Active bladder syndrome treatment. Causes of overactive bladder in women and methods of treatment for adults and children. Symptoms may be confused with other diseases

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

This is a bladder dysfunction that causes an urgent urge to urinate. The urge may be difficult to suppress, and an overactive bladder can lead to unintentional loss of urine (incontinence).

If you have overactive bladder You may feel uncomfortable, withdrawn from society, and limit your work and social life. The good news is that after a short assessment and diagnostic procedures, you can receive appropriate treatment that can significantly relieve overactive bladder symptoms 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 on time, when you feel the urge to urinate, you feel frequent urge to urinate, night urination, which can disrupt social adaptation.

When should you see a doctor?

Fewer than half of women and less than a quarter of men who ever experienced incontinence saw a doctor, according to a study in the journal Urology. Although it can be difficult to discuss the issue with your doctor, especially if overactive bladder symptoms are interfering with your work, social activities, and daily activities.

You should not avoid diagnosis and treatment, limiting yourself only to wearing panty liners and using hygiene products. There are treatments that can help you. Also, a visit to the doctor is necessary, since incontinence and hyperactivity can be the result of an underlying disease, such as malignant tumor.

Causes of overactive bladder

Filling and emptying your bladder is a complex interaction of kidney function, nervous system, and muscle function. Dysfunction of one of these links can contribute to bladder overactivity and urinary incontinence.

Bladder function is normal.

The kidneys secrete urine, which is then discharged through the ureters into the bladder. Urine from the neck of the bladder enters 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 head of the penis.

Bladder expands like a balloon to correlate with the amount of urine. When it is filled to about half of its capacity, nerve signals begin to arrive indicating that it is ready to urinate, and you begin to feel the sensation of your bladder being full. When it is three-quarters full, you feel the need to urinate. During urination, the action of the pelvic muscles is coordinated with the muscles of the bladder neck and the proximal urethra using nerve impulses. The bladder muscles contract and urine is released.

Involuntary contractions of the bladder

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

The bladder sphincter may remain contracted and prevent urine from flowing from 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 causes of overactive bladder. Neurological pathologies such as Parkinson's disease, strokes, and 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 renal 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 - enlarged prostate gland, constipation, previous surgery, which can cause other forms of incontinence.
• - excessive consumption of caffeine and alcohol.
• - medications that cause a rapid increase in urine output or cause excessive fluid intake.

Risk factors

As you age, your likelihood of developing overactive bladder increases and you become more susceptible to diseases and disorders that may contribute to the development of overactive bladder. These diseases include prostate enlargement and diabetes. Although overactive bladder and incontinence are common in older adults, they should not be considered an integral part of aging.

Complications of an overactive bladder

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

• depression
• emotional experiences

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

Preparation for the procedure

You will probably initially be seen by your family doctor or general practitioner.

However, they may refer you to a urologist or urogynecologist for diagnosis or treatment. When you first visit your doctor, ask if it is necessary to keep a urine 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, or urinary incontinence. Your diary can provide information that will help your doctor understand your symptoms and triggers.

Since the visit to the doctor may not be long, it will be helpful if you prepare for it:

• Write down any symptoms you experience, including any that may seem unrelated to the underlying cause.
• Make a list of all the medications you take, including vitamins and supplements.
• write down questions you want to ask the doctor.

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

List questions from most important to least important, in case your time runs out.

If you have an overactive bladder, there are several basic questions you should ask your doctor:

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

In addition to asking questions, you can ask your doctor at any time if anything is unclear.

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 experience unexpected urine leakage?
• Do you experience unexpected urine leakage when coughing, sneezing, or laughing?
• Do you leak urine on your 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 worsen your symptoms?

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

Examination and diagnosis

The main diagnostic points that your doctor will use will be to look for contributing factors. The study will likely include:

• medical history
• a physical examination that will mainly focus on your abdomen and genitalia
• A urine test 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 test to evaluate your bladder function and ability to fill and empty. This test usually requires additional consultation with a urologist or urogynecologist (a specialist in urological problems in women).

Research includes:

Measuring residual urine volume.
When you urinate or leak urine, it is likely that your bladder is not emptying completely. Residual urine volume can cause symptoms identical to those of 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 using catheterization. An alternative method is ultrasound examination of the contents of the bladder.

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

Cystometry and pressure-flow studies. Cystometry measures the pressure in the bladder when it is full. A pressure-flow test measures the pressure and flow rate of urine. A catheter is used to slowly fill the bladder with water. Another catheter with a sensor that measures pressure 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, and 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 pelvic floor.

Videourodynamics. This test uses X-rays or ultrasound waves to see the bladder as it fills and empties. The bladder is filled using a catheter. To empty your bladder, you need to urinate. 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. Using this equipment, the doctor can check for diseases associated with lower urinary tract symptoms, for example, tumors, bladder stones.

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

Treatment and medications.

Behavioral therapy

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

Change in fluid intake. Your doctor can advise you on when to drink fluids and how much to drink. Drinks with alcohol and caffeine can worsen your symptoms, so it is advisable to avoid these drinks.

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

Bladder training. Sometimes your doctor may recommend bladder training, training you to hold your bladder emptying when you want to urinate. Start with small episodes of delay 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 when there is a significant increase in the volume of residual urine, and double urination is possible. After urinating, you should wait a few minutes and then try to empty your bladder completely again.

