Bladder hypersensitivity treatment. Treatment of an overactive bladder in women

An overactive bladder is a syndrome that presents with symptoms such as an urgent need to urinate, increased frequency of urination, and sometimes urinary incontinence.

But what are the reasons? What are the treatment options and what natural remedies can alleviate the condition?

What is overactive bladder syndrome

Overactive Bladder Syndrome is a disorder characterized by increased frequency of urination And urgent need do this, in the absence of urinary tract disease.

From the latest data it follows that:

This disease affects 15-17% of the population;
40% men and 60% women;
In general, about 50 million people in the world suffer from overactive bladder.

However, the disorder may be much more common, and the reported data may be grossly underreported, as shame or fear of being judged by others causes many patients to avoid seeking medical attention.

Mechanism of overactive bladder syndrome

The pathophysiology of overactive bladder syndrome is associated with bladder detrusor muscle changes. Under normal conditions, this muscle is controlled by a neural network located at the level of the brain. In particular, the urinary control center is located at the level of the frontal cortex. In general, the mechanism of urination is under the control of this network.

For various reasons, some of which are not yet known, this control network is causing involuntary and frequent contractions of the detrusor muscle leading to an urgent need to urinate.

Overactive bladder can be divided into two forms:

Wet overactive bladder when, along with the need to urgently urinate, involuntary loss of urine (incontinence) occurs.
Dry overactive bladder occurs when there is an urgent need to urinate and increased frequency of urination, but there is no involuntary loss of urine.

In addition, a distinction can be made based on association with neurological disease:

Bladder overactivity in neurological diseases: associated with causes that affect the nervous system.
Bladder overactivity without neurological disease: when proven that the causes lie outside nervous system.

Symptoms can be confused with other diseases

The symptoms of an overactive bladder are not entirely specific, and can sometimes be confused with other conditions that have similar symptoms.

Among the symptoms of this syndrome, we note:

Urgent need to urinate: a characteristic feature of this syndrome. The patient experiences an urgent urge to urinate, and this symptom can manifest itself at any time of the day: on its own, after exertion, during coughing, or during emotional events.
Urinary incontinence: Some patients suffering from overactive bladder syndrome have urinary incontinence.
Increased frequency of urination: A subject suffering from overactive bladder syndrome may go to the toilet many times a day, many times above the normal threshold, in particular 8 or more times a day.
nocturia: People with this syndrome have an urgent urge to urinate not only during the day, but also at night, this leads to frequent awakenings and poor quality sleep. On average, nocturia is characterized by two episodes of urination per night, but sometimes it can be many more.

Several Causes of an Overactive Bladder

Overactive bladder syndrome can be caused by certain medical conditions, sometimes associated with neurological problems. The latter can be both the determining cause and one of the reasons for the aggravation of the symptoms of the syndrome.

Among reasons pathological , we will highlight:

Bladder anomalies: This includes both tumors or stones in the bladder, which can interfere with normal urinary function, and benign hyperplasia the prostate, which puts pressure on the urethra, causing urination disorders.
Neurological disorders: The most severe form of overactive bladder is associated with changes in the central or peripheral nervous system. Among these diseases we have sclerosis, stroke and Parkinson's disease (typical of the elderly).
Increased urine production: a metabolic disorder such as diabetes mellitus or kidney failure may lead to increased urine production.
Obesity: Excessive weight gain leads to increased pressure on the lower abdomen, and, accordingly, bladder contraction. This can lead to an overactive bladder with excessive tension on the urethral sphincter, leading to incontinence.

All non-pathological causes, as a rule, are derived from disorders of a psychological nature or are associated, for example, with lifestyle or personality characteristics:

Pregnancy and childbirth: is one of the main causes of overactive bladder in women. For pregnancy and childbirth lead to a weakening of the pelvic floor muscles and a decrease in contractile strength.
Age: most often the phenomenon of overactive bladder is observed in the elderly. This is because all the control mechanisms (neurological) of urination weaken with age.
stress and anxiety: sometimes an overactive bladder can be associated with stress or excessive anxiety, which causes an increase in the frequency of urges.
Surgery: operations that may affect the spinal nerve (for example, in the case of repair of a herniated disc), or that concern the gastro-urogenital area, may lead to disturbances in the transmission of nerve control over urination.
Menopause: The lack of estrogen in menopausal women is usually associated with frequent urge to urinate and urinary incontinence.
Medications: Those who take drugs that increase urine production, such as diuretics, may suffer from overactive bladder due to excessive urine production.
smoking and diet: Although an exact correlation with overactive bladder has not been proven, it seems that those who smoke cigarettes and consume alcohol and caffeine in large quantities are more likely to suffer from this disorder.

Correct diagnosis improves quality of life

Diagnosing the causes of overactive bladder is critical to a patient's quality of life.

To make a correct diagnosis, the doctor uses the following methods:

Anamnesis: includes a conversation with the patient about the clinical history of the disease. The patient is asked whether he has had episodes of urinary incontinence, how many times he gets up at night, whether he often feels an urgent need to urinate, whether he manages to get to the toilet or involuntary losses occur.
Survey: carried out by inspection abdominal cavity and urinary tract. In women, a pelvic exam is performed to see the condition of the pelvic floor muscles, in men, a prostate exam.
Level 1 analyzes: necessary for differential diagnosis with diseases such as cystitis, irritable bowel syndrome, urinary tract infections and the presence of stones in the bladder or kidneys.
Urodynamic test: used to evaluate the process of filling and emptying the bladder to rule out urinary stasis (i.e., the bladder does not empty completely during urination), which can lead to symptoms similar to overactive bladder syndrome. This test can be combined with uroflowmetry, which evaluates the volume and speed of urine flow.
Other level 2 examinations: in order to exclude dangerous diseases such as tumors in the bladder or changes in muscle contractility. These studies include cystometry, electromyography, and urethrocystoscopy.

