an indication for discontinuation of treatment. In 10 patients, after 12 weeks of treatment, the average I-PSS score decreased from 17.2 to 11.7 due to irritative symptoms, and the average quality of life score decreased from 5.2 to 3.1. The number of urinations according to the urination diary decreased from 14.6 to 9.2. The maximum urine flow rate not only did not decrease, but even slightly increased from 12.3 to 13.4, which is likely due to an increase in the storage capacity of the bladder. There is no doubt that further research is needed to clarify the possibility of using anticholinergic drugs in patients with OAB and bladder outlet obstruction.

There are isolated reports of a scattered nature on the use of other drugs in patients with OAB. In particular, the use of tricyclic antidepressants, calcium ion antagonists, α1-adrenergic blockers, prostaglandin synthesis inhibitors, vasopressin analogues, β-adrenergic stimulants and potassium channel openers has been reported. However, due to the small number of observations, an accurate assessment of the results of their use in the treatment of OAB is currently not possible. These drugs are usually used in combination with anticholinergic drugs.

Recently, the successful use of capsaicin

and
resiniferotoxin
[17]. These substances are injected into the bladder in the form of a solution. Capsaicin and resiniferotoxin are drugs with a specific mechanism of action, which consists of reversibly blocking the vanilloid receptors of the afferent C-fibers of the bladder. These drugs are used today mainly in patients with neurogenic detrusor overactivity in the absence of effect from traditional medications.

We tested a new method of drug treatment for OAB, which is considered very promising throughout the world. The method consists of sequential injection of a total of 200–300 units of botulinum toxin type A into various parts of the detrusor

. The mechanism of action of the toxin is to block the release of acetylcholine from the presynaptic membrane at the neuromuscular synapse, which leads to a decrease in the contractile activity of the detrusor. In most cases, previous muscle activity is restored within 3–6 months. after the introduction of the toxin, but often this can occur after a year or more. Our results of using botulinum toxin type A in 3 patients with neurogenic detrusor overactivity indicate an increase in bladder capacity, which is clinically manifested by a decrease in the number of urinations and episodes of urge urinary incontinence. However, there is not yet sufficient data to characterize with great certainty the effectiveness of this treatment method.

Thus, literature data and our own experience indicate that among drug treatment methods, anticholinergic drugs occupy a leading place in the treatment of OAB and allow obtaining good results in a significant number of patients.
Improving the methods and forms of administration of anticholinergic drugs while maintaining therapeutic effectiveness can reduce the number of side effects. It is hoped that as knowledge expands regarding the pathophysiological processes underlying the development of detrusor overactivity, fundamentally new targets for pharmacological treatment will emerge. Literature:

Complications

If the disease is treated incorrectly or untimely, the following consequences may occur:

constant anxiety and, as a result, decreased concentration on household or work matters;
prolonged depression, which can develop into apathy;
the appearance of insomnia as a consequence of sleep disturbances;
loss of ability to adapt to the conditions of the social environment;
the occurrence of congenital pathologies in the baby, if this disease was diagnosed in a pregnant woman.

It is worth noting that complications develop much faster in children than in adults.

Pathogenesis

Increased hyperreactivity of the bladder detrusor occurs through the following mechanism of action:

The activating factor reduces the number of M-cholinergic receptors.
The changes that arise are in the nature of denervation.
In this case, a response develops from the smooth muscle fibers of the bladder - structural changes in the muscle frame are formed, and closer contact between cells is formed.
Under conditions of M-cholinergic receptor deficiency, the speed of nerve impulses increases.

A special feature of the muscular frame of the bladder is its autonomous operation. When filled with urine and the volume of the bladder is filled to more than half, the urge to urinate spontaneously occurs. But with an overactive bladder, spontaneous urination can develop even with a small amount of urine.