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

Exercises for the pelvic floor muscles. These exercises are called Kegel exercises and 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 involuntary bladder contractions. Your doctor and physical therapist can help you learn how to do these exercises correctly. It may take a while 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 and achieve complete bladder emptying. This is a very safe and convenient procedure. This procedure does not make the bladder less fit, contrary to what was previously believed. Your doctor will tell you if you need this procedure.

Use of daily absorbent pads. You can use absorbent pads and hygiene products 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. Higher body weight is associated with more severe symptoms of urge incontinence. They also have an increased risk of stress incontinence.

Medications

Medications that help relax the bladder may be effective in treating bladder symptoms and reducing the number of 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 medications is combined with the behavioral treatments listed above.

Side effects of these drugs include dryness of the mucous membranes of the eyes and mouth. Drinking excess fluids can worsen the symptoms of an overactive bladder. These side effects can be reduced.

If you have dry mouth, your doctor may recommend using sugar-free hard candies or sugar-free chewing gum.
For dry eye mucosa, you can use special eye drops. You can also use some over-the-counter medications to help relieve side effects.

Botulinum toxin

This drug, brand name Botox, is a protein from a bacterium that causes a disease called Botulism. However, in small doses when directly introduced into tissues, this protein paralyzes muscles and can cause severe urge incontinence. While this method is not 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 overactive bladder is used for severe pathology when other treatment methods are ineffective. The goal of treatment is to improve the bladder's reservoir capacity and reduce bladder pressure.

Surgeries include:

• sacral nerve stimulation. The sacral nerves are the primary link between the spinal cord and the nerve fibers in the bladder tissue. Changing these nerve signals may improve overactive bladder symptoms. During this procedure, a thin wire is placed near the sacral nerves, which are located near the tailbone. Using a special device, impulses will be directed to your bladder, similar to the work of a pacemaker in the heart. If successful in reducing your symptoms, you may be fitted with a battery-powered device under the skin that sends impulses to your bladder.
• Augmentation cystoplasty. This is a basic surgical treatment designed to increase bladder capacity by using a piece of your intestine to replace a section of the bladder. If you have this surgery, 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 like the National Association for Continence can provide you with resources and information about joining a support group for people with overactive bladder and urinary incontinence. Support groups involve meetings to discuss problems, with the goal of learning to control your condition and provide proper care.

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

Preventing overactive bladder

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

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

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

Overactive bladder (OAB) is a disease associated with dysfunction of the bladder. In this case, a person experiences a frequent, strong urge to urinate that is difficult to control. In some cases, such patients experience urinary incontinence.

This disease occurs due to a violation of the innervation of the detrusor - the muscular layer of the bladder. Such a disorder is associated with neurological diseases or is idiopathic in nature - that is, it is not always possible to accurately determine the causes of the pathology. In any case, OAB can cause a lot of inconvenience to a person.

It is better to use non-drug methods to treat the disease.

1. Bladder training and exercises to strengthen the pelvic floor muscles are effective.
2. Improve the patient’s condition and take traditional medicines for the treatment of bladder diseases. This therapy will help restore normal functioning of the organ.

At the same time, folk remedies do not have a negative toxic effect on the human body.

Causes of overactive bladder

The pathology is quite common. The disease occurs in men and women of different age groups. Overactive bladder in women often develops at a young age, and in men - in old age.

The disease also often occurs in childhood, as the child has less control over his bladder. It is worth noting that an overactive bladder in women often causes urinary incontinence, while in men this symptom develops less frequently.

Currently, it is not always possible to accurately determine the causes of bladder overactivity. It has been established that a strong, sudden urge to urinate is associated with increased activity of the detrusor, the muscular lining of the organ. Patients with an overactive bladder experience sudden muscle contractions of the bladder that the person is unable to control.

Depending on what factors cause this syndrome, there are:

• neurological form of the disease - detrusor contractions are caused by neurological disorders;
• idiopathic form of the disease - the causes of bladder overactivity have not been precisely established.

The following factors are identified that can lead to the development of OAB:

1. Impaired functioning of the central and peripheral nervous system: trauma, vascular diseases, degenerative and demyelinating processes.
2. Thickening of the bladder walls against the background or stricture of the urethra. In this case, the detrusor tissues receive insufficient oxygen. Oxygen starvation leads to the death of neurons innervating the bladder and the development of spontaneous contractions.
3. Anatomical disorders of the urinary tract. The abnormal structure of organs can lead to disruption of innervation and the development of OAB.
4. Overactive bladder can occur as a result of age-related changes. Gradually, connective tissue grows and the blood supply to the detrusor deteriorates.
5. Sensory impairments. This disorder develops in response to a complex of factors. In particular, thinning of the mucous membrane of the bladder leads to impaired sensitivity of nerve fibers. As a result, acids dissolved in urine act on unprotected nerve endings, causing involuntary spasm. Thinning of the mucous membrane often develops against the background of a decrease in the amount of estrogens in women after menopause.

Symptoms of the disease

An overactive bladder is manifested by the following symptoms:

• strong and sudden urge to urinate;
• , inability to control these urges;
• the bladder does not have time to fill completely, so the volume of urine is insignificant;
• more frequent emptying of the bladder (more than 8 times a day);
• night urge to urinate.

