Hyperactive Bladder

Symptoms

Irritable bladder manifests itself in the following symptoms. By definition, there are no pathologic changes of the genitourinary tract:

  • Strong urge to urinate, which is difficult to suppress.
  • Increased urinary frequency during the day
  • Nighttime urination
  • Urinary incontinence: an involuntary loss of urine may occur

The constant urge reduces the quality of life and can be a significant psychosocial problem because the toilet must be visited constantly. Other complications include sleep disturbances, fatigue, stress, depression and increased risk of fracture.

Causes

Urinary voiding is a complex process subject to central and peripheral mechanisms. There are several hypotheses regarding the possible causes of irritable bladder. Contraction of the bladder wall muscles (detrusor vesicae muscle), which control bladder emptying, is thought to be important. This contracts before the bladder is adequately filled, leading to urinary urgency. Acetylcholine is the major mediator of bladder contraction. Of the five muscarinic receptors, particularly important are the M3– and the M2 receptors are of importance. However, not all patients with irritable bladder have detrusor hyperactivity. Treatment must take into account the many factors that influence bladder function. These include age, many medical conditions, medications (e.g., the commonly prescribed diuretics), and stimulants such as caffeine and alcohol.

Diagnosis

The diagnosis is made in medical treatment based on the patient’s history and clinical symptoms. It is important to exclude other causes. Possible differential diagnoses include, for example, prostate enlargement in men, diabetes mellitus, cystitis or other urinary tract diseases and malignancies.

Nonpharmacologic treatment

Nonpharmacologic therapy and behavioral recommendations provide an important foundation for the treatment of hyperactive bladder.

  • Bladder training involves decreasing the frequency of urination see Bladder Training.
  • Reducing fluid intake to 1-1.5 liters per day has been shown to improve symptoms
  • Avoid caffeine and triggering foods and spices.
  • Pelvic floor training (Kegel exercises), biofeedback.
  • With a micturition diary, the course can be documented
  • Treat constipation
  • Incontinence pads and similar measures for incontinence.
  • Neuromodulation, e.g. sacral nerve stimulation.
  • Surgical methods (3rd choice means).

Drug treatment

Parasympatholytics competitively abolish the effects of acetylcholine at muscarinic receptors on bladder wall muscles. Because of the potential adverse effects, they are not without controversy. Parasympatholytics are anticholinergic and can cause, for example, urinary retention, dry mouth, rapid heartbeat, constipation, and central effects such as fatigue and confusion. The potential interactions and contraindications must be considered:

Flavoxate:

  • Is a non-anticholinergic, antispasmodic agent.

Botulinum toxin:

  • Inhibits the release of acetylcholine from nerve endings, inhibiting contraction of the bladder wall muscles. It is administered parenterally and has a long duration of action. A possible adverse effect is residual urine formation, which may require catheterization. The treatment has not yet been officially approved by the authorities and is administered off-label at the responsibility of the physician.

Estrogens:

  • Are used for treatment in postmenopausal women and are well suited for this purpose (Cardozo et al., 2004). Topical drugs such as ovules or creams are usually used. Oral use has also been reported in the literature.

Beta3 agonists:

  • Such as mirabegron (Betmiga) relax the bladder wall muscles, increasing bladder capacity.Mirabegron is taken once a day regardless of meals. The drug may increase blood pressure.

Herbal medicines:

  • The herbal remedy used is an extract of pumpkin seeds with pumpkin seed oil (Granufink). An advantage of phytotherapy is better tolerability. As a rule, fewer adverse effects occur.