Treatment for an overactive bladder

Overactive bladder medications are used to control the malfunction.

Among the drugs used are:

Antimuscarinic: these drugs act on muscarinic receptors, thus regulating detrusor muscle contractions and reducing their intensity and frequency. The most commonly used are oxybutynin, darifenacin and tolterodine.
Adrenoreceptor agonists: act on different categories of beta-3 adrenergic receptors, due to which they cause relaxation of the detrusor muscles and, therefore, increase the capacity of the bladder. This category includes one of the new drugs for the treatment of overactive bladder - mirabegron.

one more possible option treatment is medico-surgical therapy if medications have not given the expected results.

Among these methods are:

Botox: to influence the contraction of the detrusor muscle, botulinum toxin can be injected directly into the tissues of the bladder. This causes numbness in muscle tissue, which reduces the frequency and intensity of contractions. Used mainly in patients who suffer from overactive bladder associated with neurological diseases such as multiple sclerosis. The effect of the injection lasts from 6 to 9 months, after which the introduction of the toxin is repeated.
Bladder expansion surgery: also known as enterocystoplasty. This operation aims to expand the bladder surgically so that it becomes larger and can hold more urine. Used rarely and only in severe cases where all other treatments have failed.
Cystectomy: used in very severe cases or in the presence of a bladder tumor. It consists in the complete removal of the bladder and the performance of a ureterostomy with the installation of an external bag to collect urine.

Lifestyle with overactive bladder

With proper therapy, overactive bladder syndrome can be completely cured. However, you should know some behaviors that will, if not get rid of the disorder, then minimize the symptoms.

Avoid certain foods eg caffeine-rich foods such as coffee, alcohol and those that can irritate the urinary tract such as spices and highly acidic foods (such as citrus fruits). Instead, fiber-rich foods such as whole grains and vegetables should be consumed to help avoid constipation that causes straining during bowel movements. In addition, reducing your intake of fats and processed foods will be helpful to keep your weight under control.
To give up smoking, as nicotine can irritate the tissues of the bladder and cause recurrent coughing episodes that lead to urinary incontinence.
Do any gymnastic exercises designed to strengthen the pelvic floor muscles. The most famous are Kegel exercises.
double urination, after you have finished urinating, wait a few minutes and try to urinate again to remove any remaining urine.
Keep a urinary diary, in which to note how many times they went to the toilet during the day and at night, whether there were episodes of urinary incontinence. It should be noted how much time passes between urination and how much urine is produced.
Train your bladder or trying to resist the urge to urinate. Once you feel the urge, wait a few minutes before heading to the bathroom, gradually increasing your waiting time from a few minutes to several hours.

Bladder overactivity is a disease that is manifested by disturbances in the initiation of urges, urinary incontinence, and a significant increase in small trips. According to statistics, such a pathology overtakes every fifth inhabitant of the planet, regardless of the country of residence. An overactive bladder is more common in middle-aged women than in men. After 60 years, the statistics are equalized.

Not everyone who suffers from it knows about overactive bladder (OAB) as a disease. Most patients hide the problem, considering it shameful. Since urination disorders increase gradually, a person explains them by personal characteristics, inevitable age-related changes. As the problem grows, a person isolates himself, reduces contacts to a minimum. So the medical problem develops into a social one. A non-life-threatening disease reduces the patient's quality of life to nothing.

A person is born without being able to control the acts of urination. A newborn urinates unconsciously (involuntarily). But already by the age of 6 months, the baby begins to show anxiety before peeing. By the age of two, a small person learns (with the patient work of the mother) to restrain the act of urination for a short time. He begins to urinate consciously (voluntarily). The developing syndrome of an overactive bladder is a rollback of the body to involuntary urination.

The bladder has two "working muscles":

detrusor - the initiator of the release of the bubble;
sphincter - holds urine, allowing it to accumulate.

The average urinary of a healthy person has a rounded shape, is able to hold up to 300 ml of urine. The daily rate of urination for an adult is about 8 times during the day and 1-2 times per night.

A healthy urination process is a coordinated work of nerve receptors, conductive fibers, muscle groups. When the organ is empty, the detrusor is relaxed, the sphincter is tense, compressed. As urine accumulates, signals about the state of the bladder are transmitted to special sections of the spinal cord and brain. A person feels the initial urge to go to the toilet when the bladder is half filled. Normally, the detrusor initiates urination when the organ is 2/3 full. Healthy man at this time, if he is out of the house, he is actively looking for a toilet, holding the beginning of the process with muscle effort.

With GAMP, the mechanism breaks down. Irresistible (urgent) urges occur with small volumes of urine, sometimes a few drops. characteristic feature OAB is the impossibility of volitional effort to control the beginning of the process of urination - it becomes involuntary, independent of the patient's consciousness.

Causes and factors for the development of pathology

Hyperactivity develops for various reasons. None of the urologists consensus about whether it is an independent disease or a characteristic symptomatology that accompanies other diseases.

It is customary to single out the nature of the causes that cause OAB. They are divided into:

idiopathic - not exactly established (fixed in 65% of patients);
neurological - uncontrolled initiation of the detrusor is caused by neurological pathologies (24% of patients).

Neurogenic hyperactivity has no selectivity for sex or age. It develops when the chain that conducts nerve impulses from the bladder to the spinal cord and further to the higher parts of the brain is damaged. The cause is traumatic injuries of the brain, spinal cord, atherosclerotic changes in the vessels of the brain, Parkinson's disease, malignant tumors in the brain, spinal cord, cerebral hemorrhages.