Such a disease is not dangerous, but can cause a lot of discomfort to a person and become an obstacle to the normal socialization of a child or the social life of an adult.

Diagnosis of the disease

Urinary disorder can be caused by a complex of different reasons:

• infectious processes in the organs of the genitourinary system;
• or ;
• bladder tumor and others.

Before making a diagnosis of “overactive bladder,” it is necessary to exclude all other possible pathologies of the urinary system. Therefore, a comprehensive examination of the body is carried out.

To make a diagnosis, the following tests are performed:

• ultrasound examination of the abdominal organs;
• laboratory tests of blood and urine;
• bacterial culture of urine;
• cytoscopy;
• urodynamic study.

The patient also needs to keep a urination diary for three days, where the exact volume of liquid drunk, the time of emptying the bladder and the amount of urine must be recorded.

Overactive bladder - treatment!

For effective therapy, it is necessary to determine exactly why the patient has developed an overactive bladder.

1. Treatment of the neurogenic form of the disease is aimed primarily at restoring the innervation of the organ and other functions of the nervous system.
2. In the case of age-related changes or the idiopathic form of the disease, therapy is aimed at improving blood circulation in the bladder and strengthening the detrusor.

Non-drug treatment of OAB is used. This therapy includes the following areas:

• bladder training;
• behavioral therapy;
• exercises to strengthen the pelvic muscles;
• correction of nutrition and drinking regime.

Diet for overactive bladder.

Behavioral therapy and bladder training

1. The patient needs to make a schedule for visiting the toilet and strictly adhere to it. Even if by a certain time a person does not feel the urge to urinate, he still needs to visit the toilet. The intervals between visits to the toilet should be small at first, but gradually they need to be increased. This schedule will help you control your bladder better.
2. The disease also needs to be taken into account when planning your daily route. It is important that the patient has constant access to the toilet, since it is very difficult for such people to predict and control the urge to urinate.
3. Urinary incontinence can be a big problem for patients with this disease. To improve the situation, you can use special adult diapers. This measure will hide the deficiency and reduce the inconvenience of this problem.

Physical exercise

For patients with overactive bladder, it is important to strengthen the pelvic floor muscles. A set of Kegel exercises is suitable for this.. A set of Kegel exercises improves blood circulation in the pelvic organs and has a complex positive effect on the organs of the genitourinary system.

• Each exercise is performed in 10 repetitions 5 times a day.
• Every week the number of repetitions of the exercises should be increased by 5 until there are 30.

1. Exercise 1. Compression. You need to tense the muscles that are responsible for stopping urination, hold in this position for a few seconds, then relax.
2. Exercise 2. Elevator. The patient needs to strain the pelvic floor muscles, gradually rising from bottom to top, like on an elevator: first the lowest level, then higher, higher and higher. At each level you need to linger for a few seconds. You also need to relax your muscles in levels.
3. Exercise 3. Contraction and relaxation. The patient needs to tense and relax the pelvic floor muscles with maximum frequency.
4. Exercise 4. Pushing. You need to tense up, as if going to the toilet, stay in this position for a few seconds and relax.

All exercises are performed while sitting. During muscle contractions, you need to control your breathing: breathe steadily, do not hold your inhalations and exhalations.

Traditional methods of treating overactive bladder

Also, for overactive bladder, treatment with folk remedies is used. These drugs improve the functioning of the organ and help restore its functions. Traditional treatment is absolutely safe. It improves metabolism and promotes the regeneration of damaged tissues.

Traditional recipes:

1. St. John's wort. It is useful to drink an infusion of St. John's wort instead of tea. To prepare an infusion in a teapot or thermos, you need to infuse 40 g of dried herb in a liter of boiling water. The drug is infused for several hours, then filtered.
2. St. John's wort can be combined with centaury. In a liter of boiling water you need to steam 20 g of each plant, leave for several hours and strain. They drink this infusion instead of tea, 1–2 glasses a day. You can add honey to taste.
3. Plantain. For treatment, plantain leaves are used: 1 tablespoon per glass of boiling water. The drugs are infused for an hour, then filtered. This infusion should be taken in small portions: 1 tbsp. l. 3-4 times a day before meals.
4. Cowberry. A decoction of lingonberry leaves is useful for treating bladder diseases. For a liter of boiling water you need to take 2 tablespoons of leaves, leave in a warm place for 1 hour, then strain. This remedy is also drunk instead of tea. You can add honey to taste.
5. Dill. Dill seeds have a healing effect. Prepare a decoction: take 1 tbsp per 200 ml of water. l. seeds, boil over low heat for 3 minutes, then cool and filter. This decoction is drunk once a day, 200 ml.
6. Elecampane. The rhizome of this plant is used in therapy. It is cut into pieces and poured with boiling water, cooked over low heat for a quarter of an hour, then left for another 2 hours and filtered. Standard dosage of this product: 3 tbsp. l. 2–3 times a day.
7. Onion, apple and honey. The onion needs to be peeled and chopped, mixed with 1 tsp. natural honey and half a grated apple. This paste is eaten in one sitting half an hour before lunch.

The maximum effect will be if you combine several medications. However, it is worth remembering to limit the amount of fluid consumed. It is also recommended to drink medicinal products in courses of 2-3 weeks. At the end of the course, you need to take a week's break or change the drug. Long-term continuous use contributes to the development of addiction to the medicinal components of plants, and the healing effect disappears.