Diagnostics

The main thing in diagnosing overactive bladder is to exclude other diseases of the urinary tract. In order to do this, they use a set of diagnostic measures, including:

collecting complete information from the patient about the possible causes of the occurrence, the time of onset of the first symptoms, and whether they are accompanied by pain. Doctors recommend keeping a toilet diary, in which you need to record the frequency of visits and the approximate amount of fluid released;
analysis of medical histories of close relatives and hereditary factors;
urine analysis, general and biochemical, testing according to Nechiporenko - will indicate pathologies of the kidneys or organs involved in the emission of urine, and Zimnitsky - in which urine collected per day is examined;
culture of urine to detect bacteria or fungi;
Ultrasound of the bladder;
MRI;
examination of the urinary tract using an instrument such as a cystoscope;
radiography with a contrast agent, which will help identify pathologies in the structure of these internal organs;
urodynamic study, complex.

In addition, additional consultations with a neurologist may be necessary, since the disease is often associated with disorders of the nervous system.

Prevalence

The disease affects approximately one in five adults on Earth.
Women are affected somewhat more often than men, especially with some forms of the disease. OAB occurs in 16% of Russian women. However, the myth that OAB is a disease exclusively of women is associated with a significantly lower frequency of men visiting a doctor about this. The incidence of this disease is comparable to the incidence of diabetes mellitus or depression, that is, it is a fairly widespread chronic disease. A special feature of the disease is that even in the United States of America, 70% of patients for some reason do not receive treatment. This is largely due to the embarrassment of patients and poor awareness of the possibility of treating this disease.

Therefore, patients adapt by changing their usual lifestyle, while its quality is significantly reduced. Long trips or even regular shopping or excursions become impossible. Night sleep is disturbed. Patients meet with family and friends less often. Their work in the team is disrupted. All this leads to disruption of social adaptation of patients with OAB, making this disease a significant medical and social problem.

It should be noted that not only patients, but also doctors have low awareness of issues related to the causes, manifestations, diagnosis and treatment of the disease.

Treatment

Treatment of overactive bladder, similar to diagnosis, consists of several measures. The main goal of therapy is to learn to control urges and, if necessary, restrain them. The treatment complex consists of:

taking individual medications, depending on the causes of the disorder;
the use of special medications that affect the functioning of the nervous system;
performing special physical exercises to strengthen the pelvic muscles;
creating the correct daily routine. Leave at least eight hours a day for rest, do not drink liquids several hours before bedtime;
rationalization of everyday life - consists of avoiding stress or unpleasant communication, increasing time spent in the fresh air;
physiotherapeutic methods of treatment, for example, electrical stimulation, current and electrophoresis treatment, acupuncture.

Surgical intervention is resorted to only in cases where other methods of therapy have proven ineffective. In such cases, several types of operations are performed:

additional supply of nerves to the bladder;
injection of sterile liquid into the bladder, which will increase the size of this organ;
introduction into the walls of the organ, using injections, of special drugs, the main task of which is to disrupt the transmission of nerve impulses;
replacement of a small part of the bladder with intestines;
removal of a certain part of the organ, but the mucous membrane remains in place.

These medical interventions are recommended not only for adult men and women, but also for children.

Lifestyle with Overactive Bladder

With proper therapy, you can completely recover from overactive bladder syndrome. However, you should know some behavior patterns that will allow you, if not to get rid of the disorder, then to minimize the symptoms.

We recommend:

Avoid consuming certain foods, such as those rich in caffeine such as coffee, alcohol and those that may cause urinary tract irritation such as spices and highly acidic foods (such as citrus fruits). Instead, consume fiber-rich foods such as whole grains and vegetables, which help avoid constipation, which causes straining during bowel movements. It will also be helpful to reduce your intake of fats and processed foods to keep your weight under control.
Stop smoking, as nicotine can irritate the bladder tissue and cause recurring episodes of coughing, which lead to urinary incontinence.
Perform any gymnastic exercises aimed at strengthening the pelvic floor muscles. The most famous are Kegel exercises.
Double urination: After you finish urinating, wait a few minutes and try urinating again to remove any remaining urine.
Keep a urination diary, in which you note how many times you went to the toilet during the day and at night, and whether there were any episodes of urinary incontinence. Note how long it takes between urinating and how much urine is produced.
Exercise your bladder or try to resist the urge to urinate. As soon as you feel the urge, wait a few minutes before going to the bathroom, gradually increasing the wait time from a few minutes to several hours.