The mechanism of development of idiopathic hyperactivity is associated with a decrease in blood circulation (ischemia) of the detrusor tissues and impaired conduction of nerve impulses. This provokes overexcitation in the detrusor tissue cells - a violation of the nervous regulation of the urination process develops. A slight stretching of the muscle tissue in the center of overexcitation is transmitted to the entire bladder, it contracts.

The remaining 11% of patients are women in whom the pathology develops without disturbances in the work of the detrusor. In this group, as a rule, women are post-menopausal. They have a violation of the urinary system, urinary incontinence develops against the background of a weakening of the sphincter.

Factors leading to the development of OAB

Factors provoking the development of pathology of the bladder are:

Belonging to the female sex.
Age-related changes in the body.
Depression, chronic stress.
organic diseases.
Excessive fluid intake, especially at night.

In women, the predisposition to urination disorders is explained by physiological characteristics - a short urethra, post-natal trauma, prolapse or displacement of the genitourinary organs. In addition, women naturally have a low level of serotonin, which decreases with age, in stressful situations, and with hormonal disruptions.

Senile OAB is associated with impaired blood circulation in the pelvic organs, proliferation of connective tissue. This is reflected in the work of the nerve endings of the urinary system - the contraction of the detrusor becomes uncontrollable.

Diseases in which OAB develops:

obesity;
mental retardation, dementia;
diabetes;
stroke;
spinal hernia;
frequent cystitis.

An overactive bladder in men develops mainly after 60 years, with the development of pathologies in the prostate gland. Adenoma, prostatitis, surgical interventions, in addition to urinary retention, can provoke its uncontrolled, frequent outflow.

Unfavorable working conditions (cold, chemical pollution), weight lifting contribute to the development of frequent, uncontrolled urination.

An overactive bladder in children can be due to the following reasons:

after a strong fright;
in unfavorable conditions in the family;
as a reaction to a strong fright, stress;
congenital overexcitability of the nervous system;
congenital malformations of the urinary system;
the habit of drinking at night.

Periodic urinary incontinence in a child is considered normal until the age of 5. However, frequent episodes should encourage parents to visit a doctor.

Clinical picture

Urinary hyperactivity is diagnosed with the following criteria:

the patient urinates more than 10 times a day;
drip leakage;
at least 2 times a day there are sudden, irresistible urges;
incontinence is fixed;
nocturnal diuresis exceeds daytime (nocturia).

The most common symptom of an overactive bladder is frequent trips to the bathroom. Characterized by sudden episodic urges of such strength that the patient does not have time to run to the toilet. Systematic incontinence is less common, it is typical for age-related patients (both men and women).

With neurogenic disorders, a violation of the process of urination is noted. This:

presence of residual urine;
jet interruption;
difficulty initiating the process with strong urges.

Adolescents and young women may complain of urine leakage while standing, during physical exertion, while laughing, coughing.

Symptoms may vary. If you regularly experience two of these symptoms, then you should consult a urologist.

Establishing diagnosis

Diagnosis of OAB begins with a questioning of the patient, studying his anamnesis and life characteristics. Gynecological or urological pathologies, surgical interventions, injuries, the presence of hormonal pathologies, diabetes mellitus, and obesity are especially noted.

The next step will be a urination diary. The patient is offered to record all trips "in a small way" with fixation of time, urge strength, urgency, features and volume of excreted urine. Separately fix all consumed liquid.

Instrumental studies include ultrasound of the bladder, urinary tract, kidneys, uterus, or prostate. Conduct laboratory tests of urine. According to indications, MRI, urodynamic examination, internal examination with a cystoscope can be performed.

If necessary, the patient is referred for a consultation with a neurologist, endocrinologist.

Treatment

Before proceeding with the treatment of OAB, the identified pathologies of the urinary and reproductive systems are treated. The leader among inflammatory diseases that cause symptoms of an overactive bladder is cystitis.

There is no single approach to the treatment of pathology. Each patient requires individual therapy depending on age, sex, history, living conditions. There are three methods:

Non-drug. Includes behavioral, nutritional, physical correction.
Surgical.
Medical.

The first method is successfully combined with drug treatment.

Non-drug therapy

The safest, most affordable is behavioral therapy. Treatment comes down to streamlining the patient's food and drink regimen, to "accustoming" him to go to the toilet not at the "dictation of the senses", but at regular intervals.

This mode of life makes the patient control the filling and emptying of the bladder. Gradually, the bladder "learns" to hold an increasing volume of urine, and the patient adapts to empty it beforehand, before the onset of "critical" moments. Psychotherapeutic tactics give the best results in young patients.

Behavioral therapy is developed for each patient individually, which helps to improve the quality of life. Every fifth patient manages to return to the usual daily routine.

Power correction

From the menu of the patient exclude or sharply limit:

Foods and drinks that have a diuretic effect. Completely exclude strong tea, coffee, carbonated drinks and any kind of alcohol.
Restrict total income liquids, given soups, watery fruits.
Prohibit drinking at night, The last meal and drink should be 3 hours before bedtime.

It is recommended to increase the amount of fresh and cooked vegetables. Bread is allowed with bran, coarse grinding. The menu is adjusted to increase the fiber in it. Prevention of constipation effectively restores the sensitivity of the bladder. A crowded intestine squeezes it and provokes premature stimulation of urination.

Physical exercise

Physical exercises target specific pelvic floor muscles. Their strengthening and training help the sphincter to retain urine during urges. The Kegel complex is recommended, with which most women who have given birth are familiar. In the postpartum period, urination disorders often occur, there is no urge to it. In addition, this complex helps to fix the uterus in its natural position and does not allow it to move down.

