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Treatment methods for overactive bladder. Treatment of overactive bladder. However, the drug has significant side effects

Physical laws and equations
23.07.2020

Overactive bladder is a syndrome that causes symptoms such as an urgent need to urinate, increased frequency of urination, and sometimes urinary incontinence.

But what are the reasons? What treatment options are there and what natural remedies can provide relief?

What is overactive bladder syndrome

Hyperactive syndrome Bladder- This a disease characterized by increased frequency of urination And urgent need do this in the absence of urinary tract diseases.

From the latest data it follows that:

  • This disease affects 15-17% of the population;
  • 40% men and 60% women;
  • Overall, about 50 million people worldwide suffer from overactive bladder.

However, the disorder may be much more common, and the reported data may be greatly underestimated because, due to shame or fear of being judged by others, many sufferers do not seek medical attention.

Mechanism of overactive bladder syndrome

The pathophysiology of overactive bladder syndrome is associated with changes in the detrusor muscle of the bladder. Under normal conditions, this muscle is controlled by a nervous 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 as yet unknown, this control network causes involuntary and frequent contractions of the detrusor muscle, which leads to the need for urgent urination.

Overactive bladder can be divided into two forms:

  • Wet overactive bladder when, along with the need for urgent urination, 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.

Additionally, a distinction can be made based on association with neurological diseases:

  • Overactive bladder in neurological diseases: associated with causes that affect the nervous system.
  • Overactive bladder without neurological disease: when it is proven that the causes lie outside nervous system.

Symptoms may be confused with other diseases

The symptoms of overactive bladder are not entirely specific and can sometimes be confused with other diseases 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 occur at any time of the day: on its own, after exercise, when coughing, or during emotional events.
  • Urinary incontinence: Some patients suffering from overactive bladder syndrome experience urinary incontinence.
  • Increased frequency of urination: A subject suffering from overactive bladder syndrome may go to the toilet many times a day, well above the normal threshold, specifically 8 or more times a day.
  • Nocturia: People with this syndrome have urinary urgency not only during the day but also at night, which leads to frequent awakenings and poor quality of sleep. On average, nocturia is characterized by two episodes of urination per night, but sometimes it can be many more.

Several Causes of 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 worsening of the symptoms of the syndrome.

Among pathological reasons, we will highlight:

  • Bladder abnormalities: This includes both tumors or stones in the bladder, which can interfere with normal urinary function, and benign prostatic hyperplasia, which puts pressure on the urethra, causing urinary problems.
  • 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 old age).
  • Increased urine production: Metabolic disorders such as diabetes or kidney failure can cause increased urine production.
  • Obesity: Excessive weight gain leads to increased pressure on the lower abdomen, and therefore compression of the bladder. 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 personal characteristics:

  • Pregnancy and childbirth: is one of the main causes of overactive bladder in women. Because pregnancy and childbirth lead to weakening of the pelvic floor muscles and a decrease in contractile strength.
  • Age: The most common phenomenon of overactive bladder is observed in older people. This happens because with age, all mechanisms that control (neurological) urination weaken.
  • Stress and anxiety: Sometimes an overactive bladder can be associated with stress or excessive anxiety, which causes an increase in the frequency of the urge.
  • Surgery: Surgeries that may affect the spinal nerve (for example, in the case of repair of a herniated disc), or that involve the gastro-urogenital area, can lead to disturbances in the transmission of nervous control of urination.
  • Menopause: The lack of estrogen in women during menopause is usually associated with frequent urination and urinary incontinence.
  • Medicines: Those taking medications 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 appears that those who smoke cigarettes and consume alcohol and caffeine in large quantities are more likely to suffer from this disorder.

Correct diagnosis will improve quality of life

Diagnosing the causes of overactive bladder is critical to the 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 has time to get to the toilet, or whether involuntary losses occur.
  • Survey: carried out by examining the abdominal cavity and genitourinary apparatus. In women, a pelvic examination is performed to look at the condition of the pelvic floor muscles; in men, a prostate examination is performed.
  • Level 1 tests: 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 filling and emptying process of the bladder to rule out urinary stagnation (that is, 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 flow rate of urine.
  • Other level 2 examinations: To rule out dangerous diseases such as tumors in the bladder or changes in muscle contractility. These studies include cystometry, electromyography and urethrocystoscopy.

Treatment for overactive bladder

Treatment for overactive bladder uses medications designed to control the malfunction.

Among the drugs used are:

  • Antimuscarinic: These drugs act on muscarinic receptors, thus regulating contractions of the detrusor muscle and reducing their intensity and frequency. The most commonly used are oxybutynin, darifenacin and tolterodine.
  • Adrenergic agonists: act on various categories of beta-3 adrenergic receptors, due to which they cause relaxation of the detrusor muscles and, therefore, increase bladder capacity. One of the new drugs for the treatment of overactive bladder falls into this category - mirabegron.

One more possible option Treatment is medical-surgical therapy if medications do not produce the expected results.

Among these methods are:

  • Botox: To influence contractions of the detrusor muscle, botulinum toxin can be injected directly into the bladder tissue. It's numbing 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 injection of the toxin is repeated.
  • Bladder enlargement surgery: Also known as enterocystoplasty. This operation aims to surgically enlarge the bladder so that it becomes larger and can hold more urine. Rarely used and only in severe cases when all other treatments have failed to improve.
  • Cystectomy: Used in very severe cases or in the presence of a bladder tumor. It involves complete removal of the bladder and performing a ureterostomy with the installation of an external bag to collect urine.

Lifestyle with Overactive Bladder

With proper therapy, you can completely recover from overactive bladder syndrome. However, you should know some behavior patterns that will allow you, if not to get rid of the disorder, then to minimize the symptoms.

