Overactive bladder: causes, symptoms and treatment

Neurogenic bladder
or
neurogenic bladder dysfunction
is a collective concept that unites a large group of disorders of the reservoir and evacuation functions of the bladder due to congenital or acquired lesions of the nerve pathways and centers at various levels and for various reasons [3] [4]. The causes may be damage or disease of the central, peripheral or autonomic nervous systems[5].

If left untreated, it can lead to progressive kidney damage, pressure ulcers, urinary tract infections, and the physical discomfort and social consequences of urinary incontinence[6].

There are two main forms of neurogenic bladder dysfunction: hypotonic and hypertonic[7].

Etiology[ | ]

Normal urination requires a properly functioning bladder and urethra, and maintaining a stream requires a detrusor capable of maintaining normal changes in pressure in the bladder depending on changes in its volume, and a properly functioning sphincter. The act of urination consists of slowly filling the bladder under low bladder pressure during the filling phase and coordinating the contraction of the detrusor with the relaxation of the external and internal parts of the sphincter during the voiding phase. Defects in this system can result in the inability of the sphincter to contract or expand in response to pressure in the bladder, resulting in urinary problems. Neurogenic bladder dysfunction can result from damage or disease of the central, peripheral or autonomic nervous systems[5].

Medical conditions that cause neurogenic bladder include Alzheimer's disease, congenital spinal cord defects such as spina bifida, brain or spinal cord tumors, cerebral palsy, encephalitis, attention deficit hyperactivity disorder, multiple sclerosis, Parkinson's disease, spinal cord injury, or stroke[8].

Also, a neurogenic bladder can be due to neuropathies, nerve damage due to severe alcoholism, due to diabetes, syphilis, pelvic surgery, herniated disc, spinal stenosis or vitamin B12 deficiency[8].

Nausea and kidney pain: should you panic?

• Misconception
• Why does it hurt?
• What causes nausea?
• Causes of diseases
• help yourself

What are kidneys? This is nothing more than a filter inside a person. Their function is to pass all the fluid in the body through themselves and produce urine, along with which all the bad things come out. They maintain the water balance inside us, and since a person consists of eighty percent liquid, it becomes clear that we cannot exist without them.

But sometimes the kidneys just can't do their job. It is very difficult to determine that something is wrong with this organ in the early stages of the development of any disease, because kidney diseases generally go away without symptoms.

Misconception

People tend to make mistakes, especially when it comes to health. Only after an examination can you be completely sure that the problem lies with them. When the kidneys hurt, the person experiences pain under the lower ribs.

It should be remembered that only doctors can diagnose themselves. But an ordinary person, until examined by a specialist, will not be able to understand what caused the pain and whether it is of a renal nature.

Why does it hurt?

The kidneys can hurt if any inflammatory process occurs in the human body or the organs themselves are damaged

To understand that the source of pain is the kidneys, you should also pay attention to:

• cloudiness in the urine, admixtures of blood, sand and pus in it;
• weakened vision;
• decrease in the amount of urine excreted per day;
• discomfort during urination;
• frequent urge to urinate.

If your kidneys hurt and you feel sick, your temperature rises, your stomach hurts or you are vomiting, you should see a doctor as soon as possible. In such cases, they usually turn to a urologist, nephrologist or oncologist.

The cause of pain in the kidneys can be:

1. Urinary tract infection (inflammation of the urethra, ureters or bladder can affect the kidneys).

2. Kidney stones.

3. Malignant organ tumor.

4. Kidney infections (pyelonephritis, glomerulonephritis).

5. Kidney injuries.

What causes nausea?

Most often, nausea and pain in the kidneys are caused by urolithiasis or kidney infections.

Urolithiasis at an early stage is asymptomatic. A person feels great until a certain moment, until the stone grows to a certain size and no factor becomes an impetus for its movement. When the stone begins to advance, the person will experience severe renal colic, and even a change in posture will not alleviate the condition. The strength of these pain sensations is comparable only to labor pains and can cause nausea and vomiting.

