Irritable Bladder Syndrome in Women, Men and Children

Frequent urinary tendencies, incontinence episodes, a feeling that the bladder is always full - with the listed problems people rarely turn to the doctor. And meanwhile, these symptoms are really problematic, because they significantly worsen the quality of life, can cause depressive conditions. Few know, but irritable bladder syndrome can and should be treated - both with medicamental and alternative methods. But what can not be done is to let the health problem run its course. The condition can be gradually aggravated and complicated. Therefore, it is better to consult the doctor as soon as possible.

[1], [2], [3]

Epidemiology

Syndrome of irritated bladder affects about one in five of the adult population of the planet. Women have a problem more often. For example, according to statistics, in the post-Soviet space a similar disease is present in 16% of women.

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

The frequency of detection of irritable bladder syndrome can be compared with the incidence of diabetes mellitus or depressive states - all of these diseases occur with approximately the same frequency. However, the characteristic feature of the syndrome is that even in the most developed countries up to 70% of patients do not receive the necessary treatment because of non-treatment to doctors. Most suffering people prefer to adjust, changing their habitual life rhythm, and significantly reducing the quality of life:

• long trips and walks become problematic;
• deteriorates the quality of night rest;
• the patient becomes asocial, working capacity worsens.

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

[4], [5], [6], [7], [8], [9], [10]

Causes of the irritable bladder syndrome

• Causes of neurogenic nature: diseases and disorders affecting the central and peripheral nervous system (cerebral blood flow disorders, Parkinson's disease, senile dementia, multiple sclerosis, osteochondrosis, traumatic spinal column injuries, complications after spinal surgery, vertebral spondyloarthrosis, vertebral hernia, myelomeningocele) .
• Causes not related to neurogenic:
  • Infravesical obstructive condition (prostate adenoma, narrowing of the urethra). Due to this pathological condition, the muscular interlayer of the bladder is hypertrophied. 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. Further, denervation occurs, nerve cells die.
  • Age changes. With age, the reducing ability of tissues decreases, blood supply is impaired, atrophic processes occur in urothelium with further denervation.
  • Anatomic features of the vesicoureteral region.
  • Sensory disorders. Such disorders arise as a result of increased secretion from sensitive nerve fibers of peptides (in particular, urinary tachykinins), which increase the degree of conduction and excitability of the nerve structures of the bladder. Similar disorders can also occur against the background of intrapuberous atrophic processes, acute or prolonged estrogen deficiency.

In addition, idiopathic syndrome of irritated bladder is isolated. This term refers to pathology, the causes of which can not be clarified.

[11],

Risk factors

Factors contributing to the development of irritable bladder syndrome are:

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

As experts note, the female predisposition to the development of irritable bladder syndrome is explained by the relatively small level of serotonin in the brain. This level falls with any changes in the hormonal background, so the woman becomes practically vulnerable to many similar pathologies.

Elderly patients are prone to developing irritable bladder syndrome, as with age they decrease the degree of elasticity of the muscular layer of the urinary system. Due to the atrophy of the muscular structures, the nerves responsible for the normal urinary mechanism are also damaged. In addition, step response of myocytes is activated, which is associated with denervation of the musculature.

Neurogenic type of irritable bladder syndrome can occur equally often in both men and women. The development factor of the neurogenic variant is the damage of the conducting paths, which are responsible for the transport of nerve impulses in the spinal cord to the superior nervous centers. Violation of the conductive pathways causes incorrect (distorted) signaling to urine, even with a weakly filled bladder. This is the case with tumor processes in the brain, with significant atherosclerotic changes, Parkinson's disease, traumatic and hemorrhagic lesions of the brain and spinal cord.

[12], [13], [14]

Pathogenesis

Syndrome of an irritated bladder is a clinical symptom complex, which is characterized by urgent urination (an unexpectedly appearing, difficultly suppressed sensation of urge). The excretion of urine increases in the daytime and at night.