The complex includes 4 types of exercises that are performed while sitting. Their specificity is such that it allows you to practice at any time and in any place where you can sit down.

Surgery

Surgical intervention can be indicated only after unsuccessful therapy with conservative methods. It is possible to treat urination disorders in hyperactivity syndrome by performing an operation according to individual indications. This method is rarely used.

Operations on the bladder are aimed at reducing the activity of the detrusor. This:

complete denervation - when the introduction of medicines into the walls of the bladder completely block the supply of nerve impulses to urination;
additional "suturing" of nerves;
removal of a part of the muscle tissue of the detrusor, without affecting the mucosa;
replacement of part of the detrusor tissue with tissues of the intestinal wall (it is not able to contract);
the introduction of a sterile solution into the bladder to increase its volume.

All three types of operations are difficult to perform, but can be shown to patients regardless of their gender and age.

Medical therapy

Medical treatment includes several areas:

decrease in the tone of the walls of the bladder;
blocking of nerve impulses of the detrusor;
improvement of pelvic blood supply.

To reduce muscle tone, drugs can be prescribed:

Trospium chloride.
Detrol.
Driptan.
Soliferacin.
Ditropan.
Tolterodine.
Oxytrol.
Dariferacin.
Sanctura.

The above anticholinergics have side effects in the form of dry mouth, visual disturbances, general lethargy, drowsiness.

Tablets effectively relieve irritable bladder syndrome. The therapeutic effect increases within 6-8 weeks. However, when the drugs are discontinued, the symptoms return.

The constant intake of pills that relax the walls of the bladder provokes insufficient emptying of it. Therapy is recommended to be carried out under the dynamic supervision of the presence / absence of residual urine. Why do periodic ultrasound examinations (ultrasounds). Uncontrolled intake of drugs of this series can provoke the development of renal failure.

With the neurogenic nature of hyperactivity, drugs Capsaicin, Resiniferotoxin are prescribed. Solutions are injected into the bladder, where they depress nerve receptors.

Vitamins, L-carnitine, succinic acid are shown to improve blood supply and nutrition to the tissues of the genitourinary organs.

In the treatment of children, medications are used in extreme cases. The focus is on working with parents to improve the psychological component of raising a child, adjusting nutrition and drinking regimen, and observing the daily routine.

Folk remedies and prevention

Folk remedies for the treatment of urination disorders are safe and can be recommended to patients with inflammatory diseases of the urogenital area. They improve the functioning of the kidneys and bladder.

Dill seeds.
Elecampane (rhizomes).
Lingonberries (leaves).
Plantain.
St. John's wort.

A decoction of any of the above raw materials is prepared as follows: a tablespoon of raw materials is poured into 200 ml of water, boiled for up to 10 minutes. After cooling, you can take it with the addition of honey. Treatment is for 3 weeks. After that, you should either take a 2-week break, or continue treatment with another component.

An overactive bladder (OAB), the manifestations of which are symptoms of frequent urination, imperative urges and imperative urinary incontinence, is a frequent reason for visiting gynecologists and urologists. The condition requires long-term treatment, the first line of which experts unanimously consider behavioral therapy.

The use of behavioral therapy in OAB is based on the assumption that this condition is caused by the loss of control of the cerebral cortex over the urination reflex developed in childhood or the presence of a pathologically formed reflex. It is known that more than half of patients with OAB have severe mental and social problems, and in 20% of them, hyperactivity is associated precisely with an incorrect urination pattern. To restore this control, establish a certain rhythm of urination and gradually increase the intervals between them. Before starting treatment, the patient is explained that normal diuresis is 1500-2500 ml / day, the average volume of urination is 250 ml, the functional capacity of the bladder is 400-600 ml, the permissible number of urination is an average of 7-8 times a day. If this volume exceeds the norm, it is necessary to teach the patient to avoid drinking unnecessarily: drink only during meals, refuse coffee and tea, especially in the evening, limit the consumption of spicy foods and salt that cause thirst. The exception is patients taking diuretics. It is also important to justify the need to give up “bad” habits: urinate “just in case”, before eating or leaving the house. The goal of bladder training is to gradually lengthen the intervals between urination (at the beginning of treatment, the intervals between urination should be short, for example 1 hour, gradually they are brought to 2.5-3 hours) and increase the functional capacity of the bladder. Thus, the patient "accustoms" her bladder to empty only voluntarily. At night, the patient is allowed to urinate only when she wakes up due to the urge to urinate.

The main tool for this method of treatment is a urination diary, in which not only the volume of urine excreted and the time of urination should be noted, but also episodes of urinary incontinence (UI) and change of pads. The diary must be studied and discussed with the doctor at scheduled regular check-ups.

Behavioral therapy is particularly effective for idiopathic detrusor overactivity. The prognosis, of course, is determined by how accurately the patient follows the doctor's recommendations. The high efficiency of OAB treatment is noted with a combination of bladder training and drug therapy.

Exercises to strengthen the pelvic floor muscles great importance not only with stress NM, when they can be used to increase urethral pressure. Clinical Application exercises in GMF is based on the effect of reflex inhibition of detrusor contractions with arbitrary and sufficient contractions of the pelvic floor muscles.

The Kegel exercise system includes alternate contraction and relaxation of the muscles that lift the anus. Exercises are performed 3 times a day. The duration of contractions is gradually increased: from 1-2 s, 5 s, 10-15 s and from 30 s to 2 min. Sometimes a perineometer is used to control the correctness of the exercises. It consists of a canister connected to a manometer. The patient inserts the balloon into the vagina and determines the strength of muscle contractions during exercises on the pressure gauge. "Functional" exercises in the future involve their performance not only in a position of relaxation, but also in situations that provoke NM: when sneezing, standing up, jumping, running. Despite their simplicity and popularity, Kegel exercises are rarely used today. Sometimes the doctor advises the patient several times a day to interrupt and resume urination. However, such exercises not only eliminate NM, but also lead to urination disorders.

