Home Diseases Irritable bladder: symptoms, treatment, prognosis

Irritable bladder: symptoms, treatment, prognosis

by Josephine Andrews
Published: Last Updated on 392 views

People with an irritable bladder suffer from a constant, often sudden urge to urinate, although only small amounts of urine are then passed. In some cases, the “overactive bladder” leads to uncontrolled leakage of urine. Its causes have not really been clarified, and therapy with bladder training and medication is sometimes difficult. Read everything you need to know about symptoms, therapy and diagnosis of irritable bladder here!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

N32 N31

quick overview

  • Symptoms: Frequent and very sudden urge to urinate, sometimes at night, sometimes with passing urine or pain towards the end of urination
  • Treatment: To be individually tailored, options include bladder or pelvic floor training, biofeedback, methods of nerve stimulation, medication and surgery, alternative approaches to homeopathy or home remedies
  • Causes: The exact causes have not yet been clarified, consequences of pregnancy, childbirth and old age as well as a lack of estrogen, possibly incorrect transmission of impulses from the nerves involved in controlling bladder filling, sexual or psychological traumata are discussed
  • Diagnosis: Medical consultation (anamnesis) and physical examination of the urogenital tract, such as ultrasound examination and determination of estrogen levels in women, recording of bladder emptying (voiding protocol), ruling out other diseases such as bladder stones
  • Prognosis: Immediate remedy not yet available, in most cases the treatment relieves the symptoms significantly, sometimes complete healing is not possible

What is an irritable bladder?

In the case of an irritable bladder (overactive bladder, urethral syndrome), the function of the urinary bladder is disrupted.

The bladder acts as a reservoir for the urine filtered by the kidneys. Since it is stretchy, it holds up to 500 milliliters of urine. However, the bladder tells the brain at around 300 milliliters that it wants to be emptied soon. When someone urinates, the muscular wall of the bladder contracts, pushing urine out of the body.

Patients with an irritable bladder feel the urge to urinate much more often than is physically necessary. According to the latest guideline on female urinary incontinence, the term is only applied to cases of urge incontinence in which no urinary tract infection or other disease has an effect on the lower urinary tract. The previous distinction between a primary irritable bladder (without organic reasons) and a secondary form (due to diseases such as tumors, bladder stones or cystitis) is therefore not used in the guideline mentioned.

The irritable bladder is considered by some doctors as a diagnosis of exclusion. If they can’t find any other causes for the symptoms, they attest to an irritable bladder. In the past, it was primarily considered a psychosomatic illness.

The irritable bladder sometimes significantly reduces the quality of life of those affected. Nevertheless, many sufferers avoid medical help for various reasons. Many certainly out of shame, others have low expectations of the therapy or believe that an irritable bladder is a normal symptom of aging. An irritable bladder occurs regardless of age, even if it becomes more common with age.

Women are particularly affected, especially between the ages of 30 and 50. Overall, the clinical picture is widespread: A study that was carried out across five countries showed that around 13 percent of women and ten percent of men suffer from an irritable bladder.

In children, a distinction is made between daytime incontinence , which includes urge incontinence, and wetting during sleep (enuresis nocturna) after the age of five.

What are the symptoms?

Basically, the irritable bladder symptoms are similar to those of a urinary tract infection. People with an irritable bladder therefore suffer from a frequent urge to urinate (pollakisuria). That means someone needs to urinate at least eight times in 24 hours. Many sufferers find the very sudden urge to urinate associated with it , which often sets in without warning, to be very stressful . It sometimes results in involuntary leakage of urine – from a few drops to larger quantities. The great pressure of having to go to the toilet, coupled with the involuntary loss of urine, is also known as urge incontinence .

Another possible irritable bladder symptom is the so-called terminal dysuria – those affected have pain towards the end of urination because the bladder cramps painfully when emptying. A burning sensation that often occurs with a urinary tract infection does not typically occur with a classic irritable bladder without a known cause.

Urine may continue to drip shortly after urinating. Doctors then speak of so-called night dripping . The symptoms are also sometimes present at night and significantly disrupt sleep ( nocturnal urge to urinate = nocturia).

The irritable bladder symptoms lead to a high level of suffering and impair the quality of life. Those affected are always careful to stay near a toilet. The loss of control over bladder continence sometimes means a serious change in lifestyle. Anxiety may also aggravate the symptoms.

How is an irritable bladder treated?