  • Avoid consumption of certain foods eg caffeine-rich foods such as coffee, alcohol and those that can cause urinary tract irritation such as spices and highly acidic foods (eg citrus fruits). Instead, consume fiber-rich foods such as whole grains and vegetables, which help avoid constipation, which causes straining during bowel movements. It will also be helpful to reduce your intake of fats and processed foods to keep your weight under control.
  • To give up smoking, since nicotine can irritate the bladder tissue and cause recurring episodes of coughing, which lead to urinary incontinence.
  • Do any gymnastic exercises aimed at strengthening the pelvic floor muscles. The most famous are Kegel exercises.
  • Double urination, after you have finished urinating, wait a few minutes and try urinating again to remove any remaining urine.
  • Keep a urination diary, in which you note how many times you went to the toilet during the day and at night, and whether there were episodes of urinary incontinence. Note how long it takes between urinating and how much urine is produced.
  • Train your bladder or trying to resist the urge to urinate. As soon as you feel the urge, wait a few minutes before going to the bathroom, gradually increasing the wait time from a few minutes to several hours.

According to statistics, 17% of women and 16% of men suffer from bladder disease, but only 4% seek help from a specialist. Many people simply do not realize that they have any health problems. So how can you recognize the presence of bladder disease? First of all, it is necessary to find out what is meant by this term.

What does overactive bladder (OAB) mean?

The bladder is an organ consisting entirely of muscle tissue. Its task is to accumulate and remove urine through the urethra. It is worth noting that the location, shape and size of the organ change depending on its filling. Where is the bladder located? The filled organ has an ovoid shape and is located above the transitional junction between the bones of the skeleton (symphysis), adjacent to the abdominal wall, displacing the peritoneum upward. The empty bladder lies completely in the pelvic cavity.

GPM is a clinical syndrome in which frequent, unexpected and difficult to suppress urges to urinate occur (they can occur either at night or during the day). The word “overactive” means that the bladder muscles work (contract) in an increased mode with a small amount of urine. This provokes frequent intolerable urges in the patient. Thus, the patient develops the false feeling that he has a constantly full bladder.

Development of the disease

Excessive bladder activity is caused by a decrease in the number of M-cholinergic receptors. Their number changes under the influence of certain reasons. In response to a lack of nervous regulation, structural formations of close relationships between neighboring cells are formed in the smooth muscle tissues of the organ. The result of this process is a sharp increase in the conductivity of the nerve impulse in the muscular lining of the bladder. Smooth muscle cells have high spontaneous activity and begin to respond to a minor stimulus (a small amount of urine). Their contraction quickly spreads to other groups of cells in the organ, causing OAB syndrome (overactive bladder).

Factors in the occurrence of gas-filled earthworms

1. Neurogenic:

Diseases of the central and peripheral nervous systems (for example, Parkinson's disease, Alzheimer's disease);

Stroke;

Multiple sclerosis;

Osteochondrosis;

Diabetes;

Spinal cord injuries;

Schmorl's hernia;

Consequences of surgical treatment of the spine;

Spondyloarthrosis of the spine;

Intoxication;

Myelomeningocele.

2. Non-neurogenic:

BPH;

Age;

Anatomical disorders of the vesico-urethral area;

Sensory disturbances, mainly associated with a lack of estrogen during the postmenopausal period.

Forms of the disease

In medicine, there are two forms of GPM disease:

Idiopathic GPM - the disease is caused by a change in the contractile activity of the bladder, the cause of the disorders is unclear;

Neurogenic bladder - disturbances in the contractile function of the organ are characteristic of diseases of the nervous system.

Characteristic symptoms

An overactive bladder is defined by the following symptoms:

Frequent urge to urinate, with small amounts of urine being released;

Inability to hold urine - a sudden urge to urinate so strong that the patient does not have time to make it to the toilet;

Repeated urination at night ( healthy man should not urinate at night);

Urinary incontinence is the uncontrollable leakage of urine.

GPM in women

2. Non-drug treatment.

Behavioral therapy consists of developing a urination routine and lifestyle correction. During the treatment period, the patient must follow a daily routine, avoid stressful situations, take daily walks in the fresh air, watch your diet. People suffering from GPM are prohibited from eating spicy foods, carbonated and caffeine-containing drinks (tea, coffee, cola), chocolate, sugar substitutes and alcohol.

In addition, during the period of behavioral therapy, the patient needs to empty the bladder according to a certain schedule (depending on the frequency of urination). This method helps to train the bladder muscles and restore control over the urge to urinate.

Physiotherapy may consist of electrical stimulation, electrophoresis, etc.

Exercise therapy is a variety of exercises aimed at strengthening the pelvic muscles.

Treatment is based on feedback biological connection. The patient, using special devices (special sensors are installed that are inserted into the body of the bladder and rectum; the sensors are also connected to a monitor, which displays the volume of the bladder and records its contractile activity) observes at what volume of fluid the bladder contracts. At this time, the patient must, through volitional efforts, through contraction of the pelvic muscles, suppress the urge and restrain the desire to urinate.

3. Surgical treatment is used only in severe cases (denervation of the bladder, intestinal plastic surgery to divert urine into the intestines, stimulation of the sacral nerve).

Complications of GPM

An overactive bladder affects the patient's quality of life. The patient develops mental disorders: depression, sleep disorders, constant anxiety. Social maladjustment also occurs - a person partially or completely loses the ability to adapt to environmental conditions.

Prevention

1. Visiting a urologist for a preventive examination once a year (taking the necessary tests, performing an ultrasound of the bladder if necessary, etc.).

2. There is no need to postpone a visit to the doctor if symptoms of urinary problems appear.

3. It is important to pay attention to the frequency of urination, the development of urge, and the quality of the stream if there are neurological diseases.

Also, as a preventative measure, you can perform Kegel exercises, which will help strengthen the bladder muscles.

1. First you need to tense your muscles, as when holding urination, slowly count to three and relax.

2. Then tense and relax the muscles - it is important to try to do this as quickly as possible.

3. Women need to push down (as during childbirth or bowel movements, but not as hard); for men to strain, as when passing stool or urination.