The main condition for the effectiveness of therapy is regular exercise and medical supervision with constant monitoring and discussion of the results.

Patients who cannot identify the necessary muscle groups, as a result of which they are unable to perform exercises correctly, are recommended to use special devices: vaginal cones, balloons, etc. (Fig. 1). The cones have the same size and different weight (from 20 to 100 g). The patient inserts the smallest mass cone into the vagina and holds it for 15 minutes. Then heavier cones are used.

According to various researchers, the number of patients unable to reduce m. pubococcygeus, reaches 40%. This was one of the reasons for the widespread use of the method of biological feedback(BFB), the purpose of which is to teach the skills of contraction of specific muscle groups and provide feedback to the patient. The effectiveness of the technique is due to the active role of patients in the treatment process by involving visual (pictures, films, animation) or auditory (voice support) analyzers. The implementation of feedback can be carried out mono- and multi-channel by recording the activity of the pelvic floor, abdominal and detrusor pressures.

We have accumulated experience in conducting pelvic floor muscle training (PMTD) in BFB mode on the UROPROCTOCOR video-computer complex (Fig. 2), which is a stationary device equipped with peripheral equipment necessary for the treatment of pelvic floor dysfunctions, and has the potential for motivational reinforcement .

The technology of using the device consists in introducing a special sensor into the vagina that measures the electromyogram (EMG) of the surrounding muscles, which is made of gold-plated porcelain. It can be used repeatedly after pre-sterilization. The EMG signal is analyzed by a computer, which plots graphs on the monitor screen, informing the patient about how the muscles of the perineum work. The patient periodically tenses and relaxes the muscles of the pelvic floor ("retraction" of the anus) according to the commands of the device. At the same time, the dimensions of the curves on the monitor increase and reach an individually set threshold. To maximize the effectiveness of the procedure, motivational reinforcement technology is used: each correctly performed exercise is accompanied by a film, slides, etc. If the task is performed poorly, all encouraging factors are minimized, which stimulates the patient to more active muscle work. The course of treatment consists of 15-20 half-hour sessions.

After TMTD in BFB mode, we noted: a decrease in the number of micturitions from 14 to 8 times a day, NM episodes - from 4 to 1 time per day; the abdominal pressure threshold indicator increased from 38 to 59 cm; H2O, mean urine loss decreased from 52 to 8 ml. When analyzing myography data, the following results were obtained: percentage correct operation pelvic floor muscles at the first session was 60.1% + 10.2%, at the 8th session - 73% + 8.7%, and by the 15th session this figure was 82.8% + 7.3% ( R< 0,05). При анализе полученных клинических данных стало очевидным влияние терапии БОС как на симптомы гиперактивности мочевого пузыря, так и на состояние тазового дна.

The prospect of biofeedback therapy lies not only in its high efficiency and lack of side effects, but also in the possibility of conducting therapy at home using individual portable devices. Biofeedback remains the method of choice for patients with severe comorbid somatic diseases when other treatments, including medication, cannot be applied.

Electrical stimulation (ES) is also effective method treatment of GMP. It is used to reduce the sensitivity of the bladder and increase its functional capacity, which is achieved by direct or indirect stimulation of nerve fibers with a weak electric shock. The electrode is inserted either into the vagina or the rectum, it is possible to use external overhead electrodes. Electrical impulses are applied continuously or intermittently. Application points are: urethral and anal sphincters, pelvic floor muscles, roots of the sacral spinal cord. Recently, tibial ES has become a popular method. Stimulation of the afferent fibers of the somatic peripheral nervous system, which are part of the nerve trunks, causes inhibition of the parasympathetic activity of the pelvic nerve and an increase in the sympathetic activity of the epigastric nerve, resulting in a decrease in the contractile activity of the detrusor.

In severe neurogenic overactivity of the detrusor, ES is performed by surgical implantation of a system for ES of the anterior sacral root S3. Side effects there may be discomfort during the procedure, pain reactions and a feeling of discomfort.

Drug therapy, like behavioral therapy, is one of the most common treatments for OAB. Such therapy is aimed at eliminating disturbing symptoms and improving urodynamic parameters, i.e., reducing detrusor activity, increasing the functional capacity of the bladder. The central targets of therapy are the urinary control areas in the spinal cord and brain, while the peripheral targets are the bladder, urethra, peripheral nerves, and ganglia. These "targets" can be affected by the following drugs:

drugs that act on ion channels of cell membranes;
antimuscarinic / anticholinergic drugs, including dual myotropic antispasmodic action;
antiadrenergic;
tricyclic antidepressants;
prostaglandin synthesis inhibitors;
vasopressin analogues;
afferent inhibitors.

One of the modern classifications medicines that reduce the symptoms of OAB, suggests the division of such drugs into four types:

1st type - drugs that reduce the efferent stimulation of the detrusor (M-anticholinergics, a1-blockers);

type 2 - drugs that increase inhibitory control, polysynaptic inhibitors (antidepressants);

type 3 - drugs that reduce the sensitivity of the bladder (toxins);

Type 4 - drugs that reduce urination (for example, vasopressin analogues).

M-anticholinergics (oxybutynin, tolterodine, trospium) are recognized as one of the most effective means used to treat GMP. Much experience has been accumulated in their use, and safety and efficacy have been evaluated in many comparative, placebo-controlled, multicenter studies. Selective M-cholinergic blockers are used. The drug atropine, which is not selective, is currently rarely used due to a pronounced systemic effect (only administration by electrophoresis).

