Irritable bladder syndrome in women, men and children

Frequent urge to urinate, episodes of incontinence, a feeling that the bladder is always full – people rarely consult a doctor with these problems. Meanwhile, these symptoms are really problematic, because they significantly worsen the quality of life and can cause depressive states. Few people know, but irritable bladder syndrome can and should be treated – both with medication and folk remedies. But what you should not do is let the health problem take its course. The condition can gradually worsen and become more complicated. Therefore, it is better to consult a doctor as soon as possible.

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Epidemiology

Approximately every fifth adult on the planet suffers from irritable bladder syndrome. The problem is found somewhat more often in women. For example, according to statistics, in the post-Soviet space, 16% of women have this disease.

The predominant age of patients suffering from the syndrome is 40 years and above. Men are more likely to suffer from the syndrome after 50-60 years.

The frequency of detection of irritable bladder syndrome can be compared with the incidence of diabetes or depressive states - all these diseases occur with approximately the same frequency. However, a characteristic feature of the syndrome is that even in the most developed countries, up to 70% of patients do not receive the necessary treatment due to failure to seek medical attention. Most sufferers prefer to adapt, changing their usual rhythm of life, and significantly reducing the quality of life:

• long trips and walks become problematic;
• the quality of night rest deteriorates;
• the patient becomes asocial, and his/her ability to work deteriorates.

Medical workers complain about the lack of awareness of people regarding this problem. After all, this disease can be cured, relieving the patient of many life difficulties associated with constant "attachment" to the toilet.

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Causes irritable bladder syndrome

• Neurogenic causes: diseases and disorders affecting the central and peripheral nervous system (cerebrovascular accidents, Parkinson's disease, senile dementia, multiple sclerosis, osteochondrosis, traumatic injuries to the spinal column, complications after spinal surgery, vertebral spondyloarthrosis, vertebral hernias, myelomeningocele).
• Non-neurogenic causes:
  • Infravesical obstructive condition (adenoma of the prostate gland, narrowing of the urethra). Due to this pathological condition, the muscular layer of the bladder hypertrophies. As a result, the energy expenditure of muscle tissue increases, and at the same time the quality of blood circulation decreases: there is a lack of oxygen. Then denervation occurs, nerve cells die.
  • Age-related changes. With age, tissue regenerative capacity decreases, blood supply is disrupted, atrophic processes occur in the urothelium with subsequent denervation.
  • Anatomical features of the vesicourethral region.
  • Sensory disorders. Such disorders arise as a result of increased secretion of peptides (in particular, urinary tachykinins) from sensory nerve fibers, increasing the degree of conductivity and excitability of the nerve structures of the bladder. Similar disorders can also arise against the background of intravesical atrophic processes, acute or prolonged estrogen deficiency.

In addition, there is idiopathic irritable bladder syndrome. This term refers to a pathology whose causes cannot be determined.

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Risk factors

Factors that contribute to the development of irritable bladder syndrome are considered to be:

• old age (after 40 years for women, after 50-60 years for men);
• presence of irritable bowel syndrome;
• frequent depressive states;
• emotional lability, lack of resistance to stress, chronic overstrain of the nervous system;
• chronic inflammatory diseases of the genitourinary system.

As experts note, women's predisposition to developing irritable bladder syndrome is explained by the relatively low level of serotonin in the brain. This level drops with any changes in hormonal levels, so a woman becomes practically defenseless against many such pathologies.

Elderly patients are prone to developing irritable bladder syndrome, as the elasticity of the muscular layer of the urinary system decreases with age. Due to atrophy of the muscular structures, the nerves responsible for the normal mechanism of urination are also damaged. In addition, a stepwise reaction of myocytes is activated, which is associated with denervation of the muscles.