Frequent urination has a very negative impact on all areas of life. To avoid development psychological problems, you need to seek help from a specialist in time.


For quotation: Mazo E.B., Krivoborodov G.G. Drug treatment of overactive bladder // Breast Cancer. 2004. No. 8. P. 522

Terms and prevalence Overactive bladder (OAB) is a clinical syndrome with symptoms of frequent and urgent urination with (or without) urgency urinary incontinence and nocturia (urination during the period from falling asleep to waking up). OAB is based on detrusor hyperactivity of a neurogenic or idiopathic nature. Neurogenic detrusor overactivity is a consequence of neurological diseases. Idiopathic detrusor overactivity means that the cause of involuntary detrusor contractions is unknown. When frequent, urgent urination is not accompanied by detrusor overactivity in the absence of other causes of these symptoms, the term OAB without detrusor overactivity is used. Thus, the term OAB is a general term to refer to all of the above urination disorders. However, the term OAB does not purport to replace the well-known terminology of the International Continence Society, which is used by a narrow circle of urologists. Figure 1 and Table 1 present urodynamic and clinical terms for frequent and urgent urination.

Overactive bladder (OAB) is a clinical syndrome with symptoms of frequent and urgent urination with (or without) urgent urinary incontinence and nocturia (urination during the period from falling asleep to waking up). OAB is based on detrusor hyperactivity of a neurogenic or idiopathic nature. is a consequence of neurological diseases. indicates that the cause of involuntary detrusor contractions is unknown. When frequent, urgent urination is not accompanied by detrusor overactivity in the absence of other causes of these symptoms, the term is used. Thus, the term OAB is a general term to refer to all of the above urination disorders. However, the term OAB does not purport to replace the well-known terminology of the International Continence Society, which is used by a narrow circle of urologists. Figure 1 and Table 1 present urodynamic and clinical terms for frequent and urgent urination.

Rice. 1. Clinical and urodynamic terms for frequent and urgent urination

Analysis of medical literature recent years shows the increased interest of doctors in the problem of OAB, which was greatly facilitated by the results of epidemiological studies on the prevalence of OAB. According to the International Continence Society, OAB occurs in approximately 100 million people worldwide. In the United States, the diagnosis of OAB is more common than that of diabetes mellitus, gastric and duodenal ulcers, and is included in the 10 most common diseases. There is evidence to suggest that 17% of European adults have symptoms of OAB. It is believed that imperative urination occurs in 16% of Russian women.

Despite the fact that OAB is more often noted in old age, symptoms of OAB are quite common in other age groups. According to our data, greatest number Patients were observed over the age of 40 years, while in men over 60 years of age there is a clear trend towards an increase in incidence, while in women, on the contrary, a decrease. The data presented clearly demonstrate that OAB is a very common clinical syndrome, occurring in various age groups and leading to physical and social maladaptation of such patients.

Clinically, patients with OAB more often have idiopathic detrusor hyperactivity, less often neurogenic, and even more rarely OAB without detrusor hyperactivity (according to our data, in 64%, 23.5% and 12.5%, respectively). If idiopathic detrusor hyperactivity is observed 2 times more often, and OAB without detrusor hyperactivity is 6 times more often in women, then neurogenic detrusor hyperactivity occurs almost equally often in both women and men.

Etiology and pathogenesis

It has been reliably established that OAB can be a consequence of neurogenic and non-neurogenic lesions. The first are disorders at the level of the supraspinal centers of the nervous system and the spinal cord pathways, the second are a consequence of age-related changes in the detrusor, bladder outlet obstruction and anatomical changes in the position of the urethra and bladder.

Some are known morphological changes in the detrusor with its hyperactivity . Thus, in most patients with OAB, a decrease in the density of cholinergic nerve fibers is detected, which, in turn, have increased sensitivity to acetylcholine. These changes are defined as “postsynaptic cholinergic detrusor denervation.” In addition, using electron microscopy, it was possible to establish violations of normal intercellular connections in the detrusor of the GMF in the form of protrusion of intercellular connections and protrusion cell membrane one myocyte into another neighboring myocyte with the convergence of intercellular boundaries - “a tight connection of two parallel planes of adjacent myocytes.” Based on these morphological changes, which are believed to be characteristic of OAB, Brading and Turner in 1994 proposed a theory of the pathogenesis of the development of detrusor hyperactivity, which is based on the increased excitability of myocytes that are in close connection with each other in places of denervation.

It is believed that the cause of denervation, in addition to nervous disorders, may be detrusor hypoxia due to age-related ischemic changes or due to bladder outlet obstruction. In the latter case, this is confirmed by the presence of OAB in 40-60% of men with benign prostatic hyperplasia. Thus, the pathogenesis of detrusor overactivity in OAB is presented as follows: hypoxia occurring in the detrusor as a result of age-related arteriolosclerosis or as a result of IVO, leading to hypertrophy and infiltration connective tissue detrusor, lead to detrusor denervation (detected in detrusor biopsies for all types of detrusor hyperactivity), as a result of which structural changes occur in myocytes (close contact between myocytes with increased nervous excitability and conductivity), as a compensatory reaction to a deficiency of nervous regulation. In this case, any spontaneous or provoked by stretching of the bladder wall (period of urine accumulation) contraction of individual myocytes in the form of “ chain reaction"leads to involuntary contractions of the entire detrusor. The proposed theory of the development of detrusor hyperactivity in OAB is currently leading.

Clinical course and examination tactics

Frequent daytime and night urination, as the predominant symptoms of OAB, we observed approximately 2 times more often without urgent urination and 3 times more often without urgent urinary incontinence, which is undoubtedly the most severe manifestation of OAB, since it causes incomparably significant suffering for patients. A feature of the course of OAB is the dynamics of its symptoms. During a 3-year follow-up period, in almost a third of patients, urge urinary incontinence spontaneously regresses without treatment and recurs again at different times. The most persistent symptom is frequent urination, which often reaches such a level that it makes patients completely unable to work and pushes them to make rash decisions.

