If you have urinary urgency and frequent urination, it may be an overactive bladder!

Author: Liao Limin, Chief Physician, Beijing Boai Hospital

Vice Chairman of the Neuromodulation Committee of the Chinese Medical Doctor Association

Reviewer: Guan Youyan, deputy chief physician, Cancer Hospital, Chinese Academy of Medical Sciences

Overactive bladder is a syndrome with urinary urgency as the core symptom, accompanied by urinary frequency, nocturia, or urge incontinence.

Figure 1 Original copyright image, no permission to reprint

According to epidemiological surveys in my country, the incidence of overactive bladder is about 11.8% among people over 18 years old, with women slightly higher than men. Despite the high incidence, few patients seek medical treatment.

First, cultural factors. People think this is an embarrassing problem and are reluctant to see a doctor because they feel ashamed.

Second, they think this problem is not important and does not affect their eating and drinking, so they do not see a doctor for economic reasons.

Third, some people think that this is not a disease, especially the elderly. They think that frequent urination is normal at old age and there is no need to see a doctor.

Fourth, they don’t know there is a way to treat it. They think that this is what it’s like to get old and don’t believe there is a good way to solve this problem.

Unless the condition becomes extremely serious and seriously affects the quality of life, and you have to see a doctor as a last resort, the incidence of severe overactive bladder is still relatively low.

1. Why does overactive bladder occur?

The cause of idiopathic overactive bladder cannot be found at present, but when inquiring about the medical history, many patients have a history of poor urine holding. Some have held urine once and then began to urinate urgently and frequently, but examinations could not find the cause. This is called idiopathic overactive bladder.

There is another category with clear causes, such as prostate hyperplasia, stress urinary incontinence, chronic cystitis, bladder aging, etc.

Is there a psychological link to overactive bladder?

Most of the time, overactive bladder causes psychological or even mental disorders, such as not being able to sleep all night and sitting on the toilet every day, which causes anxiety and depression. The psychological pressure and mental impact of overactive bladder are very serious. Psychological and mental disorders, in turn, aggravate the symptoms of overactive bladder.

Overactive bladder is a symptomatic diagnosis. As long as the symptoms of urinary urgency, frequent urination, and urge incontinence are met, it can be diagnosed as overactive bladder. However, we still need to do corresponding examinations to exclude organic diseases such as bladder tumors and bladder stones to avoid missed diagnosis and misdiagnosis.

2. How to treat overactive bladder?

Overactive bladder is treated in a gradual, step-by-step manner.

First, change your bad lifestyle habits, such as drinking strong coffee or strong tea. Some people get up four or five times a night and cannot sleep well, which is because they keep drinking strong coffee or tea at night.

If changing bad behavior does not work, you can do bladder training. Simply put, it means holding back urine. Don't go to the toilet as soon as you have a little urine. This will form a vicious cycle and the bladder will become smaller and smaller. When you have to urinate, you should gradually delay going to the toilet and hold more urine. Of course, sometimes the patient cannot hold on and feels very uncomfortable. It feels like the urine is about to leak out. At this time, some medication can be used to assist.

Another behavioral therapy method is called pelvic floor muscle training, which can achieve the therapeutic goal by contracting the anus and pelvic floor muscles to feedback inhibit bladder contraction.

If behavioral therapy is not effective, you can start drug therapy, or combine drug therapy with behavioral therapy. The main drugs currently used are bladder relaxants. The most commonly used drugs are M receptor blockers, which are common and commonly used in China, such as tolterodine, solifenacin, and propiverine. These drugs can relax the smooth muscles of the bladder. There is also another drug called β3-receptor agonist, which is a relatively new drug that can indirectly relax the bladder.

In addition, it can be combined with psychological treatment, such as anti-depression, anti-anxiety, etc.; if combined with prostate hyperplasia, some drugs to treat prostate hyperplasia can be used.

If drug treatment is not effective, you may need to enter the second-line treatment, which is minimally invasive treatment. There are two main minimally invasive treatment methods, namely bladder pacemaker and botulinum toxin type A bladder wall injection, which are currently very effective and advanced methods for treating overactive bladder.

Figure 2 Original copyright image, no permission to reprint

If the second-line treatment is still ineffective, the third-line treatment is open surgery. In the late stage of overactive bladder, some patients' bladders may become smaller and smaller. Cut a section of intestine, which can be large intestine or small intestine, cut open the bladder, sew the intestine to the bladder, and expand the bladder. In more serious cases, urinary diversion can be performed, and a stoma can be made to let urine flow out from the abdominal wall.

The following are some of the common methods for treating overactive bladder.

3. Can overactive bladder be cured?

Overactive bladder is sometimes difficult to cure and has a high chance of recurrence. Patients who receive medication usually need to take medication for a long time. In some cases, patients stop taking medication after taking it for 1-2 years and gradually get better.

For patients who repeatedly relapse after drug treatment, this refractory overactive bladder can only be treated with a bladder pacemaker or repeated injections of botulinum toxin type A. One injection of botulinum toxin type A can last at least three months. Some patients will gradually get better after a bladder pacemaker or botulinum toxin type A injection, and some cases can be cured.