The neurogenic type of irritable bladder syndrome can occur equally often in both men and women. The development factor of the neurogenic variant is damage to the conductive pathways that are responsible for the transport of nerve impulses in the spinal cord to the higher nerve centers. Disruption of the conductive pathways causes incorrect (distorted) transmission of signals for urination even with a slightly filled bladder. This happens with tumor processes in the brain, with significant atherosclerotic changes, with Parkinson's disease, with traumatic and hemorrhagic lesions of the brain and spinal cord.

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Pathogenesis

Irritable bladder syndrome is a clinical symptom complex characterized by urgent urination (a sudden, difficult to suppress feeling of urge). Urine excretion increases both during the day and at night.

Currently, the most correct pathogenetic mechanism of irritable bladder syndrome is considered to be the following: a certain provoking factor causes a decrease in the number of M-cholinergic receptors (we are talking about the so-called denervation theory). As a response to insufficient nervous regulation, persistent changes occur in the cellular structures of the smooth muscle fibers of the bladder: close connections are formed between neighboring cells (myogenicity theory). As a result, nerve-impulse conductivity in the muscular layer of the bladder increases sharply. Since smooth muscle structures have spontaneous activity, spontaneous (or caused by any weak irritant) contractile activity of a certain cellular group occurs. Contractions spread to the entire muscular layer: a persistent urge to urinate occurs.

It is important to note that the denervation process is typical for all types of irritable bladder syndrome.

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Symptoms irritable bladder syndrome

The diagnosis of irritable bladder syndrome is made when the patient is found to have increased contraction of the organ muscles with weakness of the urethral muscles. This syndrome is often detected against the background of problems with urinary incontinence. The symptoms of the pathology may vary, depending on its underlying cause, as well as on the structural damage to the bladder. Taking this into account, the following types of the syndrome are distinguished:

• The spastic type occurs in patients with impaired function of spinal structures and is manifested by spontaneous and frequent, but scanty episodes of urination. The patient does not feel the emptiness of the bladder: it seems to him that it is constantly full. Among other possible symptoms: periodic increase in blood pressure, headaches, muscle twitching in the limbs.
• The flaccid type of irritable bladder syndrome is characterized by urinary incontinence in case of filling of the organ. At the same time, the tone of the anal sphincter decreases.
• When the areas above the urethral center (located in the pons) are affected, the patient experiences very frequent urination, painful and problematic urination due to spasm of the muscular layer, as well as urgent incontinence (periodic leakage).
• When the suprasacral zone is affected, the symptoms correspond to general cerebral disorders: urgent urinary incontinence, pain in the perineum and lower abdomen are observed.

The appearance of the first signs of irritable bladder syndrome in different patients may differ slightly - mainly in their intensity, frequency of occurrence, etc. The initial symptoms depend on the initial factor that led to the development of the syndrome, on the stage of the disease process. However, the general signs are the same in many patients:

• frequent visits to the toilet to urinate – 10 or more times a day, including at night;
• incomplete control over urination – urine may “leak”, seeping out during minor exertion, coughing, sneezing;
• difficulties in starting urination - the patient cannot “start” urination, despite the presence of a feeling of a full bladder;
• periodic interruption of urine flow, weakening and strengthening of the stream;
• unpleasant or even painful sensations, both during urination and at rest.

Among the conventional signs, one can single out changes in the patient's behavior, who becomes fussy, easily excitable, irritable. This can be explained: a person becomes a hostage of the toilet cubicle, his thoughts are constantly fixated on the fact that at the most inopportune moment he can lose control over the process of urination. Thus, the social sphere suffers, communication with others is disrupted, and work capacity deteriorates.

Irritable bladder syndrome in women

There are indeed many reasons for the development of irritable bladder syndrome in women. It is a proven fact that the problem most often visits women who have given birth (according to one of the statistics, every third woman may suffer from such a syndrome). Also, the risk of developing the syndrome is higher in those patients who have had two or more cesarean sections or two or more physiological births in their medical history.

Many experts are of the opinion that it is not the number of births that plays a fundamental role, but their course. For example, if during childbirth there were ruptures of the pelvic floor muscles, or obstetric forceps and other birth procedures were used, then the woman has a high probability of muscle fibers being replaced by scar tissue.