In addition to collecting anamnesis and physical examination, all patients with frequent and urgent urination are assessed for urination frequency (based on a 72-hour urination diary), urine sediment examination and urine culture for sterility, ultrasound scanning of the kidneys, bladder, prostate, with determination of residual urine. The results of the urination diary are most important: having assessed them, one can largely assume OAB and, based on this, quickly decide on the initiation of treatment and its methods. OAB is eligible for diagnosis if there are at least 8 urinations and/or at least 2 episodes of urge urinary incontinence during the day . It is important that the results of such an initial examination, which is carried out at the outpatient stage, often make it possible to identify diseases that are accompanied by symptoms of frequent and urgent urination, but are not related to OAB.

When OAB is detected, treatment can be started immediately to improve the patient’s quality of life by stopping frequent and urgent urination. In case of ineffectiveness of treatment or at the request of the patient, to clarify the form of OAB (idiopathic or neurogenic detrusor hyperactivity, OAB without detrusor hyperactivity), cystometry and special tests with cold water and lidocaine are performed, which allow one to suspect neurological disorders underlying the development of detrusor hyperactivity. In all cases, when detrusor overactivity is detected, a detailed neurological examination is indicated.

Treatment

Treatment of patients with OAB is aimed primarily at restoring lost control over the storage capacity of the bladder. For all forms of OAB, the main treatment method is medication. Anticholinergics (M-anticholinergics) are standard drugs for such treatment . These drugs are used both as monotherapy and in combination with other drugs (Table 2). Below we will report which anticholinergic drugs are advisable to use in the modern treatment of OAB symptoms. Typically, medications are combined with behavioral therapy, biofeedback, or neuromodulation. The mechanism of action of anticholinergic drugs is the blockade of postsynaptic (M2, M3) muscarinic cholinergic receptors of the detrusor. This reduces or prevents the effect of acetylcholine on the detrusor, reducing its hyperactivity. In humans, five types of muscarinic receptors are known, of which the detrusor contains two - M 2 and M 3. The latter make up only 20% of all muscarinic receptors in the bladder, but they are responsible for the contractile activity of the detrusor. Location of M2 - heart, hindbrain, smooth muscles, potassium channels; M 3 - smooth muscles, glands including salivary glands, brain. The cellular response to M2 stimulation is negative, isotropic, decreased presynaptic release of transmitters; M 3 - contraction of smooth muscles, secretion of glands, decrease in presynaptic release of transmitters. It has been proven that activation of M2 receptors leads to inhibition of the sympathetic activity of the detrusor, which increases its contractile activity. Thus, blockade of M2 cholinergic receptors is essential along with blockade of M3 in suppressing detrusor hyperactivity. It is believed that M2 cholinergic receptors are largely responsible for the development of detrusor hyperactivity in neurological diseases and in elderly patients. M receptors are the main target of drug treatment for OAB . M 3 anticholinergic medications remain the drugs of choice, among which highly selective ones play a special role. According to their chemical structure, anticholinergic drugs are divided into secondary, tertiary (oxybutynin hydrochloride, tolterodine tartrate) and quaternary (trospium chloride) amines. From a practical point of view, this division allows us to assume the development of side effects depending on chemical structure drug. In particular, it is believed that quaternary amines, compared to secondary and tertiary amines, penetrate the blood-brain barrier to a lesser extent and, therefore, are less likely to develop side effects from the central nervous system. This point of view has not yet been fully confirmed in clinical practice, since the development of side effects is also determined by other features of anticholinergic drugs (organ specificity, drug pharmacokinetics, drug metabolites, type of receptors blocked).

The use of anticholinergic drugs was limited due to the severity of systemic side effects, primarily dry mouth, which developed with blockade of M receptors of the salivary glands, often forcing patients to refuse treatment. When using the immediate-release form of oxybutynin (used since 1960 and remains the standard for comparison with other anticholinergic drugs), only 18% of patients continue treatment during the first 6 months due to side effects. Side effects include not only dry mouth, but also blurred vision, decreased tone of smooth muscle organs and associated inhibition of intestinal motility and constipation, tachycardia, etc. in some cases central effects (drowsiness, dizziness), etc. Side effects lead to the need for dose titration (for oxybutynin - from 2.5 to 5 mg 3 times a day).

A significant step forward is the synthesis of a new anticholinergic drug - tolterodine , proposed specifically for the treatment of OAB. Tolterodine is a mixed antagonist of M2 and M3 cholinergic receptors, which has a distinct organ specificity of action in relation to the detrusor. Unlike oxybutynin, which has pronounced selectivity for M1 and M3 receptors, tolterodine demonstrates almost identical sensitivity to different subtypes of M receptors. Our experience with the use of an immediate-release form of tolterodine at a dose of 2 mg 2 times a day in 43 patients with idiopathic detrusor overactivity indicates its high efficiency. After 12 weeks of use, the number of urinations per day decreased on average from 13.5±2.2 (9-24) to 7.9±1.6 (6-17), and episodes of urge urinary incontinence from 3.6±1. 7 (1-6) to 2.0±1.8 (0-3). The immediate-release form of tolterodine is relatively well tolerated, as evidenced by data from clinical trials in which 82% and 70% of patients completed 6- and 12-month courses of treatment, respectively, indicating that the effectiveness of therapy is maintained over the long term. The incidence of side effects with the immediate-release form of tolterodine was virtually the same as in the placebo group, with the exception of dry mouth, which was observed in 39% of patients taking tolterodine and in 16% of the placebo group. Our data also indicate good efficacy and tolerability of the immediate-release form of tolterodine (4 mg) for 6 months. treatment in 16 patients with neurogenic detrusor hyperactivity. There was a decrease in the average number of daily urinations by 5.7/day, episodes of urgent urinary incontinence by 2.7/day and an increase in the average effective bladder volume by 104.5.