Pyelonephritis and glomerulonephritis, as well as other infectious kidney diseases. The infection itself is of bacterial origin and can be caused by any pathogen. The disease affects the organ in such a way that it begins to swell.

A person feels a dull aching pain in the lumbar region. Moreover, a person experiences pain constantly; it is not severe, but still causes a feeling of discomfort. It is common for a person suffering from pyelonephritis or glomerulonephritis to experience nausea and possibly vomiting.

Causes of diseases

Pain in the organs of the urinary system, namely in the kidneys, most often occurs due to concomitant diseases. In pursuit of material well-being, people are often inattentive to their working conditions.

Important factors that affect the performance and well-being of our kidneys are the water we drink and harmful impurities that enter our body through food. Alcohol also plays an important role, the consequences of which these organs are desperately fighting.

help yourself

To avoid pain in the kidney area, as well as to prevent adverse reactions such as nausea, you need to take care of your health not sporadically, but constantly. You should know moderation in everything.

1. Adhere to a balanced diet.

2. Eat more potassium, which prevents the formation of urolithiasis.

3. Drink alcohol in moderation.

4. Include foods containing amino acids in your diet.

5. Drink as much water as possible.

6. Drink rosehip decoctions and infusions of diuretic herbs.

If it happens that you experience nausea and pain in the kidneys, then first you should relieve the pain syndrome. To do this, you should consult a doctor who will identify the cause and prescribe medications that eliminate the inflammatory process and restore organs.

Symptoms[ | ]

Symptoms depend on the cause of the disease and often include urinary incontinence[8].

Symptoms of an overactive bladder include[8]:

• the need to urinate frequently in small quantities;
• problems with completely emptying the bladder;
• loss of bladder control.

For hypoactive bladder (English)Russian. symptoms include[8]:

• feeling of a full bladder with possible leakage of urine;
• inability to feel when the bladder is full;
• Trouble starting to urinate or emptying the bladder completely (urinary retention).

Sometimes there may be no symptoms, and incomplete emptying of the bladder is detected only during examinations[9].

Treatment

For effective treatment, it is necessary to determine the root cause of the disorders. A person with this problem needs to learn to control and suppress urination. For a neurogenic abnormality, therapy will be aimed at restoring innervation to the detrusor. For idiopathic disorders - to strengthen and restore blood supply to the organ. Based on this, the direction of treatment can be determined:

Non-medicinal:

• Adjusting nutrition and fluid intake.
• Training the pelvic muscles and bladder.
• Behavioral therapy.

Medication:

• Antidepressants.
• Antidiuretics to control fluid balance.
• Toxic drugs or anticholinergics to inhibit the activity of nerve receptors in the organ.

Surgical:

• Bladder denervation - blocking impulses that irritate the organ.
• Partial removal of the bladder is called detrusor myectomy.
• Enterocystoplasty, that is, the non-imperative part of the urinary tract is replaced with a part of the intestinal wall.

Treatment[ | ]

Treatment of neurogenic bladder involves achieving several goals[10]:

• ensuring continuous urination to relieve the physical or physiological consequences of incontinence;
• preventing the development of detrusor pressure with increased pressure, which can lead to damage to the upper urinary tract;
• minimizing the risk of urinary tract infections;
• preventing overstretching of the bladder.

Treatments require patient education and may include scheduled voiding, manual techniques, medications, disposable or indwelling catheters, and bladder or urethral surgery.[11]

If self-catheterization is necessary, the initial measure of treatment is to begin taking fluids as scheduled. Frequent overfilling of the bladder can lead to permanent muscle damage, stretching of the detrusor and detrusor flaccidity. Taking fluids on a schedule allows you to predict the filling of the bladder and empty it on time, preventing excessive stretching of the detrusor[10].

