Irritable bladder
Updated onClemens Gödel is a freelancer for the medical team.
More about the experts All content is checked by medical journalists.People with irritable bladder suffer from a constant, often attack-like urge to urinate, even though only small amounts of urine are passed. In some cases, the "overactive bladder" also leads to uncontrolled loss of urine. The causes are not really clear, and therapy with bladder training and medication is often difficult. Read everything you need to know about symptoms, diagnosis and treatment of irritable bladder here!
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. N32N31
Irritable bladder: description
With an irritable bladder (overactive bladder, urethral syndrome), the function of the urinary bladder is disturbed.
The bladder acts as a reservoir for the urine filtered by the kidneys. Because it is stretchy, it can hold up to 500 milliliters of urine. However, the bladder reports at around. 300 milliliters to the brain that an early emptying is necessary. When someone goes to the bathroom to urinate, the muscular wall of the bladder contracts, moving urine out of the body.
Patients with irritable bladder feel the urge to urinate far more often than is physically necessary. In most cases, no organic reasons for this can be found (primary irritable bladder). The irritable bladder is therefore considered by some doctors as a diagnosis of exclusion - if they cannot find any other cause for the symptoms, they certify an irritable bladder. It used to be mainly considered a psychosomatic illness. Others see it as a mild form of urge incontinence.
The irritable bladder can significantly reduce the quality of life of those affected. However, many sufferers avoid medical help for various reasons. Many certainly out of shame, others have low expectations of the therapy or are of the opinion that an irritable bladder is a normal symptom of old age. Irritable bladder occurs regardless of age, even if it becomes more common with age.
Women are particularly affected, especially between the ages of 30 and 50.Overall, the clinical picture is widespread: A study that was carried out across five countries found that around 13 percent of women and 10 percent of men suffer from irritable bladder.
Irritable bladder: symptoms
Basically, the irritable bladder symptoms are not unlike those of a urinary tract infection. People with irritable bladder suffer from a frequent urge to urinate (pollakiuria). This means that someone has to urinate at least eight times in a 24 hour period. Many sufferers find the associated very sudden urge to urinate very stressful, which often sets in without warning. It can lead to the involuntary leakage of urine - from a few drops to larger amounts. The great pressure of having to go to the toilet, coupled with the involuntary loss of urine, is also known as urge incontinence.
Another possible irritable bladder symptom is what is known as terminal dysuria - those affected experience pain towards the end of urination because the bladder becomes painfully cramped when emptying.
In addition, urine can drip shortly after urination. Doctors then speak of so-called dribbling. Symptoms can also be present at night and decisively disturb sleep (nocturnal urge to urinate = nocturia).
The irritable bladder symptoms lead to high levels of suffering and impair the quality of life. Affected people are always careful to stay near a toilet. Loss of control over urinary continence can mean a serious change in lifestyle. Anxiety can also exacerbate the symptoms.
Irritable bladder: causes and risk factors
The causes of an irritable bladder have not yet been fully explored scientifically. As a rule, no specific reason for the symptoms can be found (primary irritable bladder). Experts suspect that those affected have incorrect transmission of nerve impulses, which report to the brain that the bladder needs to be emptied, even though it is still a long way from being filled. This means that the sensitivity of the bladder muscles is increased. On the other hand, the perception of increased bladder pressure due to filling and tension in the irritable bladder is reduced, so that the affected person suddenly needs to urinate.
In rare cases, sexual or psychological trauma can also trigger an irritable bladder.
An overactive bladder is also rarely the result of other diseases (secondary irritable bladder), such as tumors, bladder stones or cystitis.
Irritable bladder: examinations and diagnosis
An irritable bladder is often seen as an "embarrassing" problem by those affected. Still, that shouldn't prevent anyone from discussing their condition openly with a doctor. If you suspect an overactive bladder, you can first contact your family doctor. If the diagnosis is confirmed, he or she can issue a referral to a urologist or, in the case of women, to a gynecologist.
The doctor first conducts a conversation to determine the problems more closely (anamnesis). Among other things, he can ask such questions:
- Do you have to urinate more often than usual?
- Is the urge to urinate often urgent and sudden?
- Do you sometimes not make it to the toilet in time?
- Do you have to go to the toilet often at night?
- Do you have pain when urinating?
- Are you taking any medication?
- How much do you drink a day?
In particular, the medication intake must be described in detail. There are a variety of preparations that can lead to symptoms of an irritable bladder. One example of this are drugs that are prescribed for high blood pressure. They sometimes cause an increased urge to urinate and frequent urination.
It can be very helpful to keep a micturition log before going to the doctor. This records the amount of water consumed and the use of the toilet every day. These records will help the doctor identify the cause of the "nervous" bladder.
Further investigations
The conversation is followed by a physical examination, which should rule out organic reasons for the symptoms of the irritable bladder. The basis for this is the inspection of the urogenital tract. The prostate should be examined in men and the uterus in women. These two organs can cause symptoms similar to those of the irritable bladder.
The important alternative diagnosis to irritable bladder is a urinary tract infection. To rule it out, a urine sample is taken and examined for pathogens. In the case of an irritable bladder, the pathogen detection remains negative.