Clinical studies show that anticholinergic drugs lead to a reduction in the frequency of OAB symptoms within 1-2 weeks of treatment, and the maximum effect is achieved by 5-8 weeks. At the same time, treatment involves long courses. Despite this, in most cases of monotherapy with anticholinergic drugs, after their withdrawal, a relapse of OAB symptoms is observed, which makes it necessary to take them continuously in order to maintain an adequate therapeutic effect.

The use of anticholinergic drugs, in particular tolterodine, requires careful monitoring and caution, especially in patients with neurogenic detrusor overactivity. The fact is that with prolonged uncontrolled use of these drugs, patients may experience a disturbance in the contractile activity of the detrusor, with the development of chronic urinary retention, urethrohydronephrosis and chronic renal failure. For timely monitoring of possible side effects, it is necessary to evaluate the amount of residual urine. We recommend that in the first three months after the prescription of anticholinergic drugs, the amount of residual urine is determined at least once every two weeks, and subsequently once a month. Patients should be warned about the possibility of such a complication and immediately inform the doctor if they experience incomplete emptying of the bladder.

It is known that, along with drugs, their metabolites are responsible for the development of side effects, the concentration of which in the blood and their affinity for M - cholinergic receptors often exceeds those of the original drugs. For example, the metabolism of oxybutynin leads to the formation of N-desityl oxybutynin, and tolterodine leads to the active metabolite, the 5-hydroxymethyl derivative. These data provided the basis for the use of anticholinergic drugs other than oral forms. In particular, they use intravesical administration of oxybutynin or rectal suppositories. Penetration of the drug directly into the blood, bypassing the liver, with such forms of administration is not accompanied by the formation of metabolites, which reduces the number of side effects. Since 1999 they began to use slow-release form of oxybutynin based on the OROS osmotic delivery system, which provides prolonged release of the drug and its constant concentration in the blood plasma over 24 hours. Clinical studies show that the slow-release form of oxybutynin has an effectiveness in reducing urinary urgency symptoms comparable to the immediately released form with a lower number side effects (25% versus 46%). It is believed that this is why 60% of patients with OAB continue to take the slow-release form of oxybutynin for 12 months. at a dose of 15 mg per day.

Currently, studies are being carried out to study the effectiveness and tolerability of the S-form of oxybutynin, and transdermal ( OXYtrol patch) and intravesical ( UROS) forms of use of oxybutynin.

The slow-release form of tolterodine consists of many small beads made of polystyrene. Active substance is located on the surface of the beads and is covered with a special capsule. The drug is released when the capsule is destroyed by the acidic contents of the stomach. This delivery system ensures a constant level of the drug in the blood over 24 hours. The slow-release form of tolterodine has a more significant reduction in episodes of urge urinary incontinence and is better tolerated compared to the immediate-release form. Patients treated with slow-release tolterodine had 23% fewer cases of dry mouth.

Considering the insignificant number of side effects when using slow-release forms of anticholinergic drugs, the issue of increasing their dose in the treatment of patients with OAB has recently been discussed in the literature. This is due to the fact that most patients have a positive effect when using a standard dose of anticholinergic drugs and only some of them get rid of OAB symptoms completely. At the same time, despite good tolerability, doctors usually do not increase the dose of drugs to completely eliminate the symptoms of OAB. Clinical research and practice indicate that a significant number of patients with successful results of treatment with anticholinergic drugs may subsequently have clinical improvement in symptoms when the dose of these drugs is increased.

There is a separate question about the possibility of using anticholinergic drugs in patients with OAB and bladder outlet obstruction . Despite the fact that anticholinergics reduce frequency and urgency of urination, doctors are wary of using them in patients with concomitant bladder outlet obstruction due to the risk of developing acute urinary retention. Only two randomized controlled trials have examined this issue. These studies showed that the immediate-release form of tolterodine, used alone or in combination with tamsulosin (a 1 -blocker), is safe against possible development acute urinary retention and provides an improvement in the quality of life in patients with detrusor overactivity in combination with mild to moderate bladder outlet obstruction and a moderate amount of residual urine.

We used an immediate-release form of tolterodine (2 mg twice daily) in 12 patients with OAB in combination with benign prostatic hyperplasia. In 2 patients, in the first 3 weeks of treatment, the appearance of residual urine in a volume of up to 100 ml was noted, which was an indication for discontinuation of treatment. In 10 patients after 12 weeks of treatment GPA I-PSS decreased from 17.2 to 11.7 due to irritative symptoms, and the average quality of life score decreased from 5.2 to 3.1. The number of urinations according to the urination diary decreased from 14.6 to 9.2. The maximum urine flow rate not only did not decrease, but even slightly increased from 12.3 to 13.4, which is likely due to an increase in the storage capacity of the bladder. There is no doubt that further research is needed to clarify the possibility of using anticholinergic drugs in patients with OAB and bladder outlet obstruction.

There are isolated reports of a scattered nature on the use of other drugs in patients with OAB. In particular, the use of tricyclic antidepressants, calcium ion antagonists, α1-adrenergic blockers, prostaglandin synthesis inhibitors, vasopressin analogs, β-adrenergic stimulants and potassium channel openers has been reported. However, due to the small number of observations, an accurate assessment of the results of their use in the treatment of OAB is currently not possible. These drugs are usually used in combination with anticholinergic drugs.

Recently, successful use in the treatment of patients with OAB has been reported. capsaicin And resiniferotoxin . These substances are injected into the bladder in the form of a solution. Capsaicin and resiniferotoxin are drugs with a specific mechanism of action, which consists of reversibly blocking the vanilloid receptors of the afferent C-fibers of the bladder. These drugs are used today mainly in patients with neurogenic detrusor overactivity in the absence of effect from traditional medications.

