Hyperactive Bladder

Hyperactive bladder is a clinical syndrome that determines urgent urination in combination or without urgent urinary incontinence, which is usually accompanied by frequent urination and nicturia. The hyperactive bladder is due to the detrusor hyperactivity of a neurogenic or idiopathic nature. Neurogenic detrusor hyperactivity is associated with neurological diseases.

[1],

Causes of the hyperactive bladder

With idiopathic detrusor hyperactivity, the cause of involuntary contractions of the detrusor is not known. When the rapid urination is not accompanied by detrusor hyperactivity, in the absence of other causes, the term "hyperactive bladder without detrusor hyperactivity" is used.

Thus, the term "hyperactive bladder" is a generic term for all the infringements of the act of urination and does not purport to replace the well-known terminology of the International Society for Urine Retention, which is used by a narrow circle of urologists.

The terminology of the International Society for Urinary Retention by Abrams P. Et al. (2002).

Terms to be replaced	Recommended Terms
Detrusory hyperreflexion	Neurogenic detrusor hyperactivity
Detrusory instability	Idiopathic Detrusor Hyperactivity
Motor Urbanization	Absent
Sensory Urgency	Hyperactive Bladder Without Detroiore Hyperactivity
Urgent Urinary Urinary Incontinence	Urinary incontinence due to detrusor hyperactivity with an imperative urge to urinate
Reflex incontinence	Urinary incontinence due to detrusive hyperactivity without urge to urinate

It is well established that a hyperactive bladder can be a consequence of neurogenic and non-neurogenic lesions. Neurogenic disorders occur at the level of the supraspinal centers of the nervous system and the conducting pathways of the spinal cord, and not the neurogenic disorders - a consequence of the age-related changes in detrusor, IVO, and anatomical changes in the position of the urethra and bladder.

Some morphological changes in the detrusor are known with hyperactivity.

Thus, in most patients with a hyperactive bladder, a decrease in the density of the cholinergic nerve fibers that have a hypersensitivity to acetylcholine is detected. These changes are called "post-synaptic cholinergic denervation of detrusor."

[2], [3], [4], [5]

Symptoms of the hyperactive bladder

The hyperactive bladder has the following symptoms: rapid daytime and nighttime urination; they happen approximately in 2 times more often in the absence of urgent urination and 3 times more often without urgent urinary incontinence. Urgent urinary incontinence is the most severe manifestation of the hyperreactive bladder, as it causes considerable suffering for patients. The peculiarity of the course of the hyper-reactive bladder is the dynamics of its symptoms. Within 3 years of observation, in almost a third of patients, urgent  urinary incontinence  spontaneously regresses without treatment and again recurs at different times.

[6], [7], [8]

Treatment of the hyperactive bladder

The hyperactive bladder is treated, first of all, with the purpose of restoring the lost control of the memory function of the bladder. With all forms of the hyper-reactive bladder, the main method of treatment is medication. The standard drugs of choice are anticholinergics (m-holinoblokatory). As a rule, medication is combined with behavioral treatment, biological feedback or neuromodulation.

The mechanism of action of anticholinergic drugs is the blockade of postsynaptic (m2, m1) detrusor muscarinic cholinergic receptors. This reduces or prevents the action of acetylcholine on detrusor, reducing its hyperactivity and increasing the capacity of the bladder.