There is no uniform irritable bladder therapy. Rather, the doctor will design it in coordination with the patient and his or her individual goals. Basic therapy options for irritable bladder are, for example, bladder training, pelvic floor training, biofeedback, methods of nerve stimulation, medication and surgical interventions. In addition, there is the right explanation and general tips from the doctor.

Education and general tips

In the case of an irritable bladder, it is important to have an open and honest discussion between the doctor and the patient about the possibilities and goals of the treatment. This prevents disappointments and misunderstandings.

The doctor should also educate the patient about simple but important measures to improve their quality of life. This includes information on proper intimate hygiene and the prevention of urinary tract infections. The latter occasionally increase the irritable bladder symptoms.

Small changes in habits often help to improve the symptoms. For example, irritable bladder patients should refrain from drinking diuretic drinks just before going to sleep. However, it is very important to drink enough liquid throughout the day – this should not be reduced for fear of even more severe symptoms.

Bladder training, pelvic floor training, biofeedback

Bladder training, pelvic floor training and biofeedback are effective treatment methods for irritable bladder, which can be carried out alone or in combination with medication. They are aimed at better, active control of the urge to urinate.

Bladder training is about deliberately delaying going to the toilet for a few minutes when the urge to urinate occurs. This time interval should then be increased continuously until there are finally about three to four hours between consecutive trips to the toilet.

In addition, the individual bladder capacity can be determined using a voiding protocol can be determined using a voiding protocol . Fixed toilet times are set accordingly, so that urge incontinence does not occur. First, time intervals are determined according to the clock for going to the toilet, which are increased over time.

Regular pelvic floor training is also suitable for treating an irritable bladder. It strengthens the pelvic floor muscles, which support the function of the urethral sphincter. A combination of pelvic floor training and electrical stimulation ( electrotherapy , electrical stimulation therapy) is considered to be particularly effective for irritable bladder.

Biofeedback may also help with an irritable bladder. You can find out more about this therapy method here .

Medicines for irritable bladder

For the drug treatment of the overactive bladder, so-called anticholinergics are usually used. Sometimes a local treatment with the female sex hormone estrogen makes sense. In certain cases, other active ingredients can be considered, such as the neurotoxin Botox .

You can read more about how irritable bladder can be treated with medication in the article Irritable bladder – medication .

stimulation of the nerves

Another type of therapy or extension of drug therapy is electrical stimulation therapy : the pelvic floor muscles are specifically activated with weak electrical stimulation over a period of three to six months. This makes sense, for example, if the drug therapy was not successful or the side effects, especially dry mouth or blurred vision, predominate.

If the irritable bladder symptoms do not improve significantly despite the electrical stimulation therapy, the doctor will try sacral neuromodulation . The sacral nerve node (sacral nerve plexus) is electrically stimulated through the skin in order to bring the bladder function back into balance. First, an external pulse generator is used to test whether this therapy variant works. If this is the case, a bladder pacemaker is implanted as a long-term solution, which takes over this impulse generation.

surgical interventions

If the therapy methods mentioned do not offer any relief and the symptoms are very severe, surgical methods can be considered as the last therapy option. For example, it is possible to surgically enlarge the bladder ( bladder augmentation ), for example with a piece of the small intestine. Another possibility is the removal of the bladder ( cystectomy ) to create a replacement bladder (neobladder) from sections of the intestine.

Alternative irritable bladder therapy

In addition to conventional medicine, some of those affected use alternative therapies against the irritable bladder – homeopathy, for example (such as homeopathic preparations with Nux vomica ). Yellow jasmine, Gelsemium , is also said to help with an overactive bladder. There is evidence that this plant has antispasmodic and anti-inflammatory effects.

Some irritable bladder patients report positive experiences with acupuncture.

The seeds of the garden pumpkin (Cucurbita pepo) are also known as home remedies for overactive bladder (and for problems with urination due to prostate problems). For example, preparations with whole or coarsely chopped seeds are used.

So far there is no scientific evidence for the effectiveness of these alternative methods and home remedies. If the symptoms persist over a longer period of time, do not get better or even get worse, it is advisable to see a doctor.

You can read more about which other herbal medications are suitable for an irritable bladder in the article Irritable bladder – medication .

What are the causes of an irritable bladder?

An irritable bladder often occurs as a result of pregnancy and childbirth and especially in old age. The causes of an irritable bladder have not yet been fully explored scientifically.