There is no doubt that a lack of estrogens plays a certain role in the mechanism of development of irritable bladder syndrome. Often, the onset of the syndrome coincides with the onset of menopause. Other causes of the development of pathology in women may include surgical interventions on the pelvic organs, excess weight, diabetes, frequent or severe stress, etc.

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Irritable bladder syndrome in men

For a long period of time, doctors believed that frequent episodes of urination in men were a consequence of only urological pathologies (for example, inflammatory processes, bladder stones, prostate diseases). If no abnormalities were found in the results of urine analysis and instrumental diagnostics in suffering men, they were given a conditional diagnosis of "cystalgia" or "urethral symptom complex".

Today, there is a more accurate diagnosis - irritable bladder syndrome. This syndrome can be caused not only by urological disorders, but also by neurological disorders, or even by an unknown reason (idiopathic development of the syndrome).

According to statistics, the basic causes of the syndrome in men are age-related changes in the muscular layer of the bladder, inflammatory diseases of the bladder, prostate gland and urethral canal.

Irritable bladder syndrome in a child

The development of irritable bladder syndrome in children is mainly associated with various neurological disorders that can lead to a weakening of control over the activity of the detrusor or external urinary sphincter during filling the bladder and excretion of urine.

An irritable bladder in a child sometimes occurs due to organic damage to the central nervous system, as a result of congenital anomalies, traumatic injuries, tumors and inflammatory processes affecting the spinal column. For example, this happens after birth injuries, with cerebral palsy, spinal cord hernia, impaired development of the sacrum, coccyx, etc. For the development of irritable bladder syndrome, such a problem must be associated with incomplete or complete divergence of the supraspinal and spinal neurocenters and the bladder.

The syndrome is more often diagnosed in girls: this can be explained by increased estrogen saturation, which affects the sensitivity of the detrusor receptor mechanism.

Complications and consequences

If you try to treat irritable bladder syndrome on your own, or do not treat it at all, there is a high probability of developing adverse consequences:

• a constant state of nervous tension, deterioration of concentration, impaired ability to work, inattention, absent-mindedness;
• long-term depressive states, apathy;
• irritability, sleep disorders;
• asocialization (social maladaptation);
• frequent inflammatory processes in the genitourinary system, urethritis, cystitis.

Painful complications are more common in older people and women. However, no patient suffering from irritable bladder syndrome is immune from their development.

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Diagnostics irritable bladder syndrome

Diagnostics begins with studying the complaints, life history and illness of the person. The doctor may ask the patient to fill out a special diary for 3-4 days, noting the frequency and nature of urination episodes. It is good if the patient takes care in advance and comes to the initial consultation with an existing diary.

What should be noted in such a diary:

• the time when the patient felt the urge to urinate and went to the toilet;
• approximate volume of urine excreted in one episode;
• frequency and number of episodes of incontinence (or leakage);
• when using urological pads - their quantity;
• volumes of liquid consumed per day (in any form).

When interviewing a patient, the doctor will definitely inquire about the presence of neuropathologies, urological and gynecological diseases, diabetes. In women, information about the number and characteristics of births, about operations performed that affected the perineal muscles is required.

The doctor may then order a vaginal examination and a cough test. After that, a number of additional tests and instrumental diagnostics are performed.

• General blood and urine tests. The main ones are the assessment of physical and chemical characteristics of urine, microscopy of urinary sediment, culture for the presence of bacterial and fungal pathogens, determination of sensitivity to antibiotics.
• Instrumental diagnostics:
• ultrasound examination of the urinary system helps to examine the bladder, kidneys, and assess the level of residual urinary fluid (the procedure is performed twice with a full and empty bladder);
• Comprehensive urodynamic diagnostics includes uroflowmetry (measuring the rate of urination), cystometry (determining the activity of the detrusor, sensitivity of the bladder and its distensibility), video urodynamic examination (detection of severe functional disorders of the lower urinary tract).

