What happens with OAB
Normally, the bladder quietly fills, and its muscle, the detrusor muscle, remains relaxed until the person decides to empty the bladder. With hyperactivity, the detrusor begins to involuntarily contract even with a small volume of urine.
The brain perceives these contractions as a signal “the bubble is full” - a sharp urge arises that is difficult to put off. In this case, there is no real overflow, so the volume of urine released is small.
The cause of such hyperactivity often cannot be established - then they talk about the idiopathic form. In other cases, it is caused by neurological diseases, impaired urine flow, or changes in the bladder mucosa.
Symptoms
- Urgency is a sudden, strong urge that is difficult or impossible to put off. This is the key symptom
- Frequent urination in small portions
- Nocturia - waking up at night to urinate
- Urge incontinence - leakage of urine due to an uncontrollable urge
- Constant anxiety about knowing where the nearest toilet is
- Limiting travel, meetings, sleep and social activities
Causes and provoking factors
- The idiopathic form is the most common, when an obvious cause cannot be found
- Neurological diseases: stroke, multiple sclerosis, Parkinson's disease, spinal cord injury, dementia
- Prostate adenoma in men - a long-term obstruction to the outflow changes the functioning of the bladder muscle
- Age-related changes in the mucous and muscle walls
- Menopause and estrogen deficiency
- Diabetes mellitus
- Chronic urinary tract infections and chronic cystitis
- Bladder stones and tumors - cause similar symptoms and must be excluded
- Caffeine, alcohol, carbonated and energy drinks
- Anxiety disorders and chronic stress
- Taking diuretics
Diagnosis: why is it a diagnosis of exclusion?
The diagnosis of OAB is made only after other causes of frequent and urgent urges have been excluded. Symptoms are nonspecific, and serious pathology may be hidden behind them.
- A urination diary for 2–3 days is the most important and most informative tool
- Urinalysis and culture to rule out infection
- Ultrasound of the kidneys and bladder with determination of residual urine
- Blood glucose
- In men - prostate assessment, PSA, uroflowmetry
- For women - gynecological examination
- Cystoscopy for blood in urine, persistent symptoms, suspected stone, leukoplakia or tumor
- Urodynamic study in cases of treatment failure and neurological diseases
- Questionnaires for objective assessment of symptoms and dynamics
Treatment: first line
They always start with behavioral therapy - it gives results in a significant proportion of patients and has no side effects.
- Bladder training: urination on a schedule with gradually increasing intervals
- Techniques for suppressing the urge: stop, tense the pelvic floor muscles several times, wait until the urge subsides and only then go to the toilet
- Pelvic floor exercises - help suppress involuntary contractions
- Limit caffeine, strong tea, alcohol, carbonated and energy drinks
- Even distribution of fluid throughout the day and its reduction several hours before bedtime
- Weight loss
- Treatment of constipation
- Avoiding the habit of urinating in reserve, which reduces the functional capacity of the bladder
Drug and interventional treatment
- M-anticholinergics - reduce involuntary activity of the bladder muscle; require monitoring of residual urine
- Beta-3 agonists - a modern alternative with a different tolerability profile
- Local estrogen therapy in menopausal women
- Botulinum therapy of the bladder - injection of botulinum toxin into the bladder wall during cystoscopy; effective in drug-resistant forms; the action is temporary and requires repetition
- Tibial and sacral neuromodulation - effects on the nerve pathways that regulate the functioning of the bladder
- Treatment of the underlying disease: prostate adenoma, infection, neurological pathology
Drug treatment is selected individually and usually lasts a long time. It is premature to evaluate the effect earlier than after a few weeks of use.
How to live with OAB: practical advice
- Keep a diary - it shows the relationship between symptoms and drinks, time of day and stress
- Don't cut down on drinking too quickly: this will make the situation worse.
- Plan routes and toilet visits before going out, but don't urinate too often "just in case"
- Use special absorbent products during the period of treatment selection - this reduces anxiety and restores freedom of movement
- Discuss drug tolerance with your doctor: if there are side effects, there are alternatives
- Remember that OAB is not an age norm or a death sentence: in most patients the condition can significantly improve
Where is overactive bladder treated in Tashkent
Treatment of OAB begins with the exclusion of other causes, which means that a laboratory, ultrasound, and the ability to perform cystoscopy are needed, and in case of resistant forms, botulinum therapy.
In Tashkent, examination and treatment of overactive bladder is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
Complete a voiding diary two to three days before your appointment: this is the most valuable document you can bring to your doctor with this diagnosis. Clinic contacts are below on the page.