Prognosis and prevention

The prognosis is generally favorable. The disease is not dangerous to human life and health. When performing exercises and recommendations, it is possible to restore bladder control and improve the patient’s quality of life.

The danger is posed by GAMT, which is a syndrome of severe neurological disorders. In this case, the prognosis depends on the severity of the underlying disease and the effectiveness of treatment.

To prevent this disease, it is important to lead an active lifestyle and exercise. Regular sports training improves blood circulation and helps nourish the tissues of internal organs.

1. It is also important to strengthen your pelvic and back muscles.
2. To prevent the disease from developing, it is important to promptly identify and treat diseases that can lead to hyperactivity. Such pathologies include primarily neurological diseases and vascular pathologies.
3. It is important to control your weight because people who are overweight and obese are more likely to have overactive bladder.

The topic - overactive bladder in women - treatment is in great demand for those who suffer from this problem.

It is clear that the impact on women’s quality of life is very great: families are destroyed, social ties are destroyed, work and its performance suffer.

Overactive bladder in women: treatment, causes, symptoms, diagnosis:

This disease is abbreviated as (OAB) - overactive bladder or dysuria. A urinary tract infection is not always detected with this disease.

This is not a disease - a syndrome with or without it, accompanied by urgency, nacturia, plus frequent urination.

This can be observed in the presence of stones or tumors in the bladder. From 16 to 17% of men and women living on earth suffer.

It becomes a problem to simply go outside, and not just go to the cinema or theater. The woman continues to suffer, but is in no hurry to see a doctor because of her shyness.

Many people believe that this is how it should be - old age. They begin to urinate involuntarily with large amounts of urine. This cannot be interrupted.

They cannot believe that medicine has excellent methods for treating this problem. We went to see a doctor and received ineffective therapy, giving up on ourselves.

Always consult a urologist and always a gynecologist.

Symptoms:

• A sick woman is constantly tormented by a simply irresistible desire to urinate, which appears completely suddenly and is difficult to control.
• Often has the urge to urinate in the toilet during the day (more than eight times/day). The norm is 5-7 times.
• Inability to reach the toilet.
• Instant reaction to the sound of flowing water.
• At night, a woman goes to the toilet more than once. The norm is to sleep without going to the toilet.
• It’s irritating to constantly wear pads, diapers, and special underwear for nighttime sleep so as not to get wet.
• Forced wearing of dark-colored clothing to disguise urine stains.
• Permanent limitation of physical activity or even light exercise.

• , isolation, apathy.
• Loss of self-esteem and complexes.
• Constant fear of urinating in a crowded place.
• Urinary incontinence occurs due to an urgent urge to urinate (i.e., you want to go to the toilet, but you can’t hold it back).
• The older the woman, the more often this syndrome is detected in her.
• A woman urinates 100 ml or less in 79.5% of cases.

When tested, very often women's urine is absolutely normal. Very often they treat chronic diseases with antibiotics and antiseptics, which will not help in any way.

The difference between cystitis and OAB (with this syndrome there is never pain).

OAB syndrome urinary disturbance:

• Pollakiuria – visiting the toilet more than 8 times.
• Nacturia is a trip to urinate in the toilet more than twice at night.
• Urgency is a sudden urge to urinate, and an irresistible and immediate urge. Another expression is urinary urgency.
• Urgent urinary incontinence.

They occur in different combinations at the same time and can be expressed in different ways.

Causes:

• Age is the main reason.
• Hormonal background – menopause, endometriosis, after childbirth. Chronic inflammation of the appendages.
• Intestinal tumor.
• or Parkinson's disease.
• Already common Alzheimer's disease, any damage to the spinal cord after a stroke.
• After operations on the female genital organs (hysterectomy - removal of the uterus).
• Bladder stones, inguinal hernia.
• Ectopia of the external opening of the urethra at the entrance to the vagina.
• Anatomical: severe genital prolapse due to disrupted connections with the bladder.
• Heredity – the transmission of the disease through genetics also plays a role.
• Inflammation: with recurrent cystitis, there is a high risk of provoking the development of OAB symptoms. Bladder ulcer or inflammation. Tuberculosis of the bladder, possibly even cancer.
• Neurogenic: Damage to the nervous system can lead to symptoms of OAB. Usually these moments are necessarily present in a given disease, more or less.
• Usually: during the first ten years of menopause, women experience stress urinary incontinence.
• Then, the greater the estrogen deficiency, the more often OAB syndrome develops.

Diagnostics:

• Questioning and examination by a doctor.
• Keeping a diary of going to the toilet.
• and blood (exclusion or confirmation of infection of the genitourinary tract itself).
• Ultrasound of the genitourinary organs (mandatory determination of residual urine). The examination is carried out to exclude serious diseases of the genitourinary system.
• Uroflowmetry (act of urination).

Treatment:

• The syndrome is treated with medication - the main thing.
• Be sure to train the well-known pelvic floor muscles - a common exercise (Kegel).
• Exercises for weak pelvic muscles.
• Physiotherapy: electrical stimulation.
• Surgery is rare for severely ill patients.
• Botulinum toxin in case of intolerance to conservative treatment of the patient.

Pills:

M-anticholinergic drugs are the main treatment for the disease.