Prevention

In order to prevent the occurrence of this syndrome, it is necessary:

be observed by a urologist at least once a year for men, and at least twice a year by a gynecologist for women;
contact a specialist in a timely manner (at the first symptoms of urinary obstruction);
monitor the amount of fluid released;
avoid stressful situations;
Pregnant women regularly visit an obstetrician-gynecologist;
take the child for consultation with a child psychologist;
lead a healthy lifestyle, do not expose children to second-hand smoke.

Etiological factors and causes

All causative factors for the development of a hyperreactive bladder are divided into two types:

Neurogenic,
Not neurogenic.

The first group of pathologies includes all conditions that can lead to deterioration of the innervation of the bladder:

Parkinsonism,
Alzheimer's disease,
Hemorrhagic or ischemic stroke,
Multiple sclerosis,
Osteocondritis of the spine,
Intervertebral hernia,
Spondyloarthrosis,
Traumatic spinal cord injuries,
Complications arising after spinal surgery.

Symptoms of OAB

The clinical picture of hyperactivity is quite typical and consists of a number of symptoms:

frequent urge to urinate. Frequent urge means a condition in which the need to go to the toilet occurs at least 8 times during the day (both during the day and at night);
urgent desire to go to the toilet;
the emergence of a new urge to urinate a short time after the previous visit to the toilet;
the occurrence of urge at night (more than 2 times per night);
leakage of urine in drops even when the bladder is not full.

To diagnose the disease, the presence of several of the above symptoms is sufficient. Naturally, such a clinical picture significantly disrupts the quality of life of patients and creates a number of inconveniences.

The presented type of pathology is not an independent disease, but develops against the background of other pathological processes in the body. It is for this reason that independent treatment is excluded, because first you need to identify what caused this condition.

Neurogenic causes include the following:

Systemic pathologies that disrupt the functioning of the central nervous system. These include Parkinson's disease, Alzheimer's disease;
Also, damage to the spinal cord or brain (cancer, trauma, surgery) forms hypertonicity of the MP;
Problems with the spinal canal (hernias, surgical interventions);
Poor blood supply to the brain.

Non-neurogenic causes include the following conditions:

Atony of the bladder muscles (loss of elasticity of the bladder walls);
Prostatic hyperplasia leads to persistent urodynamic disturbances;
Congenital features of the form and function of the bladder (anomalies);
Hormonal imbalance (andropause in men);
Psycho-emotional imbalance (constant stress, aggressiveness, anger). Depression and apathy are not considered in this case;
Inflammatory processes in neighboring organs (prostatitis, urethritis, orchitis), etc.;
Urolithiasis disease.

Domestic reasons include:

Excessive fluid intake (more than 2 liters). This leads to loss of elasticity of the MP walls;
Passion for alcoholic beverages (especially beer);
Long-term constipation.

It is worth noting that OAB is a serious disease, and most importantly, it radically changes a person’s lifestyle.

Often this condition forces men to wear diapers. But, of course, you can do without them if you consult a urologist in time and diagnose the cause of this disease.

This pathology greatly affects a person’s psycho-emotional health. He is often shrouded in depression, apathy, and irritability. During this period, the joy of life is simply excluded, because a person only thinks about where there is a toilet nearby. OAB surgery is performed in very rare cases when conservative therapy does not bring the desired effect, and this does not happen often.

How can you protect yourself from such an unpleasant disease?

Never cause diseases of the genitourinary system, because chronic diseases are often the cause of bladder hyperactivity;
Visit a urologist 2 times a year;
Use Kegel exercises. They are easy to perform, do not take much time, but are mega-effective, as they train the most passive human organs;
Pay attention to the frequency of urination. It is worth saying that MP hyperactivity can progress, so it is better to “put out the fire” in the bud.

If you take good care of your health and don’t indulge in bad habits, then you can avoid such an unpleasant, tiring disease as OAB.

Drug therapy

This includes taking a number of medications that help alleviate all the unpleasant symptoms of the disease. Men are greatly helped by the so-called M-anticholinergic drugs, as well as Driptan. These drugs have been successfully taken by many patients for more than 30 years.

Symptoms of the severity of bladder overactivity with their use are significantly reduced, that is, there is an increase in the intervals between urinations, the urge to empty is significantly weakened, and patients soon after taking these drugs observe their ability to hold back their urine.