Currently, the most correct pathogenetic mechanism of irritable bladder syndrome is this: 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 the lack of nerve regulation in the cellular structures of smooth muscle fibers of the bladder, persistent changes occur: close bonds of neighboring cells are formed (the theory of myogenicity). As a consequence, the neuro-impulse conductivity in the muscular interlayer of the bladder rises sharply. Since smooth muscle structures have spontaneous spontaneous activity, spontaneous (or caused by any weak stimulus) spontaneous activity of a certain cellular group occurs. The contractions extend to the entire muscular layer: there is a persistent urge to urinate.

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

[15], [16], [17], [18], [19]

Symptoms of the irritable bladder syndrome

The diagnosis of irritable bladder syndrome is set when the patient shows an increased contraction of the muscles of the organ with weakness of the urethral musculature. Such a syndrome is often found on the background of problems with incontinence. Symptomatology of pathology may differ, which depends on its underlying cause, as well as on the structural damage of the bladder. Taking this into account, the following types of syndrome are distinguished:

• Spastic type occurs in patients with impaired function of spinal structures and manifests spontaneous and rapid, but scanty episodes of urination. The patient does not feel the emptiness of the bladder: it seems to him that he is constantly full. Among other possible symptoms: periodic increase in blood pressure, pain in the head, muscle twitching in the limbs.
• Sluggish type of irritable bladder syndrome is characterized by urinary incontinence in case of organ filling. At the same time, the tone of the anal sphincter decreases.
• When lesions are located above the urethra (located in the bridge of the brain), the patient is noted for a very frequent discharge of urine, painful and problematic urination due to spasm of the muscle layer, as well as urgent incontinence (periodic leakage).
• With lesions of the supracranial zone, the symptomatology corresponds to the general cerebral disorders: urge incontinence, pain in the perineum and in the lower abdomen are observed.

The appearance of the first signs in irritable bladder syndrome in different patients may differ somewhat - mainly by its intensity, frequency of occurrence, etc. The initial symptomatology depends on the initial factor that led to the development of the syndrome, from the stage of the painful process. However, the common signs in many patients are the same:

• frequent visits to the toilet for urination - 10 or more times a day, including at night;
• incomplete control of urination - urinary fluid can leak, seeping in with minor loads, coughing, sneezing;
• difficulties with the onset of urination - the patient can not "start" urination, despite the presence of a feeling of fullness of the bladder;
• periodic interruption of urine output, weakening and strengthening of the jet;
• unpleasant or even painful sensations, both during the allocation of urine, and at rest.

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

Irritable Bladder Syndrome in Women

Reasons for the development of irritable bladder syndrome in women really a lot. The proven fact is that the problem is more often visited by women giving birth (according to one of the statistical information, such a syndrome can affect every third woman). Also, the risk of developing the syndrome is higher in those patients in whose history there were two or more cesarean sections, or two or more physiological births.

Many experts hold the opinion that the basic role is played not by the number of births, but by their current. For example, if there were ruptures of pelvic floor muscles during labor or obstetric forceps and other delivery procedures were used, then the woman has a high probability of replacing muscle fibers with a scar tissue.

There is also no doubt about the role of the lack of estrogens in the mechanism of development of irritable bladder syndrome. Often the appearance of the syndrome coincides with the advent of the menopause period. Other reasons for the formation of pathology in women can be surgery on the pelvic organs, the presence of excess weight, diabetes, frequent or severe stress, etc.

[20], [21], [22], [23]

Irritable bladder syndrome in men

Over a long period of time, doctors believed that frequent episodes of urinary output in men - this is the result of only urological pathologies (for example, inflammatory processes, bladder stones, prostate gland diseases). If the suffering men did not show any abnormalities in the results of the urinalysis and the results of instrumental diagnosis, they were given a conditional diagnosis of "cystalgia" or "urethral symptom complex."

To date, 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 for an unknown reason (idiopathic syndrome development).

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

Syndrome of irritated bladder 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 detrusor activity or an external urinary sphincter when filling the bladder and excreting the urinary fluid.

Irritable bladder in a child sometimes occurs on the soil of 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 the birth of traumatic injuries, with cerebral palsy, a herniated spinal cord, broken development of the sacrum, coccyx, etc. For the development of irritable bladder syndrome such a problem should be associated with incomplete or complete divergence of supraspinal and spinal neurocenters and 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 the irritable bladder syndrome tries to cure independently, or does not heal at all, then there is a high probability of unfavorable consequences:

• constant state of nervous tension, impaired concentration, disability, inattention, absent-mindedness;
• long-term depressive states, apathy;
• irritability, sleep disorders;
• asocialization (social disadaptation);
• frequent inflammatory processes in the genitourinary sphere, urethritis, cystitis.