• Driptan (oxybutynin) – Available in 5 mg tablets. Treatment: 5 mg x 3 times/day. The dose is selected by the doctor. It is poorly tolerated by patients due to many side effects and is not intended for long-term treatment.
• Spazmex (trospium) – tablets are produced in 5 or 15 mg doses. Treated with a dose of 10-20 mg 2-3 times a day. Doses
• the doctor selects. For elderly women, a dose of 5 mg with the same dosage schedule.
• Detrusitol (tolterodine) – Capsules 4 mg, tablets 2 mg. Treat with a dose of 2 mg/2 times a day. 4 mg capsules once.
• Especially for overactive bladder syndrome.
• Vesicare (solifenacin) - tablets in a dose of 5 mg. Treatment begins with 5 mg/day once. The medicine was created specifically for such a disease. Take for at least three months.

Other drugs:

• Tricyclic antidepressants.
• Gamma-aminobutyric acid antagonists.
• Calcium channel blockers.
• Beta blockers.
• Beta adrenergic agonists.
• Alpha-andrenergic blockers.
• Alpha andrenomimetics.
• Prostaglandin synthesis inhibitors.
• Vanilloid receptor inhibitors.
• Opioid receptor blockers.
• Purinergic receptor blockers.
• Vasopressin analogues.
• Antispasmodics.
• Estrogens for the age group of women. They prescribe creams and suppositories with estrogen and are very helpful for urinary problems.
• Tachykinins.
• Botulinum toxin.

They start with M-anticholinergic drugs, which are the most effective treatment to date. Then, according to indications, additional treatment is added.

• The positive effect is shown by strengthening the pelvic muscles and special Kegel exercises.
• Eat bran, fiber, which helps the bladder function.
• Eating cranberries will help protect the bladder lining and prevent stones from forming.
• Sea buckthorn in the diet will help improve the contractile functioning of the bladder.

Exclude:

• Spicy in food.
• Coffee or products containing caffeine due to their irritating effect.
• All carbonated drinks.
• Salty foods.

This syndrome cannot be treated with traditional methods and remedies.

All that remains is to put aside all the embarrassment and embarrassment and go to the doctors so that the question of what is an overactive bladder in women and treatment no longer bothers you.

Good luck!

Description:

People with an overactive bladder experience frequent, strong and sudden urges to urinate, both during the day and at night. Such urges can be felt even with a small amount of fluid accumulated in the bladder. Quite often, people with an overactive bladder do not have time to reach the toilet before urinating, resulting in uncontrolled leakage of urine, called incontinence.

Overactive bladder is a fairly common condition in older people. Both men and women can suffer from this problem, but women are especially susceptible to it.

Overactive bladder is a type of emergency. But not every person with an overactive bladder suffers from uncontrolled urination.

Even in the absence of incontinence, an overactive bladder, which causes the need for frequent and urgent visits to the toilet, can interfere with the usual rhythm of life, and uncontrolled urination, even small in terms of the volume of fluid released, further aggravates the situation.

An overactive bladder can lead to other problems. Rushing to go to the toilet can lead to falls and broken bones, especially for women who have reached menopause: in older women, bones become more fragile and, as a result, more susceptible to fractures. In both men and women, an overactive bladder can cause sleep problems, depression, and urinary tract infections.

Many people are embarrassed to talk about their problems related to the functioning of the bladder and in vain. Most often, professional medical help significantly improves the situation, so those suffering from overactive bladder should definitely seek advice from an appropriate specialist who will teach how to control it.

Symptoms:

The main symptoms of an overactive bladder are:

      *Urgent need to urinate.
      *Frequent urge to urinate – eight times or more per day.
      *Visiting the toilet at night - two or more times per night.
      *The urge to urinate after a very recent visit to the toilet.
      *The need to urinate even with a small amount of fluid accumulated in the bladder.
      *Uncontrolled flow of urine that accompanies the urge to urinate.

People with an overactive bladder may have some or all of the above symptoms.

Causes:

The bladder becomes overactive when the muscle contracts too much, pushing urine out of the bladder. This process can be influenced by many phenomena. These include a bladder infection, stress, or some other medical problem. Some problems related to brain function, such as Parkinson's disease, can also lead to an overactive bladder muscle, but in most cases, doctors are at a loss to answer the question of what exactly causes this problem.

Sometimes certain medications can affect overactive bladder. To find out which of the drugs a person is taking can cause such a reaction, you should consult your doctor. In no case should you take such treatments on your own, so as not to worsen your general health.

Treatment:

For treatment the following is prescribed:

The first step in treating overactive bladder is home remedies, such as urinating on a regular schedule. The doctor may advise the patient to urinate every two hours during the daytime, even if he does not feel the need to urinate. This procedure, called bladder training, can help restore lost control over it.

In addition, the doctor may advise the patient to perform special exercises, called Kegel exercises, in order to strengthen the pelvic floor muscles that control the flow of urine. These exercises can eliminate many problems associated with the functioning of the bladder. A physical therapist who specializes in specific pelvic floor muscle training can help a patient master the technique of performing Kegel exercises.

