The bladder also has "ADHD" (I)

This is the 3371th article of Da Yi Xiao Hu

Everyone may have heard of ADHD in children. It is a psychological disorder characterized by attention deficit and hyperactivity that is not commensurate with age and development level, often accompanied by learning difficulties, conduct disorders and maladjustment. The main manifestations are inattention and short attention span. It is often difficult to maintain attention when listening to classes, doing homework or other activities, and it is easy to be distracted by external stimuli. There are also too many activities, often appearing restless, with many small movements of hands and feet, unable to sit quietly, twisting and turning in the seat, and difficulty in engaging in quiet activities or games, so it is called ADHD.

Little do people know that the bladder also has "ADHD". In clinical work, I have encountered many patients with "ADHD" bladder who were mistaken for chronic urinary tract infection. These patients have had symptoms of frequent urination and urgency for many years, and have always thought that they have chronic urinary tract infection. Sometimes positive white blood cells are found in the urine, but in most cases the results are negative. After systemic anti-infection treatment, the patients have no effect, and they still have frequent urination and urgency, and in severe cases, they will suffer from urinary incontinence.

After examination, and excluding other diseases, it is not a urinary tract infection, but an overactive bladder. Simply put, the bladder smooth muscle is more active. Even if your brain does not issue a command for it to work, it will work on its own, contract, and produce the urge to urinate, leading to symptoms of frequent urination and urgency. On the premise of confirming the safety of use, I will prescribe M cholinergic receptor antagonists to such patients. This type of drug can inhibit the contraction of bladder smooth muscle. After using this drug, the symptoms of frequent urination and urgency can be improved.

Frequent urination

Normal people usually urinate 4 to 5 times during the day and 0 to 1 time at night. Urinary frequency exceeding this range is called frequent urination. Frequent urination is divided into physiological frequent urination and pathological frequent urination. Frequent urination caused by drinking a lot of water, mental stress, etc. is physiological frequent urination. The following situations can cause pathological frequent urination:

(1) Inflammatory stimulation: When the urinary tract is infected, the sensitivity of the bladder mucosa increases, causing the urinary urge center to remain in an excited state.

(2) Mechanical stimulation: Mechanical stimulation of the bladder mucosa by foreign bodies, tumors, stones, etc. in the bladder can cause frequent urination.

(3) Irritation of organs adjacent to the bladder: Diseases such as acute appendicitis, pelvic infection, seminal vesiculitis, and pelvic tumors can all stimulate the bladder and cause frequent urination.

(4) Decreased bladder capacity: True bladder capacity reduction is seen in space-occupying lesions in the bladder (such as bladder tumors and stones), compression outside the bladder (such as tumors in the abdominal cavity, pregnant uterus), bladder contracture (bladder tuberculosis), and lower urinary tract obstructive diseases (such as prostatic hyperplasia, urethral stenosis) that cause excessive residual urine and reduced bladder effective capacity.

(5) Neurological diseases: Multiple sclerosis, Parkinson's disease and other neurological diseases can cause urination reflex disorders, which can lead to frequent urination.

(6) Overactive bladder caused by various reasons. It can be seen that frequent urination is not only caused by urinary tract infection.

Urgent need to urinate

It refers to the sudden strong urge to urinate and the urgent need to urinate. The mechanism of urinary urgency is that the nerve endings of the bladder and urethra are severely stimulated, so that the excitability of the spinal micturition center exceeds the inhibitory effect of the supraspinal micturition center, or the inhibitory effect of the supraspinal micturition center is weakened. The most common causes of urinary urgency are bladder (especially the bladder trigone) and posterior urethra inflammation, stones, etc., often accompanied by frequent urination and painful urination. The more severe the inflammatory stimulation, the more severe the urinary urgency. In addition, patients with overactive bladder caused by various reasons, detrusor hyperreflexia caused by neurological diseases, and anxious patients without urological surgical diseases may also experience urinary urgency symptoms. It can be seen that urinary urgency is not only caused by urinary tract infection.

Urinary incontinence

Urinary incontinence refers to the uncontrolled overflow of urine from the bladder into the urethra. It can be divided into the following four types according to the occurrence mechanism.

(1) Stress urinary incontinence: involuntary leakage of urine occurs when coughing, laughing, sneezing, or other actions that increase abdominal pressure. It is more common in women with loose pelvic floor structures.

(2) Filling incontinence: Long-term chronic obstruction of the lower urinary tract causes urinary retention. The expanded bladder reaches the limit of compliance. When the urine volume increases and the intra-bladder pressure exceeds the maximum urethral pressure, urine will be involuntarily discharged. This is common in prostate hyperplasia, neurogenic bladder, etc.

(3) True urinary incontinence: The external urethral sphincter is damaged or accompanied by neurological dysfunction and cannot close, resulting in loss of the ability to control urination and involuntary leakage of urine.

(4) Urge urinary incontinence: involuntary urine discharge caused by a strong urge to urinate. Patients with this condition often have to go to the toilet immediately when they feel the urge to urinate, otherwise they will wet their pants. It is often seen in clinical practice in urinary tract infections, overactive bladder, etc.

Overactive bladder (OAB)

In the above discussion of the causes of frequent urination, urgent urination, and urinary incontinence, a disease called overactive bladder was mentioned. Normal people can control their bladders at will, and can delay or interrupt urination at will within a certain period of time when they do not want to urinate. However, some patients urinate significantly more frequently and cannot hold back their urination. When they feel they need to urinate, it is too late, and they even urinate in their pants, which is urgency urinary incontinence. Most people think they have a urinary tract infection, but when they go to the hospital for a checkup, the urine routine test is normal. What's going on? In fact, this is caused by the involuntary contraction of the bladder detrusor muscle.

Overactive bladder, also known as unstable bladder or bladder detrusor instability, refers to the spontaneous or cough-induced uninhibited contraction of the bladder detrusor during the storage period. According to the standards of the International Control of Urinary Incontinence Society (ICS), if the detrusor has an involuntary contraction during the bladder filling period and the intensity reaches 15 cm of water column, it can be considered that the bladder is unstable. Clinically, unstable bladder is a disease with frequent urination, urgency and/or urgency incontinence as the main symptoms. When the patient feels the urge to urinate but can still control it, urinary incontinence will not occur with the help of the normal distal urethral sphincter, and clinical manifestations are only frequent urination and urgency. The diagnosis of overactive bladder is mainly based on the clinical manifestations of frequent urination, urgency and urgency incontinence, as well as urodynamic examinations. Before diagnosis, it is necessary to exclude diseases such as acute and chronic cystitis, lower urinary tract obstruction, stress urinary incontinence, and inflammation of the male reproductive system.

(To be continued)

Author: Shanghai Fifth People's Hospital Affiliated to Fudan University

Wang Wei, deputy chief physician