irritable bladder

Irritable bladder: description

An irritable bladder (overactive bladder, urethral syndrome) disturbs the function of the bladder. Normally, the bladder acts as a pool of urine filtered by the kidneys and ureter. Stretchy, it can hold up to 500 milliliters of urine. However, the bubble reports at about 300 milliliters to the brain that a speedy emptying is needed. When someone goes to the urine to urinate, the muscular wall of the bladder contracts and thus moves the urine out of the body. Patients with irritable bladder feel urinary urgency much more often than is physically necessary. In most cases, organic reasons for this can not be found. The irritable bladder is therefore considered by some to be an exclusion diagnosis. It used to be considered a psychosomatic illness. Others see it as a mild form of urge incontinence.

The irritable bladder can be associated with a significant reduction in the quality of life. Nevertheless, many sufferers avoid medical help for a variety of reasons. Many certainly from shame, others have little expectation of the therapy or the opinion that a stimulus bladder is a normal aging symptom. An irritable bladder occurs regardless of age, although it becomes more common with age. Particularly affected are women, especially between the ages of 30 and 50 years. The irritable bladder appears to be frequent: a study conducted across five countries found that around 13 percent of women and 10 percent of men have a bladder.

Irritable bladder: symptoms

Basically, the irritable bladder symptoms are not dissimilar to those of a urinary tract infection. People with irritable bladder suffer from frequent urinary frequency (pollakisuria). This means that someone has to urinate at least eight times within 24 hours. Many feel the associated, very sudden urinary urgency, which often begins without warning. For some, this “rash-like” symptom of irritable bladder causes involuntary loss of urine. That can range from a few drops to larger amounts. The great pressure on the toilet to be paired with the involuntary loss of urine is also called urge incontinence designated.

Some patients experience a so-called terminal dysuria, meaning they have pain towards the end of urination. Because the bladder cramps painfully when emptying.

In addition, urine can dribble shortly after urination, then the doctor speaks of so-called Nachträufeln. Even at night, all symptoms can be present and disrupt sleep decisively (nocturia).

These symptoms lead to a high level of suffering and impair the quality of life. Concerned are careful to be near a toilet. Losing control of bladder incontinence can be a major lifestyle cut. Anxiety can additionally increase the symptoms.

Irritable bladder: causes and risk factors

The causes of an irritable bladder have not yet been completely scientifically explored. It is believed that there is an erroneous transmission of nerve impulses, which report to the brain that the bladder must be emptied, although this has not reached its fill limit by far. This means that the sensitivity of the bladder muscles is increased. On the other hand, the perception of increased bladder pressure is reduced by filling and tension in the irritable bladder, so that it comes to the sudden urinary urgency for the person affected.

The cause of this dysregulation remains mostly unclear!

The irritable bladder distinguishes between a primary and a secondary form. While in the primary irritable bladder, the cause is the nervous system, the secondary form of the irritable bladder is usually the result of another disease. Primary forms of the irritable bladder can in some cases be explained by neurological diseases. These include multiple sclerosis, stroke or Parkinson’s disease. Also suffering from the spinal cord can damage the nerve function and thus also the bladder.

Secondary forms of irritable bladder are usually the result of tumors, stones or inflammation. In the investigation, these causes must be excluded.

In rare cases, irritable bladder may also be the cause of sexual or psychological trauma. It can also be left as a result of chronic bladder infections, even if no infection is detectable.

Irritable bladder: examinations and diagnosis

An irritable bladder is often considered an “embarrassing” problem. Nevertheless, this should not prevent anyone from openly addressing their condition to a doctor. If you suspect a “nervous” bladder, you can first contact your family doctor. If the diagnosis is confirmed, the latter may issue a referral to a urologist or, in the case of women, also to a gynecologist. The doctor leads first of all a conversation, in order to grasp the problems more closely (anamnesis). Among other things, he can ask these questions:

• Do you need to urinate more frequently than usual?
• How much do you drink?
• Is urination often urgent and sudden?
• Can not you make it to the toilet in time?
• Do you often need to go to the bathroom at night?
• Do you have pain when urinating?
• Do you take any medicine?

Especially the medication must be described exactly. There are a variety of medications that can cause symptoms of irritable bladder. An example of this are agents that are prescribed for hypertension. They sometimes trigger increased urination and frequent urination.

It can be very helpful, even before you go to the doctor. “Voiding protocol “ feed, it is recorded in drinking and toilet. Thus, abnormalities are recorded and impairment can be assessed objectively.

Further investigations

Following the conversation follows the physical examination, which should exclude organic reasons as the cause of the symptoms of irritable bladder. The basis for this is the inspection of the urogenital tract. In men, the prostate should be examined on this occasion and the uterus in women. These two organs can cause similar irritation to the irritable bladder.

The important alternative diagnosis to irritable bladder is a urinary tract infection. To exclude it, a urine sample is taken and examined for pathogenic germs. In a stimulus bladder remains pathogen detection negative.