There are other ways to minimize this problem at home:

      *Avoid caffeine-containing drinks such as coffee, tea, carbonated water.
      *If you often get up at night to urinate, do not drink before bed. At the same time, do not deny yourself water throughout the day, because to be healthy, you need water.
      *When visiting the toilet, empty your bladder as much as possible of the fluid accumulated in it, then relax for a couple of seconds and try again. Practice this method of urination constantly.
      *If you don’t have time to get to the toilet at night, think about how to do it as quickly as possible or place a portable toilet next to your bed.

If an overactive bladder is accompanied by uncontrolled urination in a patient, the doctor may prescribe special medications that can alleviate the problem, but most often this type of treatment is resorted to only after bladder training and exercise methods have been tried to no avail.

Overactive bladder (OAB), the manifestations of which are symptoms of frequent urination, urgency and urge urinary incontinence, is a frequent reason for visiting gynecologists and urologists. The condition requires long-term treatment, the first line of which experts unanimously consider behavioral therapy.

The use of behavioral therapy for OAB is based on the assumption that this condition is caused by the loss of childhood cortical control over the micturition reflex or the presence of a pathologically formed reflex. It is known that more than half of patients with OAB have severe mental and social problems, and in 20% of them, hyperactivity is associated specifically with abnormal urination patterns. To restore this control, establish a certain rhythm of urination and gradually increase the intervals between them. Before starting treatment, the patient is explained that normal diuresis is 1500-2500 ml/day, the average volume of urination is 250 ml, the functional capacity of the bladder is 400-600 ml, the permissible number of urinations is on average 7-8 times a day. If this volume exceeds the norm, it is necessary to teach the patient to avoid drinking liquid unless necessary: ​​drink only during meals, give up coffee and tea, especially in the evening, limit the consumption of spicy foods and salt, which cause thirst. The exception is patients taking diuretics. It is also important to justify the need to give up “bad” habits: urinate “just in case,” before eating or leaving the house. The goal of bladder training is to gradually lengthen the intervals between urinations (at the beginning of treatment, the intervals between urinations should be short, for example 1 hour, gradually they are increased to 2.5-3 hours) and increase the functional capacity of the bladder. Thus, the patient “trains” her bladder to empty itself only voluntarily. At night, the patient is allowed to urinate only when she wakes up due to the urge to urinate.

The main tool for this method of treatment is a urination diary, which should record not only the volume of urine excreted and the time of urination, but also episodes of urinary incontinence (UI) and changes in pads. The diary must be studied and discussed with the doctor during scheduled regular examinations.

Behavioral therapy is particularly effective for idiopathic detrusor overactivity. The prognosis, of course, is determined by how accurately the patient follows the doctor’s recommendations. High effectiveness of treatment of OAB is observed with a combination of bladder training and drug therapy.

Exercises to strengthen the pelvic floor muscles are of great importance not only in case of stressful urinary incontinence, when they can be used to increase urethral pressure. The clinical use of exercises for OAB is based on the effect of reflex inhibition of detrusor contractions during voluntary and sufficiently strong contractions of the pelvic floor muscles.

The Kegel exercise system involves alternately contracting and relaxing the levator ani muscles. Exercises are performed 3 times a day. The duration of contractions is gradually increased: from 1-2 s, 5 s, 10-15 s and from 30 s to 2 min. Sometimes a perineometer is used to monitor the correct execution of exercises. It consists of a canister connected to a pressure gauge. The patient inserts a balloon into the vagina and determines the strength of muscle contractions during exercise using a pressure gauge. “Functional” exercises further imply their implementation not only in a position of relaxation, but also in situations that provoke UI: when sneezing, standing up, jumping, running. Despite their simplicity and widespread popularity, Kegel exercises are rarely used today. Sometimes the doctor advises the patient to interrupt and resume urination several times a day. However, such exercises not only eliminate urinary incontinence, but also lead to urination problems.

The main condition for the effectiveness of therapy is regular exercise and medical supervision with constant monitoring and discussion of the results.

For patients who cannot identify the necessary muscle groups, as a result of which they are unable to perform exercises correctly, it is recommended to use special devices: vaginal cones, balloons, etc. (Fig. 1). The cones have the same size and different weights (from 20 to 100 g). The patient inserts the smallest cone into the vagina and holds it for 15 minutes. Then heavier cones are used.

According to various researchers, the number of patients who are unable to reduce m. pubococcygeus, reaches 40%. This was one of the reasons for the widespread use of the biofeedback (BFB) method, the purpose of which is to teach the skills of contracting specific muscle groups and provide feedback to the patient. The effectiveness of the technique is due to the active role of patients in the treatment process through the involvement of visual (pictures, films, animation) or auditory (voice support) analyzers. Feedback can be carried out mono- and multi-channel by recording the activity of the pelvic floor, abdominal and detrusor pressure.

We have accumulated experience in conducting pelvic floor muscle training (PFMT) in biofeedback mode on the video-computer complex “UROPROCTOKOR” (Fig. 2), which is a stationary device equipped with peripheral equipment necessary for the treatment of disorders of the pelvic floor functions, and with the capabilities of motivational reinforcement .