We tested a new method of drug treatment for OAB, which is considered very promising throughout the world. The method is sequential injection into various parts of the detrusor for a total of 200-300 units of botulinum toxin type A . The mechanism of action of the toxin is to block the release of acetylcholine from the presynaptic membrane at the neuromuscular junction, which leads to a decrease in the contractile activity of the detrusor. In most cases, previous muscle activity is restored after 3-6 months. after the introduction of the toxin, but often this can occur after a year or more. Our results of using botulinum toxin type A in 3 patients with neurogenic detrusor overactivity indicate an increase in bladder capacity, which is clinically manifested by a decrease in the number of urinations and episodes of urge urinary incontinence. However, there is not yet sufficient data to characterize with great certainty the effectiveness of this treatment method.

Thus, literature data and our own experience indicate that among drug treatment methods, anticholinergic drugs occupy a leading place in the treatment of OAB and allow obtaining good results in a significant number of patients. Improving the methods and forms of administration of anticholinergic drugs while maintaining therapeutic effectiveness can reduce the number of side effects. It is hoped that as knowledge expands regarding the pathophysiological processes underlying the development of detrusor overactivity, fundamentally new targets for pharmacological treatment will emerge.

Literature:

About 16 percent of men suffer from overactive bladder. This disease is characterized by a sudden contraction of the bladder muscles, which causes the urge to urinate. In this case, it does not matter how full the bubble is, which causes discomfort to the patient.

GAMP (an acronym accepted in the medical community) has two forms:

  • idiopathic - when it is impossible to identify the cause of the disease;
  • neurogenic - manifests itself when the central nervous system is disrupted.

For people who do not suffer from this disease, the norm for emptying is 6 times a day. If the amount increases, then this is considered a signal and you should consult a specialist for advice.

OAB symptoms

The main symptom of the disease in question is a sudden urge to go to the toilet, regardless of time, the urge often occurs at night.

There are other symptoms:

  • a small amount of urine during bowel movements, as well as frequent urges. If they exceed the amount 8-9 times, this is not the norm;
  • involuntary urination - possibly either partial or complete;
  • double excretion of urine - means that after the bladder has been completely emptied, the patient continues to excrete urine.

It is possible that the patient may experience these symptoms simultaneously, or several of them.

Reasons for occurrence

An overactive bladder in men is a consequence of pathology in the body. Treatment without consultation is impossible, because the causes of this condition must be determined.

In neurogenic cases, the following causes are identified:

  • damage to the central nervous system caused by trauma, Parkinson's or Alzheimer's diseases;
  • disruption of the spinal cord or brain (consequences after injury, cancer or surgery);
  • in connection with hernias and surgery, problems with the central canal arise;
  • insufficient blood supply to the brain.

Bladder overactivity in men also occurs for non-neurogenic reasons:

  • the elasticity of the bladder walls is lost;
  • BPH;
  • abnormal features of the male bladder;
  • disruptions in the hormonal activity of the body;
  • changes in the patient’s mental state: work stress, aggression;
  • manifestation of inflammation in neighboring organs: prostatitis, orchitis;
  • formation of kidney stones;
  • depends on the age of the patient, most often found in men over 60 years of age.

Household origin of GIMP:

  • drinking liquid in large quantities. With daily consumption of more than two liters, MP loses its elasticity;
  • alcohol abuse, especially beer;
  • difficult defecation.

A timely visit to a urologist helps to diagnose the disease in question and return the patient to his usual lifestyle.

Diagnostics

Before making a diagnosis, a specialist must conduct an examination and rule out other diseases of the urinary system.

To make a correct diagnosis, the following studies are carried out:

  • Ultrasound of the abdominal organs;
  • urine and blood analysis;
  • bacterial culture of urine;
  • cytoscopy;
  • urodynamic study.

Treatment of OAB

The process of treating overactive bladder in men is quite long, because it is not always possible to immediately determine the source of its occurrence. Only after diagnosis can a specialist prescribe a course of treatment.

A medicinal method is possible, or a complex one, including physical activity and a change in diet.

If possible, the doctor refuses the drugs, offering the patient the following therapeutic treatments:

  • proper nutrition and identifying the appropriate amount of fluid to drink;
  • special exercises;
  • neuromodulation.

Construction proper nutrition helps improve the patient's condition. Foods and dishes that irritate the walls of the bladder should be excluded from the diet.

Most often, the list of prohibited foods includes:

  • sour and spicy foods;
  • products containing caffeine;
  • mineral water.

Prohibited:

  • watermelons;
  • melons;
  • cucumbers;
  • alcohol.

Eating protein above normal puts a strain on the kidneys, which is a source of increased urine production. The patient is asked to reduce the amount of protein and give preference to foods containing fiber.

Reducing the amount of fluid consumed is also included this method. The patient is advised to reduce the amount of fluid consumed from soups, juices and give preference to clean water. You should be careful with tea and coffee, they can have a diuretic effect.

A suitable menu is part of the treatment; experts offer another method - one that increases the elasticity of the bladder muscles. In addition to the MP, it involves the muscles of the prostate and penis.

Doctors also advise not to immediately visit the restroom as soon as the urge appears, but to try to delay going there. Developing a schedule for going to the toilet is also considered an effective way to combat the disease.

In pharmacies you can buy diapers for adults, which help avoid inconvenience.

The last method, neuromodulation, is not a surgical intervention. Its action lies in the fact that with the help of electrical impulses the spinal nerves are affected.

Drugs

However, the traditional method of treating OAB is the use of drugs from the M-anticholinergic group.

Popular ones are:

  • Oxybutynin;
  • Tolterodine;
  • Vesicare.

Drug treatment does not completely eliminate the problem of bladder overactivity, helping only in the 6-8th month. After this, the signs of OAB return, and you have to take the course again.

Drugs in this group may have side effects:

  • dry mouth;
  • changes in blood pressure (increase or decrease);
  • memory deteriorates, the patient becomes absent-minded;
  • obstipation;
  • poor vision progresses.

Surgery is performed in extreme cases and is undesirable. The doctor suggests operating only if other methods have failed.