As a rule, no concrete reason for the complaints can be found. Experts suspect that those affected experience faulty transmission of nerve impulses that tell the brain that the bladder needs to be emptied, even though it is far from being full. This means increased sensitivity of the bladder muscles. On the other hand, the perception of the increased bladder pressure due to filling and tension in the irritable bladder is reduced, resulting in a sudden urge to urinate.

Rarely are sexual or psychological trauma trigger an irritable bladder.

A lack of estrogen, the female sex hormone, which typically occurs after menopause, sometimes triggers urge incontinence.

A fungal infection is not seen as the cause of an irritable bladder. Conversely, it is sometimes possible that the skin is softened (so-called maceration) if urine is passed frequently. Maceration encourages infection, as potential germs penetrate the softened skin more easily in the humid microclimate that is favorable to them.

Prolapse of the bladder, vaginal region, or uterine prolapse may cause incontinence, particularly with exertion (such as coughing). In addition to the painful urination, there is sometimes pain in the abdomen or spine and a feeling of pressure in the vagina. Experts do not count this as an overactive bladder because incontinence caused by other medical conditions does not.

What tests and diagnoses are there?

An irritable bladder is often considered an “embarrassing” problem by those affected. Nevertheless, this should not prevent anyone from openly discussing their condition with a doctor. If you suspect an overactive bladder, it is advisable to consult your family doctor first. If the diagnosis is confirmed, this will issue a referral to a urologist or, in the case of women, possibly to a gynaecologist.

The doctor first conducts a conversation in order to record the problems in more detail (anamnesis). He may ask questions like this:

  • Do you need to urinate more often than usual?
  • Is the urge to urinate often urgent and sudden?
  • Do you sometimes not make it to the toilet in time?
  • Do you often have to go to the toilet at night?
  • Do you have pain when urinating?
  • Do you take any medication?
  • How much do you drink a day?

It is particularly important that you describe your medication intake accurately. There are a variety of preparations that sometimes lead to symptoms of an irritable bladder. An example of this are active ingredients that are prescribed to treat high blood pressure. They sometimes trigger an increased urge to urinate and frequent urination.

It is often helpful to keep a voiding log before going to the doctor. It records the amount you drink and go to the toilet every day. These records help the doctor to find the causes of the “nervous” bladder.

Further investigations

After the conversation, the physical examination follows, which excludes organic reasons as the cause of the symptoms of the irritable bladder. The basis for this is the inspection of the urogenital tract . On this occasion, the prostate is examined in men and the uterus in women These two organs sometimes cause similar ailments.

The important alternative diagnosis to an irritable bladder is a urinary tract infection. To rule it out, a urine sample is taken and examined for pathogenic germs. In the case of an irritable bladder, the detection of the pathogen remains negative.

A symptom of irritable bladder is that some sufferers are unable to empty the bladder properly. The doctor determines this by using an ultrasound scan immediately after going to the toilet to check whether there is still residual urine in the bladder. If so, it requires further investigations to clarify.

Alternatively, urologists carry out a so-called urodynamic examination . The function of the bladder and the urinary tract is checked with the help of pressure probes and electrodes. In this way, the capacity of the bladder can be determined and the closure mechanisms (especially the bladder sphincters) can be tested.

smear from the lower urinary tract may show whether a local estrogen deficiency triggers the symptoms of the irritable bladder. Such a hormone deficiency leads to changes in the surface cells, which can be recorded with the so-called karyopyknotic index.

It is possible to start a therapy attempt with a drug from the group of so-called anticholinergics as soon as there is a suspicion of an irritable bladder. If this is effective, the diagnosis is confirmed.

In the case of an irritable bladder, the doctor will try to rule out other diseases – for example causes such as bladder stones. An ultrasound scan can help with this.

If the doctor suspects mental or sexual trauma as the trigger for the irritable bladder symptoms, he will address the issue as sensitively as possible and, if necessary, include the psychosomatic nature of the disease in the treatment.

What is the course of the disease and prognosis?

Sometimes an overactive bladder can be treated well with simple remedies, but there is no immediate remedy to calm the irritable bladder. Therapy is sometimes difficult and lengthy. In most cases, however, the treatment at least significantly alleviates the symptoms of irritable bladder, although it does not always eliminate them completely.

Medical support for an irritable bladder is very important. The doctor treating you should always weigh the effects and side effects of the therapy against each other. It is also advisable to check the function of the urogenital tract regularly in order to identify and treat damage caused by the irritable bladder at an early stage.

You may also like

Leave a Comment