The technology for using the device consists of inserting a special sensor into the vagina that measures the electromyogram (EMG) of the surrounding muscles, which is made of gold-plated porcelain. It can be used repeatedly after pre-sterilization. The EMG signal is analyzed by a computer, which produces graphs on the monitor screen, informing the patient about how the perineal muscles work. The patient periodically tenses and relaxes the pelvic floor muscles (“retraction” of the anus) according to the commands of the device. In this case, the size of the curves on the monitor increases and reaches an individually set threshold. For maximum effectiveness of the procedure, the technology of motivational reinforcement is used: each correctly performed exercise is accompanied by the showing of a film, slides, etc. If the task is performed poorly, all rewarding factors are minimized, which stimulates the patient to more active muscle work. The course of treatment consists of 15-20 half-hour sessions.

After carrying out TMTD in the biofeedback mode, we noted: a decrease in the number of micturitions from 14 to 8 times a day, episodes of urinary incontinence - from 4 to 1 time a day; the abdominal pressure threshold increased from 38 to 59 cm; H2O, the average volume of urine loss decreased from 52 to 8 ml. When analyzing myography data, the following results were obtained: the percentage of correct work of the pelvic floor muscles at the first session was 60.1% + 10.2%, at the 8th session - 73% + 8.7%, and by the 15th session this figure equaled 82.8% + 7.3% (p< 0,05). При анализе полученных клинических данных стало очевидным влияние терапии БОС как на симптомы гиперактивности мочевого пузыря, так и на состояние тазового дна.

The promise of biofeedback therapy lies not only in its high efficiency and absence of side effects, but also in the possibility of conducting therapy at home using individual portable devices. Biofeedback remains the method of choice for patients with severe concomitant somatic diseases when other types of treatment, including medications, cannot be used.

Electrical stimulation (ES) is also an effective treatment for OAB. It is used to reduce the sensitivity of the bladder and increase its functional capacity, which is achieved by direct or indirect irritation of the nerve fibers with a weak electric current. The electrode is inserted either into the vagina or rectum; external patch electrodes can be used. Electrical impulses are supplied continuously or periodically. Points of application are: urethral and anal sphincters, pelvic floor muscles, sacral roots of the spinal cord. Recently, a popular method is tibial ES. Stimulation of the afferent fibers of the somatic peripheral nervous system, which are part of the nerve trunks, causes inhibition of the parasympathetic activity of the pelvic nerve and an increase in the sympathetic activity of the epigastric nerve, resulting in a decrease in the contractile activity of the detrusor.

In case of severe neurogenic overactivity of the detrusor, ES is performed by surgical implantation of a system for ES of the anterior sacral root S3. Side effects may include discomfort during the procedure, pain and discomfort.

Drug therapy, like behavioral therapy, is one of the most common methods of treating OAB. This therapy is aimed at eliminating disturbing symptoms and improving urodynamic parameters, i.e. reducing detrusor activity and increasing the functional capacity of the bladder. The central targets of therapy are the areas of voiding control in the spinal cord and brain, and the peripheral targets are the bladder, urethra, peripheral nerves and ganglia. The following drugs can affect these “targets”:

• drugs that affect ion channels of cell membranes;
• antimuscarinic/anticholinergic drugs, including dual myotropic antispasmodic action;
• antiadrenergic;
• tricyclic antidepressants;
• prostaglandin synthesis inhibitors;
• vasopressin analogues;
• afferent inhibitors.

One of the modern classifications of drugs that reduce the symptoms of OAB suggests dividing such drugs into four types:

Type 1 - drugs that reduce efferent stimulation of the detrusor (M-anticholinergics, α1-blockers);

Type 2 - drugs that increase inhibitory control, polysynaptic inhibitors (antidepressants);

Type 3 - drugs that reduce bladder sensitivity (toxins);

Type 4 - drugs that reduce urine formation (for example, vasopressin analogues).

M-anticholinergic drugs (oxybutynin, tolterodine, trospium) are recognized as one of the most effective drugs used to treat OAB. Extensive experience in their use has been accumulated, and safety and effectiveness have been assessed in many comparative, placebo-controlled, multicenter studies. Selective M-anticholinergic blockers are used. The drug atropine, which is not selective, is currently rarely used due to its pronounced systemic effect (only administration by electrophoresis).

The recommendations of the European Association of Urology on OAB and urge urinary incontinence suggest M-anticholinergics as the first line of therapy, and in terms of evidence, drugs in this group are classified as category “A” (high degree of evidence). In Russia, drugs from the group of M-anticholinergics, approved for use and widely prescribed, are oxybutynin, tolterodine, trospium (non-retarded forms). Aspects of the safety and effectiveness of these drugs in various groups of patients were studied.

The main trend characterizing the modern approach to the use of oxybutynin (driptan, oxybutin) is a change in dosage and dosage regimen in order to reduce the number of side effects. The drug is successfully used at a dose of 3 mg/day; a regimen of oxybutynin is proposed at a dose of 5 mg/day, if well tolerated, followed by an increase of 2.5 mg every 2 weeks until a clinical effect is achieved. In order to achieve maximum effectiveness and improve tolerability, intravesical or transdermal use of oxybutynin is recommended. Clinical studies are being conducted on the effectiveness and safety of sustained-release oxybutynin, which, while equally effective, demonstrates a more favorable safety profile.

Recent clinical studies on the drug tolterodine (detrusitol) have confirmed its high clinical effectiveness for OAB symptoms. The drug is used in a standard dosage of 2 mg 2 times a day. The practice of using delayed-release tolterodine can also be considered promising, which also has higher effectiveness in relation to increased frequency of urination and urge urinary incontinence compared to standard non-retarded forms of the drug.