Folk remedies

Before starting treatment at home, you should visit a doctor and consult about the safety of this method.

In treatment folk remedies includes taking tinctures of various herbs, which help improve the functioning of the MP and restore its functions.

Below are a few recipes:

  • infusion of St. John's wort. It is taken as a tea; to do this, pour 1 liter of boiling water over 40 g of herb and leave to infuse for several hours;
  • Centaury is also added to St. John's wort. The recipe is similar to the first, however, the amount of St. John's wort is reduced to 20 g and 20 g of centaury is added, all this is poured with boiling water in a volume of 1 liter, and taken 1-2 glasses per day;
  • For 1 cup of boiling water you will need 1 tbsp. l. plantain, the decoction should be left for 1 hour and taken 2-3 tbsp. l. a day before meals;
  • instead of tea, you can drink infused lingonberry leaves, which also have a beneficial effect on MP;
  • boil dill seeds in 200 ml water for 3 minutes, then cool and drink;
  • for treatment you will need honey, onion and apple. Turn these products into a paste and consume an hour before lunch.

St. John's wort

Overactive bladder (OAB) is a set of symptoms that includes frequent urination, urinary incontinence, and frequent urination at night. Associated with involuntary contractions of the muscle layer of the organ. In half of the cases, OAB becomes a manifestation of an underlying disease that is not directly related to urea. Diagnostics involves laboratory tests, urography, ultrasound of the urinary tract and bladder.

Prevalence of the problem

OAB is a disease caused by involuntary contraction of the bladder muscles. According to statistics, it occurs in 17% of the European population. It is more often found in women after 40-45 years. In men it is diagnosed mainly after 60 years.

In terms of frequency of occurrence, OAB is not inferior to hypertension, bronchial asthma, myocarditis and chronic bronchitis.

Involuntary contraction of the bladder is not an age-related norm. Hyperactivity indicates a malfunction of the nervous or urinary systems.

Causes of overactive bladder syndrome

Increased contractile activity of the urinary muscles is the main cause of the disease. In urology, there are 2 forms of OAB:

  • idiopathic - the causes of changes in tone and spontaneous contraction of the bladder cannot be determined;
  • neurogenic - hyperactivity of the detrusor (muscle layer) is caused by pathologies of the nervous system.

Normally, the bladder muscles relax and contract under the control of the centers of the nervous system.

In patients with OAB, nervous system control over the functioning of the organ is weakened, as a result of which the muscular lining of the bladder begins to shrink spontaneously. Then the desire to urinate is not suppressed by volitional effort, which is why imperative (urgent) urges to go to the toilet arise.

Factors leading to OAB

Violation of the contractile activity of the urea is caused by external and internal factors:

  • abuse of diuretics;
  • abnormal structure of the urea;
  • injuries of the groin area;
  • prolapse of the vaginal walls;
  • pregnancy;
  • urinary infections;
  • narrowing of the urinary ducts;
  • hormonal imbalance;
  • tumors in the bladder.

Hyperactivity of the bladder provokes the use of medications. OAB occurs especially often with the abuse of diuretics and antiallergic drugs. Disturbances that occur at different levels of urinary regulation lead to one of the forms of OAB.

Neurogenic overactive bladder occurs in 77% of cases due to damage to the spinal cord or brain.

What diseases can it be associated with?

OAB often occurs against the background of pathologies of the nervous, endocrine, cardiovascular and other systems. Failures in the functioning of the detrusor provoke:

  • diabetes;
  • ischemic stroke;
  • intervertebral hernia;
  • Parkinson's disease;
  • brain tumors;
  • BPH;
  • spine fracture;
  • encephalitis.

The female body is more susceptible to OAB, which is due to the anatomical features of the structure of the genitourinary system. A short and wide urethra becomes an entry point for infection, which provokes inflammatory and degenerative changes in the bladder.


Women with chronic cystitis, urethritis, cervicitis, as well as those who have gone through difficult childbirth are more susceptible to OAB.

Symptoms

Depending on the cause, signs of OAB appear constantly or occasionally. Detrusor hypertonicity increases the pressure inside the bladder, which is why the urge to go to the toilet occurs when even a small amount of urine accumulates. Typical symptoms of involuntary detrusor contraction are:

  • involuntary leakage of urine;
  • the need to urinate repeatedly;
  • an irresistible urge to urinate;
  • uncontrolled urination during the period from falling asleep to waking up.

With a stable increase in intravesical pressure, the tone of the bladder sphincter decreases. There is a desire to urinate so strong that patients cannot even make it to the toilet.

OAB is characterized by spastic contraction of the detrusor. The urge to go to the toilet occurs when no more than 250-300 ml of urine accumulates. If the disease occurs against the background of an infectious disease, the clinical picture is supplemented with the following symptoms:

  • increased sweating;
  • feverish condition;
  • muscle weakness;
  • elevated temperature;
  • cloudy urine.

If foci of inflammation are localized in the urinary tract, a burning sensation occurs when the bladder is emptied. At the end of urination, a small amount of blood may be released.

Possible complications

The inability to independently control urination becomes the cause of psychological discomfort and social maladjustment. The main complications of OAB include:

  • depression;
  • insomnia;
  • constant anxiety;
  • mental disorders;
  • decreased quality of life.

People with OAB often do not tell even close relatives about the problem. Delayed treatment leads to worsening of the disease.

Which doctor should I contact?

A urologist diagnoses and treats OAB. If the cause of the change in bladder tone is a malfunction of the kidneys or nervous system, you will need to consult a nephrologist and neurologist.

In 40% of women, OAB occurs due to gynecological pathologies. Therefore, the treatment regimen for the underlying disease - cervicitis, vaginosis, colpitis - is prescribed by a gynecologist. Diagnosis and treatment of OAB in men after 60-65 years is carried out by a urologist-andrologist. If you suspect tumors in the urinary tract, you should be examined by an oncologist.

