Constant urge to urinate and involuntary loss of urine – but only a few drops of urine are let out when going to the toilet: If no cause can be found for these symptoms, the diagnosis of irritable bladder is often made. But what really helps against the agonizing symptoms? Numerous medications promise help for irritable bladder, but side effects often occur during therapy. In mild cases, a change in lifestyle combined with pelvic floor training can usually improve the symptoms. In cases of severe suffering, there are also various options for influencing the nerves responsible for bladder function.
Constant urge to urinate: symptom of irritable bladder
In “overactive bladder syndrome,” as an irritable bladder is known in medical circles, the bladder reports an urge to urinate – usually suddenly and urgently – despite a low urine output. Those affected may have to go to the toilet more than 20 times in 24 hours, even at night. Typically, only small amounts of urine can be passed each time. Some irritable bladder patients also leak urine involuntarily. Depending on whether or not there is bladder weakness (urge incontinence), a distinction is made between a wet and a dry irritable bladder. Pain or burning during urination, on the other hand, is less common with an irritable bladder – these symptoms are more characteristic of cystitis or other urinary tract infections.
Cause: overactivity of the bladder muscles.
The exact cause of irritable bladder is unknown. It is thought that the regulation of bladder muscle activity is disturbed, so that the bladder muscle contracts even though the bladder is only slightly full. The following factors can potentially promote the development of irritable bladder or exacerbate symptoms:
- Nervousness, stress or psychological strain.
- Hormonal changes, such as a lack of estrogen in women.
- Age-related changes in the urinary tract
- “Mistraining” of the bladder: years of too frequent or too infrequent trips to the toilet.
- Chronic constipation, obesity or pregnancy (due to increased pressure on the bladder).
- Uterine prolapse in women
- Enlargement of the prostate in men
Irritable bladder: rule out pathological causes
An irritable bladder is – similar to an irritable bowel – a diagnosis of exclusion. This means that the diagnosis is only made when, despite extensive diagnostics, no disease can be found as the cause of the symptoms. As a rule, the doctor first asks about the symptoms, drinking and eating habits, and possible previous illnesses. In most cases, the patient is then asked to keep a diary for a few days in which he or she records the frequency of toilet visits, the amount of urine passed, and drinking behavior. In addition, a physical examination and an ultrasound of the urinary bladder are usually performed. It is also useful to examine blood and urine to rule out diseases or infections of the urinary tract.
Advanced diagnostics in unclear cases
Under certain circumstances, further examinations may be necessary, such as an X-ray examination of the bladder and urethra with contrast medium (micturition cystourethrography), urine flow measurement (uroflowmetry) or urinary bladder pressure measurement (urodynamics or cystometry). If certain diseases of the urethra and bladder are suspected, a cystoscopy may be performed – this can rule out bladder cancer, for example.
Start treatment without medication
At the beginning of the treatment of an irritable bladder, an attempt should first be made to get the symptoms under control without medication. A combination of behavioral therapy and pelvic floor training has proven effective for this purpose. Behavioral therapy is carried out on the basis of a guided diary. Through the diary, drinking and toileting behavior can be analyzed to create a plan for bladder training: This involves actively suppressing the urge to urinate in order to gradually increase the intervals between toilet trips.
Pelvic floor training: more effective with biofeedback
Pelvic floor training, which is best performed under the guidance of physiotherapists, particularly counteracts bladder weakness and thus involuntary loss of urine. The training effect can be enhanced by biofeedback, whereby electrodes stuck to the perineal area measure the muscle tension of the pelvic floor and convert it into visible signals.Especially in mild forms of irritable bladder, such conservative therapy can often achieve a significant improvement.
Electrostimulation: help for irritable bladder.
A study analysis found that stimulation of the pelvic floor muscles by electrical pulses can be an effective way of treating irritable bladder. This involves either placing an electrode in the vagina or anus or inserting a fine electrode needle into a superficial nerve in the ankle area. The current pulse is intended to reduce the activity of the bladder muscle – this therapy is particularly effective when used in conjunction with pelvic floor muscle training.
