Constant urination and involuntary loss of urine - but at toilet flush only a few drops of urine are left: If no cause can be found for these symptoms, the diagnosis is often made irritating bladder. But what really helps against the tormenting symptoms? Many medications promise to help with an irritable bladder, but side effects often occur during therapy.
In mild cases, usually a change in lifestyle in conjunction with pelvic floor training can improve the symptoms. In case of severe suffering there are also various possibilities to influence the nerves responsible for the bladder function.
Constant urinary urgency: symptom of irritable bladder
In the "overactive bladder syndrome", as a stimulant bladder in professional circles is called, the bladder reports despite urine filling urinary urgency - usually suddenly and urgently. Patients may need to go to the toilet more than 20 times in 24 hours, even at night. Typically, each time only small amounts of urine can be left.
In addition, some irritable bladder patients involuntarily lose urine: Depending on whether or not there is bladder weakness (urge incontinence), a distinction is made between a wet and a dry irritable bladder.
On the other hand, pain or burning when urinating is less common in a stimulating bladder - these symptoms are more characteristic of cystitis or other urinary tract infections.
Cause: hyperactivity of the bladder muscles
The exact cause of the genesis of a stimulating bladder is unknown. It is thought that the regulation of bladder muscle activity is disturbed, so that the bladder muscle contracts, although the bladder is only slightly filled. The following factors may possibly promote the development of a stimulating bladder or increase the symptoms:
- Nervousness, stress or mental stress
- Hormonal changes, such as an estrogen deficiency in women
- Age-related changes in the urinary tract
- "Misbehavior" of the bladder: years too frequent or too rare toilet operations
- Chronic constipation, obesity or pregnancy (due to increased pressure on the bladder)
- Uterine reduction in women
- Enlargement of the prostate in men
Irritable bladder: Exclude morbid causes
An irritable bladder is - similar to an irritable bowel - an exclusion diagnosis. This means that the diagnosis is only made if, despite extensive diagnostics, no disease can be found as the cause of the symptoms.
As a rule, the doctor initially asks for the symptoms, drinking and eating habits as well as possible previous illnesses. Usually, the patient is then asked to write down a few days in a diary on the frequency of toilet visits, amount of urine and drinking behavior.
In addition, usually a physical examination and an ultrasound of the bladder are performed. Also useful is the examination of blood and urine to exclude diseases or infections of the urinary tract.
Extended diagnostics in unclear cases
Under certain circumstances, further examinations may be necessary, such as an x-ray examination of bladder and urethra with contrast agent (micturition cystourethography), a urine flow measurement (uroflowmetry) or a urinary bladder pressure measurement (urodynamics or cystometry). If suspected urethral and urinary bladder disease is suspected, a cystoscopy may be performed, which may, for example, rule out bladder cancer.
Start treatment without medication
At the beginning of the treatment of an irritable bladder should first be tried to get the complaints without medication to get a grip. For this a combination of behavioral therapy and pelvic floor training has proven itself.
The behavior therapy is carried out on the basis of a led diary. Through the diary, the drinking and toilet behavior can be analyzed to create a plan for a bladder training: The urination should be actively suppressed, so as to extend the distances between the toilets gradually.
Pelvic Floor Training: More effective with biofeedback
Pelvic floor training, which is best done under the guidance of physiotherapists, counteracts in particular the bladder weakness and thus the involuntary urine loss. The training effect can be enhanced by biofeedback, whereby electrodes attached to the perineum measure the muscle tension of the pelvic floor and transform it into visible signals. Especially with mild forms of a stimulating bladder, a significant improvement can often be achieved by such a conservative therapy.
Electrostimulation: help with irritable bladder
In a study analysis it was found that the stimulation of the pelvic floor muscles by electrical impulses can be an effective way of treating the irritable bladder.
In this case, either an electrode is placed in the vagina or in the anus, or a fine electrode needle is placed in a superficial nerve in the area of the ankle. The current pulse is intended to reduce the activity of the bladder muscle - this therapy is particularly effective in conjunction with pelvic floor training.