Manual techniques include Crede and Valsalva maneuvers, as well as suprapubic tapping. The Crede maneuver involves applying pressure to the suprapubic area to increase pressure in the bladder and stimulate urination. The Valsalva maneuver also increases pressure in the bladder, which can cause the detrusor muscle to contract. In overactive bladder, detrusor contraction is stimulated by tapping over the suprapubic region[10].

If attempts to control neurogenic detrusor overactivity with drugs and other methods are unsuccessful, then surgical intervention, including neuromodulation, is performed [12].

Patients with a neurogenic bladder require regular neuro-urological monitoring[13].

OAB syndrome or overactive bladder: symptoms, causes and methods of treating pathology

Bladder overactivity (previously the disease was called bladder neurosis) is a very common pathology.

And it so happened that a person, due to his shyness, does not pay due attention to it, attributing it to the inability to activate control over the current situation in time.

As a result, the quality of life sharply decreases, which makes a person hostage to the toilet, forcing him to change far-reaching plans. But in practice it turns out that everything is not so simple. The process progresses, and the symptoms of the disease become more obvious.

Symptoms of OAB

Symptoms that accompany an overactive bladder are:

• urinating more frequently than usual (4-7 times a day is normal);
• the appearance of an irresistibly sharp desire to release the bladder (urgency), which is very difficult to suppress;
• urgency is often accompanied by urinary incontinence, both during the day and at night;
• the appearance of nocturia is a disease that is not independent, but occurs as a consequence of heart failure, chronic kidney disease and acute cystitis.

The method of diagnosing the disease comes down to excluding pathologies that do not relate to OAB:

1. for example, with diseases that are infectious in nature, the growth of benign and malignant tumors or stones in the bladder, the same symptoms may appear as when diagnosing hyperactivity;
2. some factors, which include excessive consumption of coffee (as well as tea and other non-alcoholic) drinks, also affect the frequency of urges and urgency;
3. it is necessary to exclude somatic diseases, and these are latent diabetes, Parkinson's disease, obstructed urine outflow (obstruction), dementia, multiple sclerosis. When diagnosing, be sure to ask the patient whether he is taking diuretics (diuretics) or anti-allergy medications. It is important to exclude all these factors in order for the correct diagnosis to be made and the effect of treatment to be as positive as possible.

Overactive bladder according to ICD-10 is coded as N32.8.

Treatment of the disease

The main causes of overactive bladder are a decrease in M-cholinergic receptors due to the pathogenic process, which entails a violation of the nervous regulation of smooth muscle cells of the bladder.

The nerve impulse intensifies and causes spontaneous irritation of all muscle cells of this organ, which manifests itself in the form of a sharp and difficult urge to urinate. A urologist will help you deal with this problem.

At the initial stage, the urologist will listen, perform an examination, analyze and prescribe an examination, which will include:

• collection of information on the development of the disease (history);
• entries in a diary (questionnaire) on the time and number of urinations;
• conducting an ultrasound of the relevant organ to determine its condition and determine the volume of residual urine;
• diagnosing inflammatory diseases and diabetes mellitus;
• application of a complex of urodynamic studies.

So how do you treat overactive bladder? Treatment of the disease takes place in three directions. Firstly, this is therapy not related to drug treatment, which includes: strengthening the muscles of both the bladder itself and the pelvic muscles, carrying out an electrical stimulation procedure, and developing a different behavioral line.

Secondly, it is indicated for such a problem as an overactive bladder, treatment with myotropic antispasmodics, M-anticholinergics (drugs Urotol dose 2 mg / 2 times a day, Ditran 5 mg / twice a day, Smazmex 5 (15) mg / 3 times a day), which reduce detrusor activity and simultaneously increase the volume of the bladder.

Spazmex tablets

Tricyclic antidepressants and botulinum neurotoxin (injected directly into the bladder) are also prescribed. Drug treatment is continued for 3-6 months.