The recommendations of the European Association of Urologists on OAB and urge urinary incontinence suggest M-anticholinergics as the first line of therapy, and according to the assessment from the point of view of evidence, drugs in this group are classified as category "A" (high evidence). In Russia, medicines of the M-anticholinergic group, approved for use and widely prescribed, are oxybutynin, tolterodine, trospium (non-retarded forms). Aspects of safety and efficacy of these drugs in various groups of patients were studied.

The main trend that characterizes the modern approach to the use of oxybutynin (driptan, oxybutin) is a change in dosage and dosing regimen in order to reduce the number of side effects. The drug has been successfully used at a dose of 3 mg/day; a regimen for taking oxybutynin at a dose of 5 mg/day is proposed, in case of good tolerance, followed by an increase by 2.5 mg every 2 weeks until a clinical effect is achieved. In order to achieve maximum efficacy and improve tolerability, intravesical or transdermal use of oxybutynin is recommended. Clinical studies are underway on the efficacy and safety of sustained release oxybutynin, which, with equal efficacy, demonstrates a more favorable safety profile.

Recent clinical studies on the drug tolterodine (detrusitol) confirmed its high clinical efficacy in the symptoms of OAB. The drug is used in a standard dosage of 2 mg 2 times a day. The practice of using sustained-release tolterodine can also be recognized as promising, which also has a higher efficacy in relation to the frequency of urination and urge urinary incontinence compared to standard non-retarded forms of the drug.

Trospium (Spasmex) also deserves special attention, which, being a quaternary ammonium compound, has no side effects from the central nervous system with good clinical efficacy. Thus, in a study on volunteers, side effects other than the placebo group appeared only at dosages exceeding 180 mg, which is at least 4 times the standard dosage (H. P. Breuel, S. Bondy). Our comparative study of two dosages of trospium chloride (Spasmex, PRO. MED. CS, Praha) - 15 mg/day and 45 mg/day showed that against the background of the predominant efficacy of the dose of 45 mg/day, the frequency of side effects was comparable, and side effects there were no CNS effects.

In addition to the well-known M-cholinolytics, modern selective drugs appear on the European market, which have recently passed large-scale placebo-controlled trials. Among them is solifenacin, which effectively reduces the number of episodes of urge urinary incontinence and the frequency of urination. The high efficiency and safety of the drug has been proven (dosage: 5, 10, 20 mg 1 time per day). There was a minimal percentage of dropouts from the study due to side effects. Studies have also shown good pharmacokinetic and pharmacodynamic parameters of this agent against the background of a high safety profile when used once a day. The pharmacokinetics of solifenacin does not change with food intake.

With OAB, drugs that act on sympathetic receptors can also be successfully used. It is known that α1-adrenergic blockers: tamsulosin (omnic), terazosin (cornam, setegis, haytrin), doxazosin (zoxon, kamiren, cardura), alfuzosin (dalfaz) - reduce symptoms in urination disorders associated with the presence of prostatic hyperplasia in men, have an effect on detrusor hyperactivity that occurs against the background of infravesical obstruction. In the course of an open prospective study (S. Serels, 1998), comparative analysis effectiveness of α1-blocker and anticholinergic in women. The high efficiency of the use of α1-adrenoblocker with symptoms of "imperativeness" was shown. The drugs of this group can be used to treat OAB symptoms in both men and women, especially in cases of OAB symptoms against the background of urodynamically confirmed functional infravesical obstruction (FVO). The data obtained (A. V. Sivkov, 2001; D. Yu. Pushkar, 2002) indicate a significant effectiveness of α1-blockers in the symptoms of OAB in women against the background of functional IVO. So, in the observation group, the frequency of urination per day decreased by 25-30%, and nocturnal pollakiuria - by 50%. Appointment of α1-blockers is carried out taking into account vasoactivity. In young patients, tamsulosin (0.4 mg/day) is the drug of choice. When prescribing vasoactive α1-blockers, dose titration is necessary.

Tricyclic antidepressants (imipramine, amitriptyline) have central and peripheral anticholinergic and α-adrenergic effects, as well as an inhibitory effect on the central nervous system. They are effective when taken orally (150 mg/day) in elderly patients with symptoms of OAB. Duloxetine, a combined serotonin and norepinephrine reuptake inhibitor, also belongs to the group of antidepressants. It acts on the urinary control centers in the lumbosacral region of the spinal cord (Onuf's nucleus). In these nuclei, the integration of the activity of the sphincter and the bladder is carried out. When norepinephrine is inhibited, sphincter tone increases, and when serotonin is blocked, bladder activity decreases. Currently, the possibility of using the drug for stress urinary incontinence is being considered. The conclusion about the advisability of its use in overactive bladder can be made only after the completion of large-scale clinical studies.

In recent years, there has been interest in the use of toxins in OAB. Botulinum toxin (trade names botox, dysport), used in aesthetic medicine, is able to normalize muscle tone by inhibiting the release of acetylcholine from the nerve ending. Indications for its use are sphincter dysfunction and neurogenic detrusor overactivity. The toxin is administered in the form of intravesical injections (on average 30 points) under cystoscopic control. Contraindications are urinary tract infection and hypersensitivity to the drug, although only 2% of patients develop antibodies to botulinum toxin.

Vasopressin analogues (4th type of drugs), such as desmopressin (minirin, emosynth), have a very limited scope. The main indication for their appointment is the shift of diuresis towards the night hours (nocturia) and associated urination disorders. A study is currently underway on the use of vasopressin analogs to correct urge urinary incontinence.