Medicines for irritable bladder
As a rule, so-called anticholinergics are used for the medicamentous treatment of the irritable bladder. They block receptors on the bladder muscle and can thus reduce its activity.
There are various active ingredients available, such as tolterodine (Ditropan®), trospium chloride (Spasmex®) and darifenacin (Emselex®). In addition, estrogen supplements applied locally in the vagina can improve women's health.
Side effects are common
Although anticholinergic drugs are usually very effective in the case of a stimulating bladder, the therapy often causes side effects such as:
- dry mouth
- Palpitations (tachycardia)
- blurred vision
- Increase of intraocular pressure
It is important to bring patience with the treatment, because the drugs do not help immediately - as a rule, the effect occurs only after a few weeks. Completely curable, a stimulating bladder is rare, but often a significant improvement can be achieved.
Irritable bladder surgery: help in severe cases
If the symptoms do not improve enough despite all the measures, there are surgical options for treating a stimulating bladder. For example, botulinum toxin (Botox) can be injected into the bladder wall in order to partially paralyze the bladder muscle.
Another possibility is the insertion of electrodes to the nerve roots in the sacrum. The effect comes from the stimulation of nerves that control bladder activity (sacral neuromodulation).
Whether the injection of drugs into the interior of the bladder (EMDA therapy, Electro Motive Drug Administration) is an effective treatment option for irritable bladder, is still being researched. The last options for the failure of all treatment measures are a bladder augmentation, ie an operative enlargement of the urinary bladder, or a urinary bladder replacement.
Treat irritable bladder naturally
There is no scientific evidence for the effectiveness of naturopathic therapies such as homeopathy or Schuessler salts. Nevertheless, if a diagnosis of an irritable bladder is confirmed - that is, if serious illnesses have been ruled out with medical certainty - nothing speaks against the attempt of a natural treatment by means of natural remedies.
5 tips that help against a stimulus bubble
In addition, you can do something yourself to relieve the symptoms. We have put together five tips for you that can help with a stimulus bubble:
- Avoiding sweet foods: Some foods can irritate the bladder. These include, for example, citrus fruits, tomatoes, carbonated drinks, hot spices and artificial sweeteners, flavors and preservatives. Nicotine can also irritate the bladder.
- Giving the gut a boost: Constipation increases the symptoms of a stimulating bladder, as the stuffed intestine presses on the bladder. Regular digestion thus has a positive effect on a stimulating bladder.
- Reduce excess weight: Even with overweight, the pressure on the bladder is increased. With a stimulating bladder, it is therefore recommended to reduce excess pounds.
- Avoid diuretic substances: Coffee and alcohol have a diuretic effect and can thus increase the symptoms of irritable bladder. Caution: In some over-the-counter drugs such as Cystinol® and in most kidney and bladder teas put herbal active ingredients that have a diuretic effect. These preparations are suitable for the concomitant treatment of urinary tract infections, but they are counterproductive in an irritable bladder.
- Changing your drinking behavior: Make sure you drink liquid evenly throughout the day. To counteract nocturnal urination, you should drink as little as possible for two hours before bedtime. Restricting daily intake may decrease urination, but it should not be less than one to one and a half liters per day.
Irritable bladder in children to treat well
An irritable bladder occurs more frequently with age - but even children can suffer from a bladder. In children, however, no overactive bladder muscle seems to be the cause. Rather, it is believed that the control of bladder control is not yet mature. This manifests itself by enuresis, which can occur both at night and during the day.
The treatment of the irritable bladder in children is similar to the therapy of adults: bladder and pelvic floor training in conjunction with behavioral therapy often leads to an improvement in children. In addition, some of the anti-irritant drugs are suitable for use in children and are often better tolerated by them than by adults.
Irritable bladder or bladder irritation?
According to the definition, irritable bladder should not be the cause of ailments of the urinary tract, genitals, metabolism, nervous system or endocrine system.
However, there are many diseases that cause bladder irritation and thus manifest with symptoms similar to those of an irritable bladder, namely, constant urinary urgency. Here is an overview of possible causes of urinary urgency.