To clarify the diagnosis of irritable bladder syndrome, some patients may be recommended additional consultation with specialized specialists - for example, a neurologist, endocrinologist. If necessary, computed tomography, magnetic resonance imaging, etc. are performed. Doctors note that the need for in-depth diagnostics occurs relatively rarely. In most situations, in order to diagnose irritable bladder syndrome, questioning the patient, assessing the urinary diary and ultrasound examination may be sufficient.

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Differential diagnosis

Differential diagnostics are carried out to exclude:

• developmental defects of the bladder and urethra;
• infectious lesions of the urinary tract and reproductive system;
• stone formation in the bladder;
• interstitial cystitis;
• hyperplasia or tumors of the prostate gland;
• urethral strictures;
• vesicoptosis;
• pathologies affecting the peripheral and central nervous system;
• traumatic injuries, etc.

Treatment irritable bladder syndrome

After determining the underlying causes of irritable bladder syndrome, the doctor begins to select a treatment plan. This treatment is aimed at both alleviating painful symptoms and neutralizing the underlying cause of the disease. The psychological aspects of the problem are also taken into account.

Standard treatment usually includes therapeutic exercises to strengthen the perineal and pelvic muscles, physical therapy, and medication.

Conservative treatment is carried out using anticholinergic drugs: propantheline bromide, oxybutryn, solifenacin succinate, trospium chloride, etc.

Medicines from other groups are used less frequently. These may include:

• selective α-1-adrenergic blockers (tamsulosin);
• antidepressants (amitriptyline);
• hormonal drugs (estrogen-containing drugs in women);
• vanilloid receptor blockers (capsaicin);
• muscle relaxants, antispasmodics, tranquilizers, etc.

Anticholinergic drugs are often included in the list of essential drugs:

Oxybutrin	Prescribed at 5 mg up to 3 times a day (depending on the severity of symptoms)
Trospium chloride	Prescribed 5-15 mg of the drug three times a day
Tolterodine	Prescribed 2 mg in the morning and evening
Solifenacin	Prescribed at 5 mg daily, in one dose

Treatment is usually long-term, 2-4 months. Sometimes periodic change of drugs is practiced.

Side effects of treatment with cholinergic medications may include the following symptoms:

• thirst, feeling of dry mucous membranes;
• increased heart rate;
• memory impairment, decreased concentration;
• visual dysfunctions;
• difficulty with defecation.

Vitamins

What vitamins are especially necessary for the body to cope with irritable bladder syndrome?

• Vitamin A – strengthens neurons, slows down the processes of cellular aging. Retinol can be obtained not only from medical preparations: it is present in sufficient quantities in carrots, apricots, peaches, egg yolk.
• Vitamin B ₁ – eliminates irritability, regulates the nervous system, reduces the negative impact of stress. The vitamin is present in oatmeal, buckwheat and wheat, dairy products, and seaweed.
• Vitamin B ₆ – can improve nerve conductivity and improve sleep. The vitamin is found in bananas, baked potatoes, prunes, and oranges.
• Vitamin B ₁₂ – helps maintain normal functioning of the nervous system in older people. Cyanocobalamin is present in seafood, meat, dairy products, eggs.
• Vitamin C – strengthens the immune system, helps resist infectious diseases. Ascorbic acid is present in citrus fruits, melons, kiwi, bell peppers, cabbage, tomatoes, lettuce leaves.
• Vitamin D – supports the body, providing protection against many diseases (including diseases of the urinary system). The best source of this vitamin is the sun, so doctors advise walking in the fresh air in sunny weather for at least 1 hour per day.
• Vitamin E relieves irritation and fatigue. Tocopherol strengthens tissues and provides elasticity to the muscle layer. It can be obtained by eating nuts, eggs, and vegetable oils.