Painful complications occur more often in elderly people and in women. However, none of the patients with irritable bladder syndrome is immune from their development.

[24], [25], [26], [27], [28], [29]

Diagnostics of the irritable bladder syndrome

Diagnosis begins with the study of complaints, the history of life and human disease. The doctor can ask the patient for 3-4 days to fill out a special diary, noting in it the frequency and nature of episodes of urination. It is good, if the patient takes care in advance and will come to the primary consultation with the already available diary.

What should be noted in this diary:

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

When interviewing a patient, the doctor will certainly ask about the presence of neuropathologies, urological and gynecological diseases, and diabetes mellitus. Women are required to specify information about the number and characteristics of the birth, the operations performed, which affected the musculature of the perineum.

Further, the doctor can prescribe a vaginal examination and a cough test. After that, a number of additional tests and instrumental diagnostics are performed.

• General tests of blood and urine. The main is the assessment of physical and chemical characteristics of urine, microscopy of urinary sediment, sowing for the presence of bacterial and fungal pathogens, the determination of sensitivity to antibiotics.
• Instrumental diagnostics:
• ultrasound examination of the urinary system helps to examine the bladder, kidneys, assess the level of residual urinary fluid (the procedure is performed twice with a full and empty bladder);
• complex urodynamic diagnostics includes uroflowmetry (measurement of urinary output rate), cystometry (detection of detrusor activity, sensitivity of the bladder and its extensibility), video-dynamic study (detection of severe violations of the functionality of the lower urinary tract).

To clarify the diagnosis of irritable bladder syndrome, some patients may be recommended additional consultation of narrow specialists - for example, a neurologist, an endocrinologist. If necessary, conduct computer, magnetic resonance imaging, etc. Physicians note that the need for in-depth diagnostics is relatively rare. In most situations, in order to diagnose irritable bladder syndrome, it may be enough to question the patient, assess the diary of urination and ultrasound.

[30], [31]

Differential diagnosis

Differential diagnosis is carried out for the exclusion of:

• defects in the development of the bladder and urethra;
• infectious diseases of the urinary tract and the reproductive system;
• stone formation in the bladder;
• interstitial cystitis;
• hyperplasia or swelling of the prostate;
• urethral stricture;
• vesicoptosis;
• pathologies affecting the peripheral and central nervous system;
• traumatic injuries, etc.

Treatment of the irritable bladder syndrome

After determining the underlying causes of irritable bladder syndrome, the doctor begins to select a treatment regimen. Such treatment is directed, both to alleviate the painful symptoms, and to neutralize the underlying cause of the disease. This takes into account the psychological aspects of the problem.

Standard treatment usually includes therapeutic exercises to strengthen the muscles of the perineum and small pelvis, physiotherapy, as well as medical treatment.

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

Medications representing other groups are used less frequently. It can be:

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

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

Oxybutyrin	Assign 5 mg to 3 times a day (depends on the severity of the symptoms)
Trospium chloride	Assign 5-15 mg of the drug three times a day
Tolterodin	Assign 2 mg in the morning and in the evening
Solifenacin	Assign 5 mg daily, at a time

Treatment is more often long, for 2-4 months. Sometimes a periodic change of drugs.

Side effects on the background of treatment with cholinergic medications can become such symptoms:

• thirst, a feeling of dryness of the mucous membranes;
• cardiopalmus;
• memory impairment, weakening of concentration;
• visual dysfunction;
• difficulties with defecation.

