Brief overview
- Symptoms: Frequent and very sudden urge to urinate, sometimes at night, sometimes with leakage of urine or pain toward the end of urination
- Treatment: To be individualized, options include bladder or pelvic floor training, biofeedback, nerve stimulation methods, medications and surgical interventions, alternative approaches of homeopathy or home remedies
- Causes: Exact causes not yet clear, consequence of pregnancy, childbirth and age as well as lack of estrogen, possibly faulty transmission of impulses from nerves involved in control of bladder filling, sexual or psychological trauma is discussed
- Diagnosis: Medical interview (anamnesis) and physical examination of the urogenital tract, such as ultrasound examination and determination of the estrogen content in women, recording of bladder emptying (micturition protocol), exclusion of other diseases such as bladder stones.
What is irritable bladder?
In irritable bladder (overactive bladder, urethral syndrome), the function of the urinary bladder is disturbed.
The bladder functions as a collection basin for urine filtered by the kidneys. Since it is expandable, it can hold up to 500 milliliters of urine. However, at around 300 milliliters, the bladder signals to the brain that it wants to be emptied soon. When someone urinates, the muscular wall of the bladder contracts and thus transports the urine out of the body.
Irritable bladder is considered a diagnosis of exclusion by some doctors. If they do not find any other causes for the symptoms, they diagnose irritable bladder. In the past, it was mainly considered a psychosomatic disease.
Irritable bladder can significantly reduce the quality of life of those affected. Nevertheless, many sufferers avoid seeking medical help for various reasons. Many certainly out of shame, others have low expectations of therapy or believe that an irritable bladder is a normal symptom of old age. Irritable bladder does not depend on age, even if it becomes more frequent with increasing age.
Women are particularly affected, especially between the ages of 30 and 50. Overall, the clinical picture is widespread: A study conducted across five countries found that around 13 percent of women and ten percent of men suffer from irritable bladder.
What are the symptoms?
Basically, irritable bladder symptoms are similar to those of a urinary tract infection. People with irritable bladder suffer from frequent urination (pollakiuria). This means that someone has to urinate at least eight times within 24 hours. Many sufferers find the associated very sudden urge to urinate, which often starts without warning, very distressing. It sometimes results in involuntary urine leakage – ranging from a few drops to larger quantities. The great pressure of having to go to the bathroom, coupled with the involuntary loss of urine, is also known as urge incontinence.
Another possible irritable bladder symptom is called terminal dysuria – sufferers experience pain toward the end of urination because the bladder tightens painfully during emptying. A burning sensation, which is common with a urinary tract infection, does not typically occur with a classic irritable bladder without a known cause.
Irritable bladder symptoms lead to a high level of suffering and impair the quality of life. Affected persons are always anxious to be near a toilet. The loss of control over bladder continence sometimes means a severe cut in lifestyle. Anxiety may further aggravate the symptoms.
How is irritable bladder treated?
There is no single irritable bladder therapy. Rather, the physician will design it in coordination with the patient and his or her individual goals. Basic therapy options for irritable bladder include bladder training, pelvic floor training, biofeedback, nerve stimulation methods, medications and surgery. In addition, there is proper education and general tips from the doctor.
Education and general tips
The physician should also educate the patient about simple but important measures to improve his or her quality of life. These include information on proper intimate hygiene and the prevention of urinary tract infections. The latter occasionally exacerbate irritable bladder symptoms.
Often, even small changes in habits help to improve symptoms. For example, irritable bladder patients should avoid diuretic drinks shortly before sleeping. Throughout the day, however, it is very important to drink enough – this should not be reduced for fear of even more severe symptoms.
Bladder training, pelvic floor training, biofeedback
Bladder training, pelvic floor training, and biofeedback are effective treatments for irritable bladder, performed alone or in combination with medication. They aim to improve active control of urinary urgency.
In addition, the individual bladder capacity can be determined using a micturition protocol. Fixed toilet times are set in line with this so that urge incontinence does not occur. Initially, time intervals are determined according to the clock for toilet visits, which are then increased over time.
Regular pelvic floor training is also suitable for irritable bladder treatment. It strengthens the pelvic floor muscles, which support the urethral sphincter in its function. A combination of pelvic floor training and electrostimulation (electrotherapy, stimulation current therapy) is considered particularly effective for irritable bladder.
Biofeedback may also help with irritable bladder. You can learn more about this therapy method here.
Medication for irritable bladder
You can read more about how irritable bladder can be treated with medication in the article Irritable bladder – medication.
Stimulation of the nerves
Another therapy option or extension of drug therapy is stimulation current therapy: Over three to six months, the pelvic floor muscles are specifically activated with weak stimulation current. This is useful, for example, if drug therapy has not been successful or if the side effects, especially dry mouth or visual disturbances, predominate.