Treatment of overactive bladder

To understand how to treat bladder pathology, the urologist conducts a comprehensive examination:

  • Ultrasound of the bladder;
  • excretory urography;
  • MRI of the urinary tract;
  • laboratory analysis of blood and urine;
  • Zimnitsky's test.

To reduce the tone of the muscular lining of the organ, diet therapy, medications, physiotherapeutic and surgical techniques are used. During therapy, patients should keep a toilet diary. These records are used to evaluate the effectiveness of treatment.

Diet

To reduce the load on the bladder and prevent irritation of the mucous membrane, avoid spices, spicy foods, sour and diuretic foods:

  • watermelons;
  • caffeinated drinks;
  • tomatoes;
  • canned vegetables;
  • alcohol;
  • cucumbers;
  • chocolate.
  • cereals;
  • seafood;
  • sunflower seeds;
  • olive oil;
  • green vegetables.

During treatment, constipation should be avoided, which only increases intravesical pressure. To normalize stool, the menu includes foods with fiber - bananas, pumpkin, oats, legumes, broccoli, pears.

Physical exercise

Physical education is aimed at strengthening the pelvic muscles and restoring the contractile activity of the bladder. Treatment for men and women is no different. To regain control over urination, you need to regularly perform Kegel exercises every day:

  • Compression. Slowly tighten the pelvic muscles, which are involved in stopping urination. The strength of their contraction is gradually increased, and then relaxed.
  • Fast compression. They sharply tense and relax the pelvic floor muscles. Repeat the exercise at least 20 times.
  • Pushing out. Imitating the process of defecation, strain the corresponding muscles for 10-15 seconds. Repeat the exercise up to 30 times.

With regular performance of the gymnastic complex, control over muscle function is restored. Exercise therapy is indicated for people with OAB who suffer from uterine prolapse, rectal pathologies, and prostate adenoma.

Surgery

To normalize the functioning of the bladder, the following surgical techniques are used:

  • denervation of the ureter - reducing the hypertonicity of the bladder due to the removal of the nerves that innervate it;
  • hydrobougation - the introduction of a sterile liquid into an organ, which leads to disruption of blood microcirculation and death of nerves;
  • enterocystoplasty – replacement of part of the urea with intestinal tissue;
  • Detrusor myectomy is a partial excision of the muscle layer of the bladder.

Excision of the detrusor, enlargement of the bladder and other types of surgical intervention are indicated when medication and physiotherapeutic methods are ineffective, and in case of purulent complications.

Drugs

To treat an overactive bladder, medications are used that reduce detrusor tone, improve blood circulation in the pelvic organs and prevent tissue oxygen starvation:

  • tricyclic antidepressants (Azafen, Imipramine) - eliminate anxiety, insomnia, and depression;
  • alpha-blockers (Phenoxybenzamine, Dibenilin) ​​- lower blood pressure, improve blood microcirculation in the bladder;
  • anticholinergic drugs (Spaztil, Pantelin, Hyoscine) - relieve spasms of the bladder and urinary ducts;
  • calcium antagonists (Adalat, Phenigidine) - reduce the tone of smooth muscle muscles, reducing intravesical pressure.

Tablets are prescribed exclusively by a doctor, taking into account the degree of impairment of the contractile activity of the detrusor. For the neurogenic form, injections of butulinum toxin into the wall of the bladder are recommended.

Folk remedies

Treatment with folk remedies is carried out only as an addition to the main therapy:

  • Infusion. Yarrow and St. John's wort are mixed in equal quantities. 20 g of raw materials are steamed with 1.5 liters of boiling water. Leave in a thermos for up to 7 hours, then filter. Drink 150-200 ml of infusion three times a day.
  • Decoction. 3 tbsp. l. Boil lingonberry leaves in 1 liter of water for 7 minutes. Take instead of coffee and tea for 1 month.

It is undesirable to resort to folk remedies for hypersensitivity to herbs and severe kidney failure.

Other methods

Physiotherapeutic procedures are used to combat OAB:

  • electrical stimulation of the anogenital zone;
  • heat treatment of the bladder;
  • intravesical electrical stimulation.

Treatment of overactive bladder in women involves the following procedures:

  • diadynamic therapy – exposure of affected organs to low frequency currents;
  • hyperbaric oxygenation therapy atmospheric masses high oxygen content;
  • laser therapy - exposure to low-intensity laser beams.

To reduce intravesical pressure and normalize the functioning of the bladder sphincter, a suprapubic catheter is installed to remove urine.

Features of treatment during pregnancy

Pregnancy is one of the factors that provoke OAB. Treatment is carried out by a urologist under the supervision of an obstetrician-gynecologist. In the 1st trimester of pregnancy, therapy is symptomatic. The use of many medications - alpha-blockers, anticholinergics, antidepressants - is fraught with complications:

  • spontaneous abortion;
  • defects in fetal development;
  • fetoplacental insufficiency.

Surgical and physiotherapeutic methods are resorted to after childbirth.

Diagnosis of OAB in children

OAB in children is caused by acquired and congenital diseases:

  • abnormal structure of the bladder;
  • birth injuries;
  • congenital diseases of the central nervous system;
  • urogenital infections.

In 6 out of 10 children, urinary incontinence occurs due to insufficient extensibility of the bladder walls.

A decrease in bladder volume leads to an increase in pressure due to fluid accumulation. Subsequently, the work of the sphincter is disrupted, so children have an acute urge to go to the toilet.

Is the disease completely curable?

The likelihood of complete relief from OAB depends on the cause of detrusor hypertonicity. With adequate and timely treatment of underlying diseases, up to 80% of patients are cured. The rest take symptomatic medications throughout their lives that reduce the tone of the muscle layer of the bladder.

If drug therapy does not help, surgical endoscopic intervention is performed. To prevent relapses of OAB, all provoking factors must be eliminated.

How to live with urinary hyperactivity

To reduce bladder tone you should:

  • to refuse from bad habits;
  • exercise;
  • Do Kegel exercises regularly;