Vitamins

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

• Vitamin A - strengthens neurons, inhibits the processes of cellular aging. Retinol can be obtained not only from medical preparations: it is in sufficient quantity present in carrots, apricots, peaches, egg yolks.
• Vitamin B ₁  - eliminates irritability, regulates the work of the nervous system, reduces the negative impact of stress. Vitamin is present in oat, buckwheat and wheat cereals, in dairy products, algae.
• Vitamin B ₆  - is able to improve nerve conduction, establish sleep. Vitamin is contained in bananas, baked potatoes, prunes, oranges.
• Vitamin B ₁₂  - helps maintain the normal functioning of the nervous system in the elderly. Cyanocobalamin is present in seafood, meat, dairy products, eggs.
• Vitamin C - strengthens the immune system, promotes resistance to infectious diseases. Ascorbic acid is present in citrus, melon, kiwi, bell pepper, cabbage, tomatoes, lettuce leaves.
• Vitamin D - supports the body, providing protection from many diseases (including from diseases of the urinary system). The best source of this vitamin is the sun, so doctors advise to walk outdoors in sunny weather for at least 1 hour a day.
• Vitamin E relieves irritation, fatigue. Tocopherol strengthens tissues, provides elasticity of the muscular layer. It can be obtained by eating nuts, eggs, vegetable oils.

Physiotherapeutic treatment

It is possible to directly influence the irritated bladder by applying certain methods of physiotherapy. In the absence of contraindications (for example, tumor processes), such procedures are prescribed:

• electrophoresis - the effect of a constant electric current in combination with the ingestion of medicinal substances into the skin or mucous membranes;
• Ultrasound - a method using ultrasonic vibrations that cause alternating compression and relaxation of tissues to stimulate regeneration processes;
• Wax applications are a variant of heat treatment using heated paraffin;
• galvanization is the use of a constant electric current of low power and low voltage, which leads to stimulation of blood circulation and lymph flow, elimination of stagnant phenomena, anesthesia;
• electrosleep - a procedure that allows you to establish the functionality of the central nervous system; The method is based on the influence of weak pulses of low-frequency current on the brain region;
• galvanic collar - a kind of electrophoresis of the neck-collar zone.

If the patient shows an inflammatory process in the genitourinary system, then physiotherapy is performed only after removing acute symptoms of inflammation.

Alternative treatment

• In irritable bladder syndrome, honey is successfully used, which can prevent frequent urinary urges. The essence of honey treatment is this: before going to bed and in the morning on an empty stomach should drink 100 ml of warm water with the addition of 1 tsp. Of real honey. In severe syndrome, honey can be consumed three times a day. Treatment is continued until the symptoms of the disease ease.
• Honey can be added to the composition of more complex medicines. For example, they prepare an equal mixture of chamomile, centaury, leaves of mint, sporis, herb St. John's wort, birch leaves. Take 15 grams of the resulting mixture, pour 200 ml of boiling water, stand overnight under the lid. Take the drug 4 times a day, 100 ml. Before use, add 1 tsp. Honey.
• Perform simple but effective exercises (they are called exercises Kegel), which activate the muscular system of the small pelvis and strengthen the urinary sphincter. The basic exercise is:
  • compress (strain) the pelvic musculature responsible for inhibition of the urinary stream, hold for 5 seconds, after which 10 seconds rest;
  • strain the musculature for 10 seconds, after which 10 seconds rest, repeat 4 times;
  • strain the musculature for 30 seconds, then 10 seconds rest, repeat twice;
  • The described cycle of exercises is repeated at least twice a day.

It is also recommended at the time of urination to try to interrupt it three or four times. With each attempt, the braking period of the jet can be increased. It is believed that the visible effect in irritable bladder syndrome is noted no earlier than 4 weeks of regular exercise.

[32], [33], [34]

Herbal Treatment

Herbal home remedies for irritable bladder syndrome:

• Prepare a collection of an equal number of leaves of blackberries, sporis, color immortelle, herbs yarrow and St. John's wort. Pour 300 ml of boiling water 10 g collection, insist for two hours, filter. Drink 100 ml to five times a day, 20 minutes before meals. Approximately 1-1½ hours before night sleep drug use is discontinued.
• Prepare the infusion of fennel seeds: 1 tbsp. L. Seeds pour 200 ml of boiling water, insist 2 hours. Take twice a day after meals, 100 ml.
• Prepare the broth from the laurel leaves: three medium leaves pour 200 ml of boiling water and stand on the lowest heat for about 10 minutes. Next, the remover is removed from the fire and insists another hour. Drink 100 ml three times a day. The minimum duration of treatment is one week.
• Pour 200 ml of boiling water 20 grams of pork, insist for one and a half hours. Take 1/3 cup for a quarter of an hour before a meal, three times a day. In a warm infusion, you can add a little honey.
• Pour 150 ml of hot water 15 g of thyme, evaporated on low heat to leave a third of the water. Take 5 ml of broth three times a day for one and a half to two months.