The main goal of drug treatment is to reduce the increased contractile activity of the bladder. In first place are antispasmodic drugs and antidepressants. The elements included in their composition have a strong relaxing effect on the bladder muscles.

Conservative treatment helps many men, but for some this method of therapy does not provide adequate relief. In such cases, doctors resort to an extreme method - surgical intervention, namely plastic surgery. Augmentation is performed, that is, expanding plastic surgery of the bladder. The operation is very complex, but the results of such treatment provide the patient with relief from his suffering.

Diagnostic measures

Diagnosis is carried out by primary care specialists - a urologist, a gynecologist, and, if necessary, an endocrinologist and a neurologist.

Examination of the entire body is a priority, since diagnostic measures at this stage imply the exclusion of other pathologies that have similar symptoms to the overactive organ.

The diagnosis of a hyperreflex bladder is made exclusively in the proven absence of infection of the excretory system or various neoplasms, genital prolapse, prostatitis, stones in a characteristic organ, or cystitis.

The following procedures help eliminate these diseases:

collecting anamnesis about the possible causes of the development of the anomaly, the time of occurrence of the first manifestations;
examination by a gynecologist or prostate examination;
urine culture for bacterial and fungal flora;
assessment of neurological condition;
general and biochemical urine and blood tests;
Ultrasound of the bladder;
assessment of the condition of muscle tissue;
measurement of the residual amount of urine in the organ;
performing cystoscopy.

If pathological processes of another etiology are suspected, the patient is consulted by highly specialized specialists: endocrinologist, oncologist and nephrologist. Subsequently, additional procedures and clinical studies may be prescribed.

Signs

How can a person determine the presence of this disease? What main symptoms should you focus on to prevent the disease from progressing and to prevent complications from occurring? This:

visiting the toilet more than 8 times a day;
feeling of a very strong urge to empty the bladder;
frequent awakening at night to go to the toilet;
automatic release of urine;
inability to control the urge to urinate;
if coughing, laughing, sneezing or sudden heavy lifting provoke urine leakage;
inability to empty the bladder even when it is full;
the influence of such external factors on the occurrence of the urge to urinate, such as the noise of pouring water, washing dishes, a sharp telephone call;
inability to stop urination.

The presence of at least one sign is a signal that a visit to a urologist is necessary. It is not recommended to postpone this trip, since timely diagnosis and treatment of the disease guarantees a successful outcome. You should not attempt treatment on your own, much less listen to the advice of loved ones and friends and use folk remedies that can only reduce symptoms for a short time, but not cure the disease.

Reasons that are not directly related to the innervation of the bladder:

Difficulty urinating, which is obstructive in nature due to prostatic hyperplasia or urethral stricture. In this case, there is a compensatory increase in the muscular lining of the bladder and an increased need for energy. This condition is accompanied by a deterioration in blood flow - hypoxia develops. Lack of oxygen and nutrients leads to nerve death. As a result, detrusor overactivity develops.
Old age is often accompanied by the development of bladder overactivity. The changes primarily affect the connective tissue - the growth of collagen fibers occurs, which are not supplied with blood. As a result, tissue hypoxia develops, the epithelium atrophies and the process of innervation of the bladder is disrupted.
Violation of the anatomical integrity of the bladder after injuries and surgical interventions.
Atrophy of the mucous membrane, causing sensory disturbances in the bladder. This condition occurs under the influence of toxic compounds that are excreted through the kidneys (long-term use of medications, contact with chemicals, paints).
Deficiency of female sex hormones, which is noted in the postmenopausal period.

In our clinic

Our clinic is one of the expert centers of the Russian Federation on issues of overactive bladder. The leading experts on this issue are employees under the leadership of Associate Professor G.R. Kasyan, who deal with the issues of functional urology and urodynamics. The clinic has created all the conditions for a comprehensive examination of this category of patients.

All types of diagnostics are carried out, including complex urodynamic studies using expert-level instruments, ambulatory urodynamic monitoring and video urodynamics. Individual selection of anticholinergic drugs, intravesical administration of botulinum toxin, percutaneous and needle tibial stimulation and many other types of treatment are carried out.