Thirdly, (and this is an extreme measure) - surgical intervention, when the bladder is enlarged to increase its volume or another fragment of the intestinal tube is formed. Drug and non-drug treatment are combined.

The effect of therapy should be noticeable after 2-3 months; if this does not happen, then proceed to a urodynamic study, which evaluates:

• urination rate (uroflowmetry) and pressure in the bladder in a full and empty state (cystometry);
• pressure in the urethra (profilometry), one-time indicators of pressure in the bladder and urine flow rate;
• electromyography of the pelvic muscles (especially the fundus) and residual urine volume.

At the same time, tests are performed using cold water and lidocaine to diagnose the nature of OAB.

It may be idiopathic, neurogenic, or without detrusor overactivity. The clearly expressed neurogenic nature of the disease requires a neurological examination.

If anticholinergic drugs are ineffective, they begin pumping botulinum neurotoxin (A-type) into the detrusor, a dose of 200-300 units dissolved in 10-20 ml of saline. The drug is injected into 20-30 points of the bladder muscle, repeating the procedure as needed after 3-12 months to consolidate the clinical effect. It is combined with neurotoxic drugs, for example, capsaicin.

Differences between men and women in the course of the disease

It should be noted that an overactive bladder in women occurs 2 times more often than in men, although this figure is practically equalized in old age with the progression of degenerative processes in the body.

The reason for this excess lies in the fact that most women who seek help become mothers at a young age.

The process of childbirth, especially the first birth, often involves a violation of the integrity of the pelvic floor muscles. The process of muscle scarring occurs. Scars cause discomfort in the adjacent bladder, causing it to contract involuntarily. During the postmenopausal period and in old age, the main cause of the syndrome is a lack of sex hormones (estrogens). In addition to this, diabetes, obesity, and pelvic surgery can cause urinary incontinence.

Recently, hormonal drugs have also been added to the general scheme of diagnosis and subsequent therapeutic treatment. For women, the vaginal form of estrogens is indicated, since with its help the best therapeutic effect is achieved: symptoms of the disease are eliminated, urgency disappears, urine output becomes controlled, the condition of the vaginal epithelium improves, and the possibility of developing complications after infection of the lower urinary tract is sharply reduced.

If we take into account men with this pathology, then OAB is more common in them in old age.

Neurogenic overactive bladder occurs in men due to:

• nervous system disorders;
• infection in the genitourinary system;
• Parkinson's disease, stroke;
• decrease in testosterone levels.

Men, first of all, are recommended to improve fluid intake, get rid of bad habits (smoking, drinking alcohol), adhere to an individually developed urination pattern, train (strengthen) the muscles of the bladder and use drugs to reduce detrusor tone.

Features of the development of OAB syndrome in children

This problem has not spared children either. Overactive bladder is common in children and is the leading cause of urinary incontinence, regardless of how much fluid the child drinks.

It turns out that the child either does not have time to control the situation associated with urination, or does not notice it at all and pees right in his pants.

The root cause of the phenomenon is associated with the age of the child, when he has not yet learned to control the urge to urinate. Also, the muscles themselves may contract uncontrollably at this age, or the muscles around the urethra in the urethra may not perform their main function of holding urine.

What causes overactive bladder syndrome in a child:

• neurological diseases, stress;
• infection of the urinary canals and their structural changes;
• prolonged urinary retention with low bladder capacity;
• caffeine-containing products such as chocolate, carbonated drinks, sweet tea;
• constipation, both acute and chronic.

Fortunately, in the vast majority of children, OAB decreases as they get older. They develop the skills to manage their desires.

For a small percentage, OAB remains a problem, and it is necessary to pay attention to such children and turn to specialists so as not to miss the time of adaptation of the little personality in society. Bladder problems can complicate this process as well.

Troubleshooting methods

Only with the help of a specialist can one resist the disease in childhood if the internal forces of the young body cannot cope with this disease on their own. Simultaneously with drug intervention, the child develops skills in a different behavioral line, where he is taught:

• how to strengthen the pelvic muscles;
• control the urge to urinate;
• visit the toilet at a certain time and completely empty the bladder;
• Do not overuse caffeine-containing foods and drinks.