Physiotherapy treatment

Direct action on the irritated bladder is possible by using certain methods of physiotherapy. In the absence of contraindications (for example, tumor processes), the following procedures are prescribed:

• electrophoresis – the effect of direct electric current in combination with the introduction of medicinal substances into the skin or mucous membranes;
• Ultrasound exposure is a method using ultrasonic vibrations that cause alternating compression and relaxation of tissues to stimulate regeneration processes;
• Paraffin applications are a type of heat therapy using heated paraffin;
• galvanization is the use of direct electric current of low strength and low voltage, which leads to stimulation of blood circulation and lymph flow, elimination of congestion, and pain relief;
• Electrosleep is a procedure that allows you to improve the functionality of the central nervous system; the method is based on the influence of weak low-frequency current impulses on the area of the brain;
• Galvanic collar is a type of electrophoresis of the cervical-collar zone.

If a patient is diagnosed with an inflammatory process in the genitourinary system, physiotherapy is carried out only after the acute symptoms of inflammation have been relieved.

Folk remedies

• Honey is successfully used for irritable bladder syndrome, which can prevent frequent urge to urinate. The essence of honey treatment is as follows: before going to bed and in the morning on an empty stomach, you should drink 100 ml of warm water with the addition of 1 teaspoon of real honey. In severe cases, honey water can be consumed three times a day. Treatment continues until the symptoms of the disease are relieved.
• Honey can also be added to more complex medicines. For example, prepare an equal mixture of chamomile flowers, centaury, mint leaves, knotweed, St. John's wort, birch leaves. Take 15 g of the resulting mixture, pour 200 ml of boiling water, and leave overnight under a lid. Take the remedy 4 times a day, 100 ml. Before use, add 1 teaspoon of honey.
• Perform simple but quite effective exercises (they are called Kegel exercises), which activate the pelvic muscles and strengthen the urinary sphincter. The following is considered a basic exercise:
  • squeeze (strain) the pelvic muscles responsible for inhibiting the flow of urine, hold for 5 seconds, then rest for 10 seconds;
  • tense the muscles for 10 seconds, then rest for 10 seconds, repeat 4 times;
  • tense the muscles for 30 seconds, then rest for 10 seconds, repeat twice;
  • The described exercise cycle is repeated at least twice a day.

It is also recommended to try to interrupt urination three or four times during urination. With each attempt, the period of stream inhibition can be increased. It is believed that a visible effect in irritable bladder syndrome is noted no earlier than after 4 weeks of regular exercises.

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Herbal treatment

Herbal Home Remedies for Irritable Bladder Syndrome:

• Prepare a mixture of equal amounts of blackberry leaves, knotweed, immortelle flowers, yarrow and St. John's wort. Pour 300 ml of boiling water over 10 g of the mixture, leave for two hours, and filter. Drink 100 ml up to five times a day, 20 minutes before meals. Stop taking the medicine approximately 1-1½ hours before going to bed.
• Prepare an infusion of fennel seeds: pour 1 tbsp of seeds with 200 ml of boiling water, leave for 2 hours. Take twice a day after meals, 100 ml.
• A decoction of bay leaves is prepared: three medium leaves are poured with 200 ml of boiling water and kept on the lowest heat for about 10 minutes. Then the remedy is removed from the heat and infused for another hour. Drink 100 ml three times a day. The minimum duration of treatment is one week.
• Pour 200 ml of boiling water over 20 g of agrimony and leave for an hour and a half. Take 1/3 cup a quarter of an hour before meals, three times a day. You can add a little honey to the warm infusion.
• Pour 150 ml of hot water over 15 g of thyme, evaporate over low heat until a third of the water remains. Take 5 ml of the decoction three times a day for one and a half to two months.

Homeopathy

Homeopathic medicines have long been a part of the treatment regimen for many diseases. Irritable bladder syndrome is no exception. Homeopathic treatment is virtually free of side effects, and only in isolated cases can an allergic reaction develop.

The safety of use allows such drugs to be included in complex therapy for patients of all ages.