A symptom of the irritable bladder is that some sufferers can no longer empty the bladder properly. This can be determined by the doctor by directly after a toilet using ultrasound, the filling of the bladder, the residual urine, controlled. Alternatively, urologists carry a so-called urodynamic investigation by. With the help of pressure probes and electrodes the function of the bladder and the discharging urinary tract is checked. Thus, the capacity of the bladder can be determined and the closure mechanisms, especially the musculature, tested. The finding of remaining residual urine after bladder emptying should be a reason for further investigations.

One possible cause of the irritable bladder can be a local reduction of estrogen be. A smear can be taken from the lower urinary tract. In this study, local estrogen deficiency shows changes in superficial cells (so-called karyopyknotic index below 50 percent).

It is possible to start the therapy attempt with a drug from the anticholinergic group already in case of a suspected irritable bladder. If this is effective, the diagnosis is confirmed.

It is important that in case of irritable bladder secondary forms the irritable bladder are excluded. It must not happen that an obvious cause, such as a stone suffering, is overlooked. To preclude this, the attending physician can perform an ultrasound.

In individual cases, mental or sexual traumas can also trigger irritable bladder symptoms. Here, the treating physician is asked to be sensitive to the issues and, if necessary, to include the psychosomatics of the disease in the treatment.

Irritable bladder: treatment

There is no uniform irritable bladder therapy. It is to be selected individually in agreement with the patient and his individual goals. The conversation about the goals of the therapy must be open and be conducted honestly on both sides. It is very important that sufferers understand their illness. This prevents disappointment and misunderstandings. The irritable bladder can be treated with bladder training, medicinal and also surgical. Overall, the therapy is often tedious.

Patients should also be educated about simple but important ways to improve their lives, such as proper intimate care or prevention of urinary tract infections. The latter can increase symptoms. Often small changes in habits help to improve the symptoms. For example, you should stop drinking diuretic drinks shortly before sleep. Nevertheless, a sufficient amount of drinking is very important and should not be reduced for fear of even stronger symptoms.

If causes of the irritable bladder, such as a tumor, are known, the symptoms of irritable blisters often disappear with the therapy of the underlying disease.

training

Bladder training, pelvic floor exercises or biofeedback training are effective treatments for the irritable bladder that can be performed alone or in combination with medication. They serve for better, active control of urinary urgency. The main goal is to delay the intervals between the toilets. Pelvic floor training together with electrostimulation are considered to be particularly effective. Psychotherapy and relaxation procedures are also helpful – sometimes as a sole therapy.

If it is too frequent to go to the toilet, can be learned as part of the bladder training, the urine consciously withhold – despite strong urinary urgency. The intervals are always extended a little, so that the patients learn again a realistic picture of the capacity of their bladder. In addition, due to the micturition protocol, the individual bladder capacity can be determined and fixed toilet times can be determined so that urge incontinence does not occur. Thus, first time intervals are determined after the clock for toilets, which are increased over time.

This therapy can be very exhausting, so there are always therapy-breakers. The long-term effect of this therapy is controversial. Overall, however, training measures that need to be individually tailored, are recommended.

drugs

How the irritable bladder is treated with medication, read in the article irritable bladder – drugs.

Stimulation of the nerves

Another therapy variant or extension of the drug therapy is the Electrotherapy, It can be tried for three to six months treatment with local electrical stimulation. The muscles are specifically activated by means of weak stimulation current. This is especially useful if the drug therapy was not successful or the side effects, especially dry mouth or blurred vision, outweigh.

If no significant improvement can be achieved despite the stimulation current therapy, the next stage is the direct one neuromodulation, This means that the sacrum (sacral nerve plexus) is electrically stimulated through the skin. This leads to an inhibition of the bladder. First, an external pulse generator is used to test whether this therapy variant works. If the therapeutic success is confirmed, one can Bladder Pacemaker be implanted.

Alternative irritable bladder therapy
Some sufferers rely on conventional medicine as well as alternative therapies for the irritable bladder. Homeopathy can be an approach, such as the homeopathic remedy Nux vomica. Also acupuncture is sometimes used. Some report improvements in symptoms, but the efficacy is not scientifically proven.

Last means – the operation

If the mentioned therapy methods do not offer a remedy and the symptoms are very difficult, the bladder can be surgically raised as a last resort (cystoplasty) or removed (cystectomy). In case of removal of the urinary bladder, a new urinary diversion must also be created.

Irritable bladder: disease course and prognosis

In part, the hyperactive bladder can be treated well by simple means. Often, however, the long-term therapy of the irritable bladder is often difficult. Although complete freedom from symptoms is not easy to achieve, most patients experience significant relief from the symptoms.

The medical assistance with the irritable bladder is very important. The balance between effects and side effects of the therapy must be made again and again. The function of the urogenital tract should be monitored regularly to avoid damage from the irritable bladder to recognize and treat at an early stage.