Irritable bladder (overactive bladder, vegetative irritable bladder, [psychosomatic] urethral syndrome): clinical picture with complaints of urge incontinence and/or bladder inflammation, but without pathological findings. The cause is unclear; a chronic irritable condition is thought to be at the bottom of the disorder. Psychological (psychosomatic) problems can be added to cause irritable bladder "the bladder can't cope anymore".
Almost exclusively women are affected, so that hormonal changes probably also play a role. Therapy is difficult and includes psychotherapeutic treatment as well as elements of urge incontinence therapy.
Whether irritable bladder is a disease in its own right is disputed. For some scientists it is identical with urge incontinence, others speak of irritable bladder as an "embarrassment diagnosis".
– Frequent and strong, sudden urge to urinate – also at night – with only small amounts of urine – No (or only slight) pain during urination – Possibly cramp-like bladder pain – Occasionally uncontrolled discharge of small amounts of urine, but usually controllable.
The symptoms usually increase over many weeks or they remain as a "residual condition" after cystitis. They vary in intensity. Are dependent on other well-being.
When to go to the doctor's office
See a doctor in the next few days for
– above mentioned complaints.
Show background information
Origin of the disease and causes
In the opinion of many experts, the disease is the result of a chronic irritation of the bladder, which causes the bladder to "unlearn" the complicated interaction of filling and emptying the bladder has. To such stimuli belong for example
– Inflammation – mucosal changes and slackening of the pelvic floor due to a lack of estrogen (e.g., a lack of blood prere). B. in menopause) – chronic job or relationship stress – medical interventions such as radiation of a gynecological tumor.
More recent research suggests a psychoimmunological process, which means that the underlying psychological problem (such as stress) affects the autonomic nervous system and leads to a weakening of the defenses – but only in the bladder wall. In addition, there is a dysfunction of the bladder muscles, which gives rise to bladder infections and incontinence problems. Since the autonomic nervous system is involved, irritable bladder is considered a functional disorder and not an organic one, because the organ bladder is not pathologically altered.
First, the doctor discusses the patient's symptoms with her. However, since the symptoms cannot be readily distinguished from the clinical picture of cystitis or urinary incontinence, the doctor examines the urine for bacteria (urine culture) and/or urine sediment to rule out cystitis.
Next, the physician performs an ultrasound examination and a urinary bladder scan to determine any other organic causes, i.e., diseases such as z. B. identify interstitial cystitis or a bladder tumor as the cause of the symptoms.
If the doctor does not find any clear signs of disease, the bladder is said to be irritable. It is a diagnosis of exclusion in gynecological and urological practice – so it is left when examinations have not revealed any tangible disease (with organic findings). It is particularly difficult to clearly distinguish irritable bladder from cystitis if the patient occasionally suffers from cystitis, but this does not explain her complaints and an attempt at treatment for cystitis does not eliminate the complaints.
Differential diagnoses: cystitis and urinary incontinence are the most important differential diagnoses.
Treatment is long and almost always unsuccessful without the active participation of the patient. The focus is on psychosomatic therapy, for example in the form of conversational psychotherapy, to make the patient aware of the unresolved conflicts that usually exist and to help her develop solutions and improve her ability to deal with conflict.
Other therapeutic options include:
Medication. Anticholinergic drugs, which are also used for urge incontinence, can alleviate the symptoms. These include z. B. Trospium (such as z. B. Spasmex® ), oxybutinin (such as z. B. Kentera® ) and darifenacin (such as z. B. Emselex® ). Beta-3 receptor agonists such as mirabegron (z. B. Betmiga® ) are prescribed by doctors for irritable bladder. Mirabegron can, however, increase blood prere; it must not be used in patients with blood prere values> 180/110 mmHg should not be used.
Pelvic floor training with electrostimulation. A probe is inserted into the vagina, which stimulates the pelvic floor muscles to contract with weak electrical impulses. Read more about this in the article Urinary incontinence under electrostimulation.
Vaginal estrogens. For women after menopause, doctors often recommend therapy with estrogen suppositories or estrogen cream.
Botulinum toxin A. If the symptoms are pronounced, the doctor considers injecting botulinum toxin (Botox) into the bladder muscles. The injection weakens the bladder muscles, increases the capacity of the bladder and reduces the urge to urinate. The injection must be repeated every 6 months.
Your pharmacy recommends
What you can do yourself
Bladder training. If urge incontinence is not very pronounced, bladder and/or toilet training will help. Keep regular times when you visit the toilet and gradually increase the time between toilet visits. Helping
– A bladder diary in which you note when you visit the toilet and urinate – A toilet schedule with which you regularly plan urination at fixed intervals – Distraction between trips to the toilet. If you have an urge to urinate, try postponing going to the toilet for 5 minutes. It helps to bend forward slightly while sitting on a chair or to tense the pelvic floor – A fixed drinking schedule and an adequate drinking quantity of about 1.5 l/day. If you drink too little, the highly concentrated urine irritates the bladder mucosa and increases the urge to urinate. If possible, don't drink anything from 2 hours before going to bed. Kidney or bladder tea should only be enjoyed during the day.
take away prere. Stress is one of the factors that promotes irritable bladder. It is therefore all the more important not to put yourself under prere, at least when urinating – even if the toilet is often perceived as a stressful place after prolonged suffering. Take your time when urinating, relax and do not put yourself under prere.
Learn relaxation techniques. Stress is not only a trigger, but also a consequence of irritable bladder. Once caught in this cycle of stress, relaxation often needs to be relearned. Relaxation techniques such as Jacobsen's Progressive Muscle Relaxation and Autogenic Training are helpful.
Pelvic floor training. Targeted training of the pelvic floor helps to strengthen the urethral sphincter and counteract possible incontinence. A simple method is to briefly hold the urine stream while urinating, as this automatically tenses the right muscles. Your pharmacy also sells tampon-like devices with different weights that are held in the vagina by muscle force.
. Extracts of pumpkin seeds, nettles, saw palmetto or goldenrod can relieve symptoms. However, when using herbal therapy for bladder problems, it is important that a doctor first clarifies whether it is really "only" urinary urgency an irritable bladder is present and not an infection or other disease of the urogenital tract that requires treatment.
. Nux vomica D12 taken over a longer period of time is supposed to support the bladder muscles. In addition, depending on the predominant symptoms, Pulsatilla pratensis D12, Sepia D12 or Equisetum D6 are used.
Magnetic field therapy. Some medical professionals recommend magnetic therapy for the treatment of irritable bladder. Magnetic fields are generated that stimulate blood flow and cell metabolism in the bladder and relieve pain. This should reduce the urge to urinate. Facilitate urination. The effect is not scientifically proven.