Surgical interventions
If the above-mentioned therapeutic methods do not offer any relief and the symptoms are very severe, surgical procedures may be considered as a last resort. For example, it is possible to surgically enlarge the urinary bladder (bladder augmentation), perhaps with a piece of the small intestine. Another option is removal of the bladder (cystectomy) with creation of a replacement bladder (neobladder) from sections of intestine.
Alternative irritable bladder therapy
Some sufferers rely on alternative therapies for irritable bladder in addition to conventional medicine – homeopathy, for example (such as homeopathic preparations containing Nux vomica). Yellow jasmine, Gelsemium, is also thought to help with overactive bladder. There is evidence that this plant has antispasmodic and anti-inflammatory effects.
Some irritable bladder patients report positive experiences with acupuncture.
There is no scientific evidence for the effectiveness of these alternative methods and home remedies so far. If the symptoms persist over a longer period of time, do not improve or even get worse, a visit to the doctor is advisable.
You can read more about which other herbal medications may be considered for irritable bladder in the article Irritable Bladder – Medications.
What are the causes of irritable bladder?
An irritable bladder often occurs as a result of pregnancy and childbirth, and especially with age. The causes of an irritable bladder are not yet fully understood scientifically.
Rarely, sexual or psychological trauma is the trigger for an irritable bladder.
A deficiency of estrogen, the female sex hormone, which typically occurs after menopause, sometimes triggers urge incontinence.
A fungal infection is not considered a cause of irritable bladder. Conversely, it is sometimes possible for frequent urination to soften the skin (called maceration). Maceration favors infection because potential germs can penetrate the softened skin more easily in the moist microclimate that is favorable for them.
Decrease of the bladder, vaginal region or uterine prolapse may cause incontinence, especially during exertion (such as coughing). In addition to painful urination, pain in the lower abdomen or spine and a feeling of pressure in the vagina sometimes occur here. Experts do not count this as overactive bladder, since incontinence triggered by other diseases is not included.
Irritable bladder is often considered an “embarrassing” problem by those affected. Nevertheless, this should not prevent anyone from openly discussing their condition with a doctor. If an overactive bladder is suspected, it is advisable to first contact the family doctor. If the diagnosis is confirmed, the doctor will refer the patient to a urologist or, in the case of women, to a gynecologist.
First of all, the doctor conducts an interview to get a better understanding of the problems (anamnesis). He may ask questions such as:
- Do you have to urinate more often than usual?
- Is the urge to urinate often urgent and sudden?
- Do you sometimes not make it to the toilet in time?
- Do you have to go to the bathroom frequently at night?
- Do you have pain when urinating?
- Are you taking any medications?
- How much do you drink during the day?
It is often helpful to keep a micturition log even before going to the doctor. In it, drinking quantity and toilet trips are recorded every day. These records help the doctor to find the causes of the “nervous” bladder.
Further examinations
The interview is followed by a physical examination to rule out organic causes as the reason for the symptoms of irritable bladder. This is based on an inspection of the urogenital tract. On this occasion, the prostate is examined in men and the uterus in women. These two organs sometimes cause similar symptoms.
The important alternative diagnosis to irritable bladder is urinary tract infection. To rule it out, a urine sample is taken and examined for pathogenic germs. In the case of an irritable bladder, the pathogen detection remains negative.
Alternatively, urologists perform a so-called urodynamic examination. With the help of pressure probes and electrodes, the function of the bladder and the urinary tract is checked. This allows the capacity of the bladder to be determined and the closure mechanisms (especially the bladder sphincters) to be tested.
A swab from the lower urinary tract may show whether a local estrogen deficiency is causing the symptoms of irritable bladder. Indeed, such a hormone deficiency leads to changes in the superficial cells, which can be detected by the so-called karyopycnotic index.
It is possible to start the therapy attempt with a drug from the group of so-called anticholinergics already in case of a suspected irritable bladder. If this is effective, the diagnosis is confirmed.
If the doctor suspects psychological or sexual trauma as a trigger for the irritable bladder symptoms, he or she will address the issue as sensitively as possible and, if necessary, include the psychosomatic aspects of the disease in the treatment.
What is the course of the disease and prognosis?
Sometimes a hyperactive bladder can be treated well by simple means, but an immediate remedy to calm the irritable bladder does not yet exist. Therapy is occasionally difficult and protracted. In most cases, however, the treatment at least significantly alleviates the irritable bladder symptoms, even if it does not always eliminate them completely.
Medical monitoring of irritable bladder is very important. The treating physician should always weigh up the effects and side effects of the therapy. In addition, it is advisable to regularly check the function of the urogenital tract in order to detect and treat damage caused by the irritable bladder at an early stage.