Homeopathy

Homeopathic remedies have long and densely been included in the treatment of many diseases. Syndrome of an irritated bladder is not an exception. Treatment with homeopathy is practically devoid of side effects, only in isolated cases can an allergic reaction develop.

The safety of the application makes it possible to include such drugs in the complex therapy for patients of all ages.

• Pulsatilla - is prescribed with drip leakage of urine, even from a minor provocation, with nocturnal incontinence.
• Sepia - is prescribed with frequent night urge to urinate.
• Causticum - helps improve patient control over the urinary process.
• Rus tox - prescribed with increasing urge to urinate at rest; during the motor activity, the urges are minimized.
• Bryonia - it is used for strengthening of urges during movements, walking.

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

Surgery

In recent years, urologists have paid maximum attention to the problem of irritable bladder syndrome. Particular attention was paid not only to the elimination of 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 (where the nerve endings of the bladder are localized). Clinical testing demonstrated 70% success rate of stimulant application.

The next step was a similar, but more perfect method: a small electrode was introduced into the ankle zone. Electrostimulation occurs along the lower limb, affecting the nerve endings of the bladder. Such treatment also demonstrated an excellent effect. In addition, it was more sparing because of less invasiveness.

More recently, Israeli urogynecologists have presented a new technique, the essence of which is to restore the ligamentous apparatus supporting the connective tissue adjacent to the urethra. Intervention can be performed by the cavity method, or by laparoscopic access. This innovation is currently in the trial process, but the first results already indicate its 80% efficiency.

Among other, the most known surgical methods of correction in irritable bladder syndrome, we can name such:

• operative denervation of the organ (blocking the supply of impulses leading to detrusor reduction);
• detrusor myoectomy (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 weaken imperative contractions.

These operations are very difficult: they are seldom performed and only on strict indications.

Prevention

There is no specific prevention of irritable bladder syndrome. However, specialists were able to identify a number of measures that should be taken to prevent the development of problems with urination.

• It is necessary to warn in advance stressful situations, avoid conflicts, learn to control their emotions. Doctors say that it is the nervous breakdown that can provoke the aggravation of the syndrome. If the development of such situations is minimized, many troubles can be prevented. Many people who already had episodes of irritable bladder syndrome helped to get rid of the problem of psychological training, treatment with sedatives (eg, plant tranquilizers).
• If a person has already encountered a similar problem with an irritated bladder, then he should definitely visit a urologist to find the cause of the disease and eliminate it. Early treatment to a doctor allows you to cure many diseases in the shortest possible time.
• Additional preventive measures should be: a full balanced diet, physical activity, a healthy lifestyle. Periodic practice is recommended with the use of Kegel exercises - this is especially important for female patients, since it helps to prevent many malfunctions with the muscular system of the pelvic organs.

With a tendency to develop irritable bladder syndrome, special attention should be paid to nutrition. To prevent exacerbations of the disease, it is recommended to avoid the use of such products:

• citruses, pineapples;
• chocolate, cocoa, coffee, strong black tea, green tea;
• sugar, sweets, pastries;
• spicy seasonings and spices (horseradish, mustard, black and red pepper, ginger, etc.);
• whole milk.

The sensitivity of the body to certain foods in humans can be different. Therefore, you should adjust your own daily menu according to your feelings.

[35], [36], [37]

Forecast

Irritable bladder syndrome is considered by many to be too delicate a disease, and do not rush to see a doctor. But you should know that independent attempts to recover can only lead to an aggravation of the problem. After all, the cause of the syndrome may be not only a malfunction from the urinary system: it can be a secondary pathology, the severity of which can only be guessed. To avoid negative consequences, you just need to consult an experienced doctor, take a few tests. It is unlikely that a lot of time and effort will be spent on a doctor's visit, and the diagnostics carried out in time will in many cases help preserve human health.

[38], [39], [40]