• Pulsatilla is prescribed for dripping urine even from minor provocation, and for nocturnal enuresis.
• Sepia - prescribed for frequent nocturnal urge to urinate.
• Causticum – helps improve the patient’s control over the urinary process.
• Rus tox is prescribed when the urge to urinate increases at rest; during physical activity the urge is minimized.
• Bryonia is used when the urge to urinate increases with movement and walking.

The above-mentioned drugs are prescribed by a homeopathic doctor. He determines the dosage of each remedy based on the constitutional and other characteristics of a particular patient. The duration of treatment is also determined individually.

Surgical treatment

In recent years, urologists have paid maximum attention to such a problem as irritable bladder syndrome. Particular attention was paid not only to eliminating symptoms, but also to getting rid of the cause of the pathology.

One of the first such developments is a special neurostimulator implanted in the coccygeal region (this is where the nerve endings of the bladder are located). Clinical testing has demonstrated a 70% success rate of using the stimulator.

The next step was a similar, but more advanced method: a small electrode was inserted into the ankle area. Electrical stimulation occurs along the lower limb, affecting the nerve endings of the bladder. This treatment also demonstrated an excellent effect. In addition, it turned out to be more gentle due to its less invasiveness.

Recently, Israeli urogynecologists have presented a new method, the essence of which is to restore the ligamentous apparatus that supports the connective tissues adjacent to the urethra. The intervention can be performed using an open method or laparoscopic access. This innovation is currently in the testing process, but the first results already indicate its 80% effectiveness.

Among other, the most well-known surgical methods of correction for irritable bladder syndrome, we can name the following:

• operative denervation of the organ (blocking the supply of impulses that lead to contraction of the detrusor);
• detrusor myectomy (surgery to reduce the size of the hypersensitive muscle layer);
• plastic surgery to replace part of the bladder with part of the intestinal wall to relieve imperative contractions.

The listed operations are particularly complex: they are performed rarely and only according to strict indications.

Prevention

There is no specific prevention for irritable bladder syndrome. However, experts have identified a number of measures that should be taken to prevent the development of urinary problems.

• It is necessary to prevent stressful situations in advance, avoid conflicts, learn to control your emotions. Doctors note that it is nervous breakdowns that can provoke an exacerbation of the syndrome. If you minimize the development of such situations, you can prevent many troubles. Many people who have already had episodes of irritable bladder syndrome have been helped to get rid of the problem by psychological training, treatment with sedatives (for example, herbal tranquilizers).
• If a person has already encountered a similar problem of irritated bladder, then he should definitely visit a urologist to find the cause of the disease and eliminate it. Early treatment allows you to cure many diseases in the shortest possible time.
• Additional preventive measures should include: a complete balanced diet, physical activity, and a healthy lifestyle. Periodic practice with the use of Kegel exercises is encouraged - this is especially important for female patients, as it helps prevent many problems with the muscular system of the pelvic organs.

If you are prone to developing irritable bladder syndrome, you should pay special attention to your diet. To prevent exacerbations of the disease, it is recommended to avoid the following foods:

• citrus fruits, pineapples;
• chocolate, cocoa, coffee, strong black tea, green tea;
• sugar, sweets, baked goods;
• hot seasonings and spices (horseradish, mustard, black and red pepper, ginger, etc.);
• whole milk.

The sensitivity of the body to certain foods may vary from person to person. Therefore, you should adjust your daily menu according to your feelings.

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Forecast

Many people consider irritable bladder syndrome to be too delicate a disease, and are in no hurry to see a doctor. But you should know that independent attempts to cure yourself can only lead to a worsening of the problem. After all, the cause of the syndrome may lie not only in problems with the urinary system: it may be a secondary pathology, the seriousness of which can only be guessed at. To avoid negative consequences, you just need to consult an experienced doctor, take several tests. A visit to the doctor is unlikely to take much time and effort, and timely diagnostics in many cases will help to maintain a person's health.

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