An overactive bladder is a syndrome of problems associated with the urinary system. The characteristic symptoms include: frequent urination, urgency and nocturia. Bladder overactivity is caused by neurological disorders of the nerves responsible for the proper functioning of the urinary system. How is overactive bladder syndrome treated?

Overactive bladder syndrome is manifested by frequent, often uncontrolled urination with a feeling of a strong pressure on the bladder. This disorder is commonly referred to as overactive bladder or overactive bladder. The cause of the symptoms of an overactive bladder is a disturbance in the functioning of the nerves responsible for the proper functioning of the urinary system. It occurs in both women and men. The symptoms of an overactive bladder are very frustrating and often seriously hinder everyday functioning.

Overactive bladder – what is it?

Overactive bladder syndrome( OSA)is characterized by urinary symptoms such as pollakiuria, urgency, nocturia (nocturia) and urinary incontinence. The symptoms of an overactive bladder cannot be explained by the existence of diseases such as urinary tract infections, neoplastic diseases of the urinary tract or urolithiasis.

The causes of an overactive bladder

The symptoms of an overactive bladder are caused by neurological disorders of the nerves responsible for the proper functioning of the urinary system.These disorders can be caused by damage to the spinal cord, dysfunction of the nerve-to-muscle junction, and sensory disturbances.The characteristic symptoms of an overactive bladder may also occur in the course of chronic diseasessuch as uncontrolled diabetes, overactive bowel syndrome, multiple sclerosis, Parkinson’s disease or Alzheimer’s disease. The frequency of symptoms related to overactive bladder increases with age. Factors contributing to the onset of symptoms include the menopause in women, an enlarged prostate in men, constipation, certain medications, stress, and lack of exercise.

The main symptoms of an overactive bladder are urgency and overactive bladder muscles (the so-called detrusor). Urgency is a sudden feeling of urgency to urinate even with little bladder filling. In contrast,detrusor overactivity is where the bladder muscles contract when the urine volume is low and that pressure is generated in the bladder. In people with overactive bladder, detrusor contraction becomes independent of the degree of bladder filling and is independent of our will (the patient has no full control over urination). In healthy people, urination (micturition) is consciously controlled. Typically, the maximum volume of the bladder is around 500–600 ml, and the need to urinate appears after filling more than half of this volume. The bladder, which is made up of smooth muscles, normally stretches and allows urine to accumulate without a sudden increase in pressure inside the bladder. Micturition, i.e. urination, remains under conscious control and consists in reducing the tension of the urethral sphincters and the contraction of the detrusor muscle.

The symptoms of an overactive bladder are common in male prostatic hyperplasia. The prostate (prostate gland) is located below the bladder in the area of ​​the urethra. Its main function is to produce a fluid that nourishes the sperm cells. A correctly sized prostate does not cause any problems with urination. The most common diseases of the prostate include its hypertrophy, inflammation or neoplastic disease.Typical symptoms of prostate dysfunction are frequent, small amounts of urine, pain and burning during voiding, a feeling of pressure on the bladder even with a small amount of urine, weak urine stream and prolonged voiding time, blood in the urine, pain in the lower abdomen, scrotal area or penis.

Overactive bladder – symptoms

The characteristic symptoms of an overactive bladder are:

• pollakiuria– that is, urinating small amounts of urine repeatedly (more than 8 times a day). Additionally, there is a painful urge to urinate, due to contraction of the detrusor muscle, even though the bladder is small.
• Urgent pressures– they are a sudden, painful and unrestrained need for micturition. They are caused by muscle contractions in the bladder.
• urge incontinence– involuntary leakage of urine due to a feeling of urgency.
• the presence of residual urine in the bladder after the end of voiding– despite the end of urination, a small amount of urine remains in the bladder.
• nocturia– that is, urinating at night (remember that the need for voiding at night after consuming large amounts of fluids in the evening is the norm).

The symptoms of an overactive bladder can occur together or individually. The symptoms of overactive bladder syndrome may also appear in the course of other diseases, such asdiabetes, diseases and infections of the urinary system, therefore, during the diagnosis, the presence of other diseases should be excluded by performing a general urine test, ultrasound of the abdominal cavity with the assessment of the kidneys and bladder, cystoscopy (bladder endoscopy) and urodynamic examination (it consists in measuring the pressure in the bladder function of the muscles responsible for urination and measurement of urine flow through the urethra).