Hormone replacement therapy occupies a certain place in the treatment of women of the older age group with OAB. Estrogen deficiency leads to a number of changes in the genitourinary system of a woman in the form of vaginal atrophy, a decrease in the tone of the sphincters and an increase in the sensitivity of the bladder. However, many of the positive effects of estrogen therapy, with the exception of the effect on the signs of osteoporosis, have not yet been sufficiently substantiated, and opinions on this matter should be recognized as contradictory. The effectiveness of estrogen therapy in the treatment of OAB can be considered controversial. Researchers advocate the feasibility of conducting research in accordance with the principles of evidence-based medicine and good clinical practice.

When choosing a method drug treatment GMP must take into account the presence of concomitant diseases, the results of previous treatment, the ability and ability of the patient to follow the doctor's prescriptions. This will help implement correct selection drug and ensure high efficiency of treatment.

After the selection of adequate and effective therapy for OAB, subsequent dispensary observation and control examinations are required at intervals of 3-6 months.

V. V. Romikh
I. A. Apolikhina, candidate medical sciences
V. M. Andikyan
NTsAGiP RAMS, MMA named after I.M. Sechenov, Research Institute of Urology, Moscow

Literature

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Hay-Smith E., Bo K., Berghmans L. et al. Pelvic floor muscle training for urinary incontinence in women (Cochrane review) // Oxford: The Cochrane Library, 2001.

Herbison P., Plevnik S., Mantle J. Weighted vaginal cones for urinary incontinence // Cochrane Database Syst. Rev. - 2000. - Vol. 2. - CD002114.

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This disease is accompanied by discomfort, frequent urge to urinate.

Treatment for overactive bladder in women and men should be as soon as possible until the pathology has developed into more serious diseases.

The most effective treatment approaches for children and adults are described in this article.

What is overactive bladder syndrome?

Overactive bladder syndrome is an ailment characterized by frequent urge to urinate in the absence of a disease of the genitourinary system. ICD 10 code: N31.

Enterocystoplasty. A small part of the walls of the organ is removed and replaced with the intestines. The operation is used quite often, the recovery period is short: from 1 to 2 weeks.
Detrusor myectomy. Partial elimination of the muscular membrane of the organ.
bladder denervation. A procedure that leads to the death of nerve endings. It is rarely used, since the recovery period is very long.

Doctors choose the right surgical method individually. The recovery period can vary from 1 to 3 weeks.

After the operation, the patient recovers for a certain time in the hospital. Only after that he is allowed to go home, accompanied by relatives.

How to treat the disease in children?

Children are much more difficult to treat, as far not every drug is suitable may cause complications and side effects.

This syndrome is common in children.

Sometimes this is due to the growth and development of the body. Passes in the period of growing up, leaves no consequences.

First of all, the child is assigned special. He is forbidden to take diuretic foods and drinks.

You can not eat watermelon, cucumbers, berries, citrus fruits. Tea and coffee only in small quantities. The child is prescribed vitamin complexes.

Medicines are not prescribed for children, as they can harm. Usually they can be avoided, as children quickly recover without them. Even if the drugs are prescribed, they are recommended by the doctor after examining the child, conducting tests.

When choosing medicines, you need to take into account the age of the child, the individual characteristics of his body, heredity. Perhaps the syndrome was passed on to the child from the parents.

Folk remedies

Prevention

It is enough to simply prevent the occurrence of this syndrome. You just need to fulfill simple preventive measures:

accept vitamin complexes. They will help strengthen the body, normalize the work of various systems.
Refusal of diuretic products and drinks. Tea and coffee should be only in small quantities. You can not drink alcohol and sweet carbonated drinks.
Eating healthy food. Junk food can lead to improper functioning of the kidneys, liver and bladder.
Healthy sleep. At least 8 hours a day.
Performance Kegel exercises daily, at least 4 times a day.
Sports. A person must regularly perform physical activity but it shouldn't be too big.
outdoor recreation. You need to walk, breathe fresh air. A sedentary lifestyle weakens the pelvic muscles, leads to pathologies of the genitourinary system.
Hygiene. You need to regularly change underwear, go to the shower to avoid urinary tract infections.

Diet

Watermelon.
Bananas.
Apples.
Cherries, strawberries.
Plum.
Green tea.
Coffee.
Alcoholic and sugary carbonated drinks.
Spicy, fatty and fried foods.

Good to eat:

Vegetables.
Cereals.
Vegetable salads.
Lean meats and fish.
Low-fat cottage cheese.

The duration of the diet should be at least two weeks, can be extended in case of a long recovery. During the diet, sweet carbonated drinks should not be consumed. Doctors advise to use pure drinking water, without gases.

Condiments, sauces and mayonnaise prohibited, they should not be used. You need to eat food often, but in small portions. Overeating and hunger are prohibited during the diet.

This syndrome causes a lot of harm to the human body, can cause discomfort, leads to pain and discomfort. It is necessary to fight the disease as early as possible by avoiding diuretic foods and drinks. Timely treatment will lead to a quick recovery.

You can learn more about an overactive bladder and why it is dangerous from this video:

The topic - an overactive bladder in women, treatment is in great demand for those who suffer from this problem.

It is clear that the impact on the quality of life of women is very great: families are destroyed, social ties are collapsing, work and its performance suffer.

Overactive bladder in women treatment, causes, symptoms, diagnosis:

Abbreviated this disease is called (OAB) - an overactive bladder or dysuria. Not always with this disease, a urinary tract infection is detected.

This is not a disease - a syndrome with or without it accompanied by urgency, naturia, plus frequent urination.

This can be observed in the presence of stones in the bladder, its tumor. Suffer from 16 to 17% of men and women living on earth.

It becomes a problem just to go out, and not just go to the cinema or theater. The woman continues to suffer, but she is in no hurry to see a doctor because of her modesty.