Medications for irritable bladder
So-called anticholinergics are usually used to treat irritable bladder with medication. They block receptors on the bladder muscle and can thus reduce its activity. There are various active ingredients to choose from, such as tolterodine (Ditropan), trospium chloride (Spasmex) and darifenacin (Emselex). In women, estrogen preparations applied locally in the vagina can also lead to improvement.
Side effects are common
Anticholinergics are usually effective for irritable bladder, but side effects are common with therapy, such as:
- Nausea
- Dry mouth
- Constipation
- Palpitations (tachycardia)
- Visual disturbances
- Increase in intraocular pressure
It is important to be patient during treatment, because the drugs do not help immediately – usually the effect occurs only after a few weeks. Completely curable is an irritable bladder only rarely, but often a significant improvement can be achieved.
Surgery for irritable bladder: help in severe cases.
If the symptoms do not improve sufficiently despite all measures, there are surgical options for treating an irritable bladder: for example, botulinum toxin (Botox) can be injected into the bladder wall during a minor procedure to partially paralyze the bladder muscle. Another option is to insert electrodes to the nerve roots in the sacrum. The effect comes from stimulating nerves that control bladder activity (sacral neuromodulation). Research is ongoing to determine whether injecting medication into the interior of the bladder (EMDA therapy, Electro Motive Drug Administration) is an effective treatment option for irritable bladder. Last options if all treatment measures fail are bladder augmentation, which is surgical enlargement of the bladder, or urinary bladder replacement.
Treating irritable bladder naturally
There is no scientific evidence for the effectiveness of alternative medical therapies such as homeopathy or Schüßler salts. Nevertheless, if the diagnosis of an irritable bladder is confirmed – that is, if serious diseases have been safely ruled out by a doctor – there is nothing to be said against trying natural treatment using alternative medicine.
5 Tips that help against an irritable bladder
In addition, you can do something yourself to alleviate the discomfort. We have compiled five tips for you that can help with an irritable bladder:
- Avoid irritating foods: Some foods can irritate the bladder. These include citrus fruits, tomatoes, carbonated drinks, hot spices, and artificial sweeteners, flavors and preservatives. Nicotine can also irritate the bladder.
- Get the bowels moving: Constipation intensifies the symptoms of an irritable bladder, because the filled bowel presses on the bladder. Regular digestion thus has a positive effect on an irritable bladder.
- Reduce excess weight: Also with excess weight, the pressure on the bladder is increased. So if you have an irritable bladder, it is recommended to reduce excess pounds.
- Avoid diuretic substances: Coffee and alcohol have a diuretic effect and can thus increase the symptoms of an irritable bladder. Attention: in some over-the-counter medicines such as Cystinol and in most kidney and bladder teas are herbal active ingredients that have a diuretic effect. These preparations are suitable for the concomitant treatment of urinary tract infections, but they are counterproductive in the case of an irritable bladder.
- Change drinking behavior: Be sure to drink fluids evenly throughout the day. To counteract nocturnal urge to urinate, you should drink as little as possible two hours before going to bed.Limiting the amount you drink each day can reduce the urge to urinate, but it should still not be less than one to one and a half liters of fluid per day.
Irritable bladder in children well to treat
Irritable bladder occurs more frequently with age – but even children can suffer from irritable bladder. In children, however, an overactive bladder muscle does not appear to be the cause. Rather, it is assumed that the bladder control system is not yet fully developed. This is then manifested by enuresis, which can occur at night as well as during the day. The treatment of irritable bladder in children is similar to the treatment of adults: Bladder and pelvic floor training combined with behavioral therapy often leads to improvement in children. In addition, some of the medications for irritable bladder are suitable for use in children and are often better tolerated by them than by adults.
Irritable bladder or bladder irritation?
By definition, irritable bladder must not have a pathological change in the urinary tract, genitals, metabolism, nervous system or endocrine system as the cause of the symptoms. However, there are numerous diseases that cause bladder irritation and thus manifest themselves through symptoms similar to those of an irritable bladder, namely a constant urge to urinate. Here is an overview of possible causes of constant urination.