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Features of the disorder and the reasons for its occurrence

Among the causes of bladder overactivity, there are either neurological diseases, and then it is called neurogenic, or there is no clear cause, and then we are talking about idiopathic hyperactivity. The development of neurogenic bladder hyperactivity is caused by lesions of the central nervous system above the sacral micturition center (S2-S4).

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

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

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 impaired urine flow, for example, enlarged prostate gland, constipation, previous surgery;
excessive consumption of caffeine and alcohol;
the use of medications that cause a rapid increase in urine output or excessive fluid intake.

Symptoms of an overactive bladder cause obvious concern, although they are not always a reason to seek 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, resulting in incontinence;
Urge incontinence is 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.

diseases of the brain and spinal cord (multiple sclerosis, tumors, dementia, Parkinson's disease, consequences of stroke);
brain and spinal cord injuries;
congenital spinal cord defects;
alcoholic neuropathy;
diabetic neuropathy.

Non-neurogenic causes include:

age-related changes;
genitourinary diseases;
congenital bladder defects;
hormonal imbalance.

Of course, in order to receive recommendations for the treatment of this disease, it is necessary to consult a specialist. And don't be shy! Remember that this is a very common problem. Women need to be examined by a gynecologist, men – by a urologist for prostate diseases. In addition, you will have to visit a neurologist.

I will not tell you about drug and surgical methods of treating this disease, since treatment for each person is strictly individual. In this article we will focus on the methods you can use to help yourself at home.

Surprisingly, overactive bladder is a disease that is not only dealt with by a urologist. When this disease is detected, the patient begins to be observed by a urologist and a neurologist. By the way, this disease does not tend to manifest itself; sometimes the pathological state of other systems of the human body can lead to its occurrence.

What causes and factors can contribute to the development of the disease? As long-term medical practice shows, women are most often affected by the disease and in most cases the main cause is the distinctive anatomical structure of the body, but it affects men due to damage to the nervous system, pathologies of the prostate gland and developing infections in the genitourinary system.

Overactive bladder is a disease whose symptoms affect the quality of life of men; it can also occur as a result of surgery or persistent constipation.

Often, genetic predisposition is a factor in triggering the development of the disease.

It is worth considering in more detail the main causes of the development of the disease, and they are very diverse:

The presence of pathology in the pelvic structure. Often, activities such as surgery on the pelvic organs and playing sports lead to some disturbances in the pelvic organs or to the destruction of their sensitivity. This phenomenon can be caused by excess weight gain and the development of chronic inflammatory processes.
Nervous system disorder. Due to inflammation, spinal cord injury or multiple sclerosis, the peripheral nervous system experiences real changes, resulting in disruption of the genitourinary system.
Changes in the structure of the bladder. The bladder in men can change its structure due to prostate disease. Due to inflammation, the prostate gland enlarges, which entails compression of the urethra. The result is a disruption of the normal process of urine outflow. The bladder experiences a very heavy load, and nervous regulation fails. The consequences of such disorders lead to increased contractile movements of the bladder, and the urge occurs even when there is a very small amount of urine in the bladder.
Hormonal imbalances. This leads to tissue aging, changes in their structure, thinning of the muscles, ligaments and membranes of the genitourinary organs, resulting in urinary incontinence.

Children often face a similar problem. Common causes of overactive bladder in children are:

postpartum consequences, that is, injury;
some disorders of the spinal cord;
strong excitement, resulting stress.

The disease can develop in children for the following reasons:

infectious diseases of the urinary tract;
chronic constipation;
presence of diabetes mellitus.

Quite often, parents do not really monitor what foods their child eats, but most of them can easily cause problems with the bladder. These are foods and drinks that contain a large amount of caffeine, namely:

strong tea;
chocolate cupcakes, sweets;
carbonated drinks.

In any case, the help of a doctor if even minor symptoms are detected, since hyperactivity of the bladder may indicate more serious disorders in the child’s body.

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 worsening of the symptoms of the syndrome.