The most important thing is to instill confidence in the little man that he will definitely cope with his problem, and a calm and friendly environment in the house will help him in this.

Video on the topic

The video presents modern capabilities for assessing the etiology, pathogenesis, diagnosis and treatment of OAB manifestations:

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Complications[ | ]

The most common complications are urinary tract infections and urolithiasis. Less commonly, morphologic changes in the lower urinary tract may occur, such as bladder diverticulum, trabeculae, thinning of the bladder wall, or pelvic organ prolapse. In parts of the upper urinary tract, vesicoureteral reflux may occur and renal failure may develop[14].

Patients with a history of using indwelling catheters, recurrent urinary tract infections, or a history of cyclophosphamide use for neurological disorders for more than 8 years have an increased risk of squamous cell carcinoma [14].

Additional facts

 Overactive bladder (OAB, detrusor overactivity/hyperreflexia) in women is a urinary tract disorder that affects quality of life and interferes with socialization. The pathology occurs in millions of patients around the world, regardless of race. The prevalence increases with age, but urgency, urinary frequency, and nocturia are not normal signs of aging. Women over 75 years of age suffer from vesicular hyperactivity in 30-50%. It has been proven that the higher the body mass index, the higher the risk of developing the syndrome.

Notes[ | ]

1. Disease ontology database (English) - 2020. Retrieved May 15, 2019.
2. Monarch Disease Ontology release 2018-06-29sonu - 2018-06-29 - 2018. Retrieved July 27, 2020.
3. M. D. Karve, V. S. Dmitrieva.
   Antihomotoxic therapy for neurogenic bladder dysfunction (Russian) // Attending physician: journal. — 2020. — October 15 (vol. 16, no. 9). - pp. 13-16. — ISSN 1560-5175.
4. Yu. F. Isakov, A. F. Dronov.
   Pediatric surgery: national. hands.. - GEOTAR-Media, 2009. - P. 634. - 1164 p. — ISBN 978-5-9704-0679-3.
5. ↑ 12
   Dorsher, McIntosh, 2012, 1. Background, p. 1.
6. Dorsher, McIntosh, 2012, Abstract, p. 1.
7. Neurogenic bladder
8. ↑ 12345
   Neurogenic bladder: MedlinePlus Medical Encyclopedia. MedlinePlus (20 April 2018). Retrieved May 24, 2020. Archived May 24, 2020.
9. Xavier, Fowler, Panicker, 2010, Neurogenic bladder symptoms, p. 23.
10. ↑ 123
    Dorsher, McIntosh, 2012, 5.1.1. Bladder Retraining and Fluid Schedule, p. 6.
11. Dorsher, McIntosh, 2012, 5. Neurogenic Bladder Management, p. 5.
12. Dorsher, McIntosh, 2012, 6. Surgical Interventions for Neurogenic Bladder, p. 6.
13. Xavier, Fowler, Panicker, 2010, Follow-up, p. 28.
14. ↑ 12
    Xavier, Fowler, Panicker, 2010, Complications, p. 24.

Literature[ | ]

• Peter T. Dorsher, Peter M. McIntosh.
  Neurogenic Bladder: [English]: [arch. May 29, 2020] // Advances in Urology. - 2012. - Vol. 2012, No. 816274. - ISSN 1687-6369. - doi:10.1155/2012/816274. - PMID 22400020. - PMC 3287034.
• Xavier Gamé, Clare J. Fowler, Jalesh N. Panicker.
  Neuropathic bladder dysfunction: [English]: [arch. June 1, 2020] // Trends in Urology, Gynaecology & Sexual Health. - 2010. - Vol. 15, no. 1. - P. 23–28. — ISSN 1931-2288. - doi:10.1002/tre.133.