Overactive bladder syndrome – treatment

Treatment of an overactive bladder involves various methods. The most important methods of treating overactive bladder syndrome include: lifestyle modification, behavioral methods, pharmacotherapy, electrostimulation and, ultimately, surgical treatment.

Lifestyle modification

Lifestyle modification includes a number of recommendations. Among them there are also home remedies. The most important guidelines include:

• limiting the consumption of drinks containing caffeine, alcohol, carbonated drinks and reducing the amount of fluids taken before bedtime,
• taking care of personal hygiene,
• avoiding infections,
• quitting tobacco smoking,
• weight reduction and obesity prevention (abdominal obesity causes pressure on the bladder and may cause urgency and urinary incontinence),
• avoiding constipation (a diet rich in plant fiber, drinking the right amount of fluids, proper physical activity), constipation make you struggle to pass stools, which can lead to urinary incontinence.

Behavioral methods and bladder training

Behavioral methods are recommended in the case of moderately severe symptoms associated with an overactive bladder. They rely on learning the correct voiding reflexes and strive to restore the appropriate urination rhythm (constant voiding pores at similar intervals). Behavioral methods are aimed at increasing the capacity of the bladder by means of exercises that consist in gradually extending the intervals between successive micturitions. It is worth mentioning:

• pelvic floor muscle exercises – the Kegel muscles are responsible for supporting the abdominal organs, including the bladder. In order to check where the Kegel muscles are located, it is recommended to tighten the pelvic muscles during urination to stop urinating (the tense muscles of the urethra, anus, vagina and the muscles surrounding them are Kegel muscles). It is important not to exercise the Kegel muscles during voiding, as they can lead to inflammation of the urinary tract. Kegel exercisescan be performed in any position. They consist in alternating tightening of the muscles and relaxing them (each stage should initially last about 2 seconds, then after 5 seconds). Remember not to tighten the muscles of your thighs and buttocks while exercising. It is recommended that you tighten your muscles when you breathe out and relax them while you breathe in. Pelvic floor muscle exercises should be performed several times a day. Pelvic floor muscle exercises can also be performed prophylactically in people without the symptoms typical of an overactive bladder, in order to prevent later possible problems of urinary incontinence. Regular Kegel exercise helps to reduce the symptoms of stress urinary incontinence (when laughing, coughing, sneezing or sports).
• learning to react when urgent to urinate by distracting attention, relaxing muscles reflexively, or causing other muscle groups to contract.
• methodbiofeedback, i.e. biological feedback, through which patients can perceive unconscious changes occurring during physiological processes and then influence them.

Medications for an overactive bladder

In symptoms accompanying an overactive bladder,preparations are used that reduce excessive bladder contractions. Medicines with anticholinergic and relaxing properties of the smooth muscles that form the bladder are usually recommended. However, be aware that many of these medications have side effects such as dry mouth, constipation, blurred vision, or sleepiness. They can also make the symptoms of dementia worse, especially in elderly people with dementia.

If no improvement is observed after the use of the above-mentioned groups of drugs, neurotoxins can be used, such as botulinum toxin, which inactivates the nerve fibers responsible for excessive bladder contractions, causing the detrusor to relax. Botulinum toxin is the most potent neurotoxin found in nature.

Bladder electromodulation at OAB

Electrostimulation works by stimulating the nerves with electrodes that stimulate the nerve fibers responsible for the functioning of the pelvic and bladder muscles.

This method uses electrodes that are placed on the skin of the vulva, vagina or anus. Their task is to generate rhythmic impulses that stimulate the muscles of the pelvic floor to contract, thanks to which they gradually increase their strength and tension. In addition,electrostimulation supports the regeneration of damaged nerve fibers. It also helps locate the muscles that the patient can later exercise on their own.

Surgical treatment in overactive bladder syndrome

Surgical treatment is used in overactive bladder syndrome that is resistant to other forms of therapy. The most commonprocedures are denervation of the bladderby cutting the nerves supplying it or enlarging it by implanting a fragment of the intestine, thanks to which the strength of the detrusor muscle contractions is also weakened by its partial dissection. It should be remembered thatthese are invasive procedures, therefore they are the final form of therapy.