Trospium (spazmex) also deserves special attention, which, being a quaternary ammonium compound, with good clinical efficacy, has no side effects from the central nervous system. Thus, in a study on volunteers, side effects different from the placebo group appeared only at dosages exceeding 180 mg, which is at least 4 times higher than the standard dosage (H. P. Breuel, S. Bondy). Our comparative study of two dosages of trospium chloride (spazmex, PRO. MED. CS, Praha) - 15 mg/day and 45 mg/day showed that, against the background of the predominant effectiveness of the dose of 45 mg/day, the frequency of side effects was comparable, and side effects there were no central nervous system effects.

In addition to the well-known M-anticholinergics, modern selective drugs are appearing on the European market, which have recently undergone large-scale placebo-controlled studies. Among them is solifenacin, which effectively reduces the number of episodes of urge incontinence and the frequency of urination. The drug has been proven to be highly effective and safe (dosage: 5, 10, 20 mg once a day). There was a minimal percentage of dropouts from the study due to side effects. Studies have also shown good pharmacokinetic and pharmacodynamic parameters of this drug against the background of a high safety profile when used once a day. The pharmacokinetics of solifenacin does not change with food.

For OAB, drugs that act on sympathetic receptors can also be successfully used. It is known that α1-blockers: tamsulosin (omnic), terazosin (cornam, setegis, hytrin), doxazosin (zoxon, kamiren, cardura), alfuzosin (dalfaz) - reduce symptoms of urinary disorders associated with the presence of prostatic hyperplasia in men, have an effect on detrusor hyperactivity that occurs against the background of bladder outlet obstruction. In an open prospective study (S. Serels, 1998), a comparative analysis of the effectiveness of an α1-blocker and an anticholinergic drug in women was carried out. The use of an α1-blocker for symptoms of urgency has been shown to be highly effective. Drugs in this group can be used to treat symptoms of OAB in both men and women, especially in cases of symptoms of OAB against the background of urodynamically confirmed functional bladder outlet obstruction (IVO). The data obtained (A.V. Sivkov, 2001; D.Yu. Pushkar, 2002) indicate the reliable effectiveness of α1-blockers for symptoms of OAB in women against the background of functional IVO. Thus, in the observation group, the frequency of urination per day decreased by 25-30%, and nocturnal pollakiuria - by 50%. The prescription of α1-blockers is based on vasoactivity. In young patients, the drug of choice is tamsulosin (0.4 mg/day). When prescribing vasoactive α1-blockers, dose titration is necessary.

Tricyclic antidepressants (imipramine, amitriptyline) have central and peripheral anticholinergic and α-adrenergic effects, as well as an inhibitory effect on the central nervous system. They are effective when administered orally (150 mg/day) in elderly patients with symptoms of OAB. The group of antidepressants also includes duloxetine, a combined serotonin and norepinephrine reuptake inhibitor. It affects the urinary control centers in the lumbosacral spinal cord (Onuf's nucleus). These nuclei integrate the activities of the sphincter and bladder. When norepinephrine is inhibited, sphincter tone increases, and when serotonin is blocked, bladder activity decreases. The possibility of using the drug for stress urinary incontinence is currently being considered. A conclusion about the advisability of its use in overactive bladder can only be made after the completion of large-scale clinical studies.

In recent years, there has been interest in the use of toxins in OAB. Botulinum toxin (trade names botox, dysport), used in aesthetic medicine, can normalize muscle tone by inhibiting the release of acetylcholine from the nerve ending. Indications for its use are sphincter dysfunction and neurogenic detrusor hyperactivity. The toxin is prescribed in the form of intravesical injections (an average of 30 points) under cystoscopic control. Contraindications include urinary tract infection and hypersensitivity to the drug, although only 2% of patients develop antibodies to botulinum toxin.

Analogs of vasopressin (type 4 drugs), such as desmopressin (minirin, emosint), have a very limited scope of application. The main indication for their use remains a shift in diuresis towards the night hours (nocturia) and associated urinary disorders. Currently, a study is being conducted on the use of vasopressin analogues for the correction of urge urinary incontinence.

Hormone replacement therapy occupies a certain place in the treatment of older women with OAB. Estrogen deficiency leads to a number of changes in a woman’s genitourinary system in the form of vaginal atrophy, decreased sphincter tone and increased sensitivity of the bladder. However, many of the positive effects of estrogen therapy, with the exception of the effect on signs of osteoporosis, have not yet been sufficiently substantiated, and opinions on this matter should be considered contradictory. The effectiveness of estrogen therapy in the treatment of OAB can be considered controversial. Researchers defend the feasibility of conducting research in accordance with the principles of evidence-based medicine and quality clinical practice.

When choosing a method of drug treatment for OAB, it is necessary to take into account the presence of concomitant diseases, the results of previous treatment, and the patient’s ability and ability to follow the doctor’s prescriptions. This will help to select the correct drug and ensure high effectiveness of treatment.

After selecting adequate and effective therapy for OAB, follow-up follow-up and control examinations are required at intervals of 3-6 months.

V. V. Romikh
I. A. Apolikhina, Candidate of Medical Sciences
V. M. Andikyan
NTsAGiP RAMS, MMA named after I.M. Sechenov, Research Institute of Urology, Moscow

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