Among the pathological causes, we highlight:

Bladder abnormalities: These include both tumors or stones in the bladder, which can cause problems with normal urinary function, and benign prostatic hyperplasia, which puts pressure on the urethra, causing problems with urination.
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 old age).
Increased urine production: Metabolic disorders such as diabetes or kidney failure can cause increased urine production.
Obesity: Excessive weight gain leads to increased pressure on the lower abdomen and therefore compression of the bladder. 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 personal characteristics:

Pregnancy and childbirth: is one of the main causes of overactive bladder in women. Because pregnancy and childbirth lead to weakening of the pelvic floor muscles and a decrease in contractile strength.
Age: Overactive bladder is most common in older people. This happens because with age, all mechanisms that control (neurological) urination weaken.
Stress and anxiety: Sometimes an overactive bladder can be due to stress or excessive anxiety, which causes an increase in the frequency of the urge.
Surgery: Surgeries that may affect the spinal nerve (for example, in the case of repair of a herniated disc) or that involve the gastro-urogenital area can lead to disturbances in the transmission of nervous control of urination.
Menopause: The lack of estrogen in menopausal women is usually associated with frequent urination and urinary incontinence.
Medications: Those taking medications 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 appears that those who smoke cigarettes and consume alcohol and caffeine in large quantities are more likely to suffer from this disorder.

The disorder can occur in any age group. This clinical syndrome is associated with unpleasant symptoms that often indicate the presence of a urinary tract infection.

There are two main types of syndrome:

idiopathic;
neurogenic.

The first type is a violation without an identified cause. The second type is caused by one of the diseases of the nervous system, including multiple sclerosis and parkinsonism.

There is also a type of disease in which the indicated symptoms are observed, but hyperactivity of the bladder muscles itself is not noted.

Non-drug treatment

Bladder training. The point of this method is that the man agrees with the attending physician on a urination plan, that is, the patient learns to empty his bladder at certain intervals. This method itself is not easy, and it involves 3 stages. It is a process of learning, creating a plan and then executing it.
Gymnastics of the pelvic muscles. Exercises are intended not only to treat the disease, but also to prevent it. These exercises have become very popular, and this very successful technique has been used for a long time. This method was first discovered by Kegel, and it got its name thanks to its discoverer. The main principle is to perform exercises in the early stages of the disease. If regularity is observed, the first successful result is felt by the patient within a couple of weeks.
Physiotherapy is also considered a fairly successful form of treatment and includes electromagnetic therapy aimed at reducing bladder activity.

Causes of disease in children

Children often face a similar problem. Common causes of overactive bladder in children are:

postpartum consequences, that is, injury;
some disorders of the spinal cord;
strong excitement, resulting stress.

The disease can develop in children for the following reasons:

infectious diseases of the urinary tract;
chronic constipation;
presence of diabetes mellitus.

strong tea;
chocolate cupcakes, sweets;
carbonated drinks.

In any case, the help of a doctor if even minor symptoms are detected, since hyperactivity of the bladder may indicate more serious disorders in the child’s body.

Complications and consequences

Bladder hyperactivity is the subject of attention of modern urology, which is characterized by impaired functionality of this organ, which manifests itself in a frequent urge to urinate. For some, the disease does not manifest itself in pronounced symptoms, but for others, in its development it often reaches such an extent that the patient is sometimes simply unable to get to the toilet in a timely manner.

This disease affects not only the physical health of men, but also their psycho-emotional state. Many who have to suffer from them simply refuse to show themselves in public. They completely lose the desire and desire to contact close relatives and friends.

Spending time with their loved ones becomes a complete torment for them. This condition often leads to depression and a complete lack of desire to communicate with other people. Almost every aspect of the life of a person suffering from overactive bladder is disrupted.

Because of the emerging feeling of shame about the state of their health, men are in no hurry to consult a doctor for help, unlike women, and somehow adapt to such a “suffering” lifestyle. This is one of the main reasons why the disease often starts and progresses in many people.

If an active bladder is not treated promptly, unpleasant consequences and complications may occur. Among them, we note increased agitation, sleep disturbances, the appearance of depression, difficulty adapting to the work team, and the appearance of complications during pregnancy.

It is important to know that the disease develops much faster in children. If a woman is diagnosed with hyperactive urinary tract during pregnancy, then there is a possibility that a similar pathology will appear in the baby. Therefore, OAB must be treated.