A symptom of irritable bladder is that some people can no longer empty their bladder properly. The doctor can determine this by using an ultrasound scan to check whether there is any residual urine in the bladder immediately after using the toilet. If so, this requires further investigations for clarification. Alternatively, urologists carry out a so-called urodynamic examination. With the help of pressure probes and electrodes, the function of the bladder and the urinary tract is checked. In this way, the capacity of the bladder can be determined and the locking mechanisms (especially the bladder sphincters) tested.
A smear from the lower urinary tract can show whether a local lack of estrogen is causing the irritable bladder symptoms. Such a hormone deficiency leads to changes in the superficial cells, which can be recorded with the so-called karyopyknotic index.
It is possible to start a therapy attempt with a drug from the group of so-called anticholinergics even if an irritable bladder is suspected. If this is effective, the diagnosis is confirmed.
In the case of an irritable bladder, the doctor must absolutely rule out secondary forms - for example, causes such as bladder stones. An ultrasound scan, for example, can help.
If the doctor suspects emotional or sexual trauma as the cause of the irritable bladder symptoms, he should address the topic as sensitively as possible and, if necessary, include the psychosomatic aspects of the disease in the treatment.
Irritable bladder: treatment
There is no uniform irritable bladder therapy. Rather, the doctor will design them individually in coordination with the patient and his or her individual goals. Basic therapy options for irritable bladder are, for example, bladder training, pelvic floor training, biofeedback, methods of nerve stimulation, medication and surgical interventions. In addition, there is the right information and general tips from the doctor.
If the irritable bladder has an organic cause (e.g. tumor, bladder stone), it is important to treat it properly. Then the irritable bladder symptoms often disappear.
Education and general tips
An open and honest conversation between doctor and patient about the possibilities and goals of the treatment is important with an irritable bladder. This prevents disappointment and misunderstandings.
The doctor should also educate the patient about simple but important measures to improve their quality of life. This includes information on proper intimate hygiene and the prevention of urinary tract infections. The latter can increase the irritable bladder symptoms. Even small changes in habits often help to improve the symptoms. For example, irritable bladder patients should avoid diuretic drinks shortly before sleep. However, it is very important to drink enough water throughout the day - this should not be reduced for fear of even stronger symptoms.
Bladder training, pelvic floor training, biofeedback
Bladder training, pelvic floor training and biofeedback are effective treatment methods for irritable bladder, which can be carried out alone or in combination with medication. They are aimed at better, more active control of the urge to urinate.
Bladder training is about deliberately delaying going to the toilet for a few minutes if you feel the urge to urinate. This time interval should then be increased continuously until there are ultimately about three to four hours between successive visits to the toilet.
In addition, the individual bladder capacity can be determined using a micturition protocol. Depending on this, you can set fixed toilet times so that urge incontinence does not occur. First, time intervals are determined after the clock for going to the toilet, which increases over time.
Regular pelvic floor training is also suitable for treating irritable bladder. It strengthens the pelvic floor muscles, which support the urethral sphincter in its function. A combination of pelvic floor training and electrical stimulation (electrotherapy, electrical stimulation therapy) is considered to be particularly effective for irritable bladder.
Biofeedback can also help with irritable bladder. You can find out more about this therapy method here.
Irritable bladder medication
For the drug treatment of the overactive bladder, so-called anticholinergics are usually used. Sometimes, however, local treatment with the female sex hormone estrogen is also useful. In certain cases, other active ingredients can also be considered, for example the neurotoxin botox.
You can read more about how the irritable bladder can be treated with medication in the article Irritable bladder - medication.
Stimulation of the nerves
Another therapy variant or an extension of drug therapy is electrical stimulation therapy: the pelvic floor muscles are specifically activated with weak electrical stimulation over a period of three to six months. This is useful, for example, if the drug therapy was unsuccessful or the side effects, especially dry mouth or visual disturbances, predominate.
If the irritable bladder symptoms do not improve significantly despite electrical stimulation therapy, sacral neuromodulation can be tried. The sacral nerve node (sacral nerve plexus) is electrically stimulated through the skin in order to bring the bladder function back into balance. First, an external pulse generator is used to test whether this therapy variant works. If so, as a long-term solution, a bladder pacemaker can be implanted to provide this pulse.
Operative interventions
If the therapy methods mentioned do not provide a remedy and the symptoms are very severe, the last possible therapy option is surgical procedures: the bladder is surgically enlarged. For example, the urinary bladder can be surgically enlarged (bladder augmentation), for example with a piece of the small intestine. Another option is to remove the bladder (cystectomy) by creating a replacement bladder (neobladder) from sections of the intestine.
Alternative irritable bladder therapy
In addition to conventional medicine, some sufferers rely on alternative therapies against irritable bladder - homeopathy, for example (e.g. homeopathic preparations with Nux vomica). Some irritable bladder patients also report positive experiences with acupuncture. So far, however, there is no scientific proof of the effectiveness of these alternative methods.
Irritable bladder: disease course and prognosis
Sometimes a hyperactive bladder can be treated well by simple means. However, therapy can also be difficult and lengthy. In most cases, however, the treatment can at least significantly reduce irritable bladder symptoms, if not always completely.
Medical support with irritable bladder is very important. The attending physician should always weigh the effects and side effects of the therapy against each other. In addition, the function of the urogenital tract should be checked regularly in order to identify and treat damage caused by the irritable bladder at an early stage.
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