A brief discussion on overactive bladder

This is the 3181th article of Da Yi Xiao Hu

Aunt Lin next door is 52 years old and has been having problems lately. In the past three months, she has been suffering from frequent urination, urgency, and increased nocturia, and sometimes even urinary incontinence. This has never happened before.

For this reason, she went to the urology department of a nearby tertiary hospital for treatment today. After the doctor asked about the medical history, he initially considered urinary tract infection. He gave blood and urine routine and urinary system color Doppler ultrasound examinations. Xiao Lin asked the doctor: "What is urinary tract infection?" The doctor gave Aunt Lin some knowledge in this area. Urinary tract infection is divided into upper urinary tract infection and lower urinary tract infection. Upper urinary tract infection generally refers to acute or chronic pyelonephritis, and lower urinary tract infection generally refers to acute or chronic cystitis and urethritis. Therefore, Aunt Lin's initial judgment is that chronic cystitis among urinary tract infections is likely.

According to the examination results, there was no abnormality in the urinary system ultrasound, and the results of blood and urine routine tests were normal. The diagnosis of urinary tract infection was not established. Aunt Lin asked the doctor, "Since urinary tract infection has been ruled out, what disease could it be?" Based on the examination results and medical history, the doctor considered overactive bladder to be a high possibility. Then he patiently explained the situation to Aunt Lin. The International Urinary Continence Association defines overactive bladder as a syndrome manifested by urinary urgency symptoms, which may or may not be accompanied by urge incontinence, and is usually accompanied by increased frequency of urination during the day and at night.

Overactive bladder usually causes storage symptoms, which are attributed to overactivity of the detrusor muscle, manifested as involuntary contractions of the detrusor muscle during bladder filling. Uninhibited detrusor contractions can be detected by bladder pressure-volume measurement in urodynamic examinations. Therefore, if you want to make a clear diagnosis, you can do a urodynamic examination. Since urodynamic examination is an invasive examination, based on the current test results and symptoms, the doctor prescribed an M receptor blocker for Aunt Lin. Of course, after asking clearly that there is no glaucoma. Because M receptor blockers are contraindicated for patients with glaucoma. Pay attention to rest, do not overwork, and avoid alcohol, coffee and spicy food. Come to the hospital for a follow-up visit in two weeks.

Aunt Lin took the medicine home with a trepidation. After taking it for a week, it started to work. After taking it for 2 weeks, the symptoms were significantly relieved. When she went to the hospital for a follow-up visit, the doctor asked about the situation and recommended that Aunt Lin take the medicine for at least 3 months. Aunt Lin asked the doctor, "What is the cause of this disease? Can it be prevented?" The doctor told her that the cause of the disease is still unclear, and it is currently believed to be related to the following 4 factors:

1. Detrusor instability: caused by non-neurogenic factors, abnormal detrusor contraction during the storage period causes corresponding clinical symptoms;

2. Bladder sensitivity: the urge to urinate occurs at a smaller bladder capacity;

3. Abnormal urethra and pelvic floor muscle function;

4. Other reasons: such as mental and behavioral abnormalities, hormone metabolism disorders, etc.

Therefore, some mild cases can be treated through behavioral therapy. For example, through bladder training, bladder contraction can be inhibited and bladder capacity can be increased. For example, through biofeedback, self-control can be learned to achieve the purpose of inhibiting bladder contraction. For example, pelvic floor muscle training can inhibit bladder contraction by contracting the pelvic floor muscles. Through communication, Aunt Lin also learned a lot of knowledge in this area.

Aunt Lin learned a lot during the diagnosis and treatment of this disease. Have you readers also learned anything?

Author: Gu Wei