Many people think that this is how it should be - old age. Begin to urinate involuntarily with large amounts of urine. It cannot be interrupted.

They cannot believe that there are excellent methods of treating this problem in medicine. We got an appointment with a doctor, and received ineffective therapy, waved a hand at ourselves.

Always consult a urologist and always a gynecologist.

Symptoms:

A sick woman is constantly tormented by a simply irresistible desire to urinate, which appears absolutely suddenly and is difficult to control.
Wants to urinate often in the toilet during the day (more than eight times / day). The norm is 5-7 times.
Inability to reach the toilet.
Instant response to the sound of flowing water.
At night, a woman goes to the toilet more than 1 time. The norm is to sleep without going to the toilet.
Irritates the constant wearing of pads, diapers, special underwear for a night's sleep, so as not to get wet.
Forced to wear clothes dark shades to mask traces of urine.
Permanent limitation of physical activity or even light exercise.

, isolation, apathy.
Loss of self-esteem and complexes.
Constant fear of urinating in public places.
Urinary incontinence occurs due to an urgent urge to urinate (i.e., I wanted to go to the toilet, but cannot keep it).
The older the woman, the more often this syndrome is found in her.
A woman urinates 100 ml or less in 79.5% of cases.

When passing tests, very often urine in women is absolutely normal. Very often they treat chronic with antibiotics, antiseptics, which will not help here.

The difference between cystitis and OAB (with this syndrome there is never pain).

Syndrome OAB violation of urination:

Pollakiuria - going to the toilet more than 8 times.
Nakturiya - a trip to urinate at night in the toilet more than two times.
Urgency - a sudden desire to urinate, and an irresistible and immediate desire. Another expression is the imperative urge to urinate.
Urgent urinary incontinence.

They occur at different combinations at the same time, can be expressed in different ways.

Causes:

Age is the main reason.
Hormonal background - menopause, endometriosis, after childbirth. chronic inflammation appendages.
Intestinal tumor.
or Parkinson's disease.
Already common Alzheimer's disease, any damage to the spinal cord, after a stroke.
After operations on the female genital organs (hysterectomy - removal of the uterus).
Bladder stones, inguinal hernia.
Ectopia of the external opening of the urethra at the entrance to the vagina.
Anatomical: pronounced prolapse of the genitals due to impaired relationships with the bladder.
Heredity - has a role and the transmission of the disease by genetics.
Inflammation: With recurrent cystitis, there is a high risk of provoking the development of OAB symptoms. Bladder ulcer or inflammation. Tuberculous process of the bladder, possibly even cancer.
Neurogenic: Damage to the nervous system can lead to OAB symptoms. Usually these moments are necessarily present in this disease more or less.
Usually: the first ten years of menopause in women, stress urinary incontinence.
Then, the greater the estrogen deficiency, the more often OAB syndrome develops.

Diagnostics:

Questioning and examination by a doctor.
Keeping a toilet diary.
and blood (exclusion or confirmation of infection of the urinary tract itself).
Ultrasound of the genitourinary organs (mandatory determination of residual urine). The examination is carried out to exclude serious diseases of the genitourinary system.
Uroflowmetry (the act of urination).

Treatment:

The syndrome is treated with medication - the main thing.
Be sure to train the famous pelvic floor muscles - a common exercise (Kegel).
Exercises for weak pelvic muscles.
Physiotherapy: electrical stimulation.
Surgery is rare for severely ill patients.
Botulinum toxin in case of intolerance to conservative treatment of the patient.

Pills:

M-anticholinergics are the main treatment for the disease.

Driptan (oxybutynin) - Available in 5 mg tablets. Treatment: 5 mg x 3 times / day. The dose is selected by the doctor. Poorly tolerated by patients due to many side effects, not intended for long-term treatment.
Spasmex (trospium) - release tablets of 5 or 15 mg. Treated with a dose of 10-20 mg 2-3 times / day. Doses
doctor chooses. Elderly women dose of 5 mg with the same intake schedule.
Detrusitol (Tolterodine) – 4 mg capsules, 2 mg tablets. Treated with a dose of 2 mg / 2 times a day. 4 mg capsules once.
Especially for overactive bladder syndrome.
Vesicar (solifenacin) - tablets in a dose of 5 mg. Treatment begins with 5 mg/day once. The medicine was created specifically for such a disease. Take at least three months.

Other drugs:

Tricyclic antidepressants.
Antagonists of gamma-aminobutyric acid.
Calcium channel blockers.
Beta-blockers.
Beta adrenomimetics.
Alpha andrenoblockers.
Alpha-andrenomimetics.
prostaglandin synthesis inhibitors.
Vanilloid receptor inhibitors.
Opioid receptor blockers.
Purinergic receptor blockers.
Vasopressin analogues.
Antispasmodics.
Estrogens for the age group of women. They prescribe creams, suppositories with estrogen and help a lot with urination problems.
Tachykinins.
Botulinum toxin.

They start with M-anticholinergics until they effective treatment to date. Then, according to indications, additional treatment is added.

The positive effect is shown by the strengthening of the pelvic muscles and a special Kegel exercise.
Eat bran, fiber, helping the bladder.
Eating cranberries will help protect the lining of the bladder and prevent stones from forming.
Sea buckthorn in the diet will help to establish the contractile work of the bladder.

Exclude:

Sharp in food.
Coffee or products containing caffeine due to their irritant effect.
All carbonated drinks.
Salty foods.

treatment folk methods and this syndrome is not amenable to means

It remains to discard all embarrassment and embarrassment and go to the doctors so that the question of what an overactive bladder in women is treatment no longer disturbs you.

Good luck!