Hyperactive bladder means urgency accompanied by frequent urination and nocturia. Crucial symptom of bladder hyperactivity is a sudden forced desire to void the bladder which is difficult or impossible to delay. Transient and reversible causes of involuntary urination are misuse of alcohol, caffeine, limited physical activity and application of some medicinal products. Involuntary urination may occur due to chronic retention of urine on the setting of infravesicular obstruction or damage of bladder innervation.
Understanding of hyperactive bladder morbid physiology is essential for effective treatment of this syndrome. Normal function of lower urinary tract (LUT) lies in a sophisticated coordinated interaction between cortex, pons cerebelli, and spinal centers with anatomic components of LUT. Lower urinary tract dysfunction occurs due to functional or morphological alterations at any stage of this complicated chain.
As a rule, hyperactive bladder may be classified in accordance with etiological causes: neurogenic (diseases and spine and medulla injuries), myogenetic (obstruction on the setting of hyperplasia of prostatic gland), inflammatory (interstitial cystitis) and idiopathic. Regardless of etiological cause, hyperactive bladder is shown with particular complex of symptoms. They are: sudden increase of intravesical pressure in case of small volume of bladder, increase of spontaneous myogenetic activity, alteration of response on stimulation, tetanic contractions of detrusor and characteristic alterations of smooth muscle cells of detrusor.
Risk Factors for Hyperactive Bladder Development
Nowadays, a role of the whole range of factors of hyperactive bladder development is being discussed.
They are as follows:
– Sex and Age
Hyperactive bladder risk increases with the age. The critical age is above 60 – elderly people have maximal probability to get affected by hyperactive bladder. For men, this risk is explained by prostatic hyperplasia the symptoms of which are present in almost all men above 60. Nevertheless, absence of hyperplasia doesn’t exclude occurrence of age-related changes of bladder which are nearly identical in both, men and women.
Hyperactive bladder development in elderly people is usually an accompanying disease with neurogenic and vascular component, such as diabetes, cerebrovascular pathology, atherosclerosis of huge vessels, etc.
– Genetic Factor
It is difficult to detect this factor in hyperactive bladder syndrome. For unbiased estimate of heredity role, it is essential to examine affined individuals under conditions of similar environment and lifestyle. Nevertheless, some epidemiologic research studies prove the interdependence between family history in relation to urinary disorders and possibility of hyperactive bladder occurrence in descendants. According to statistics, genetic factor is determinant in pathogenesis of this syndrome in 19% of cases.
– Cultural characteristics, lifestyle particularities
Epidemiologic research studies show the results in different countries: U.S., Western and Eastern Europe, Asia. They demonstrate considerable differences in incidence of hyperactive bladder among their population. On the one hand, it is explained by social causes, for instance Japanese women are more tolerant to present symptoms of hyperactive bladder in comparison with European and American females. On the other hand, diffusion of this syndrome may depend on cultural causes, particularities of lifestyle and dietary regimen.
– Pathologies of urinary bladder
Tumor or bladder stones may accelerate the development of detrusor hyperactivity and cause occurrence of hyperactive bladder symptoms. Also, this syndrome may be potentiated by damaged detrusor contractility. Typical consequences of contractibility disorder are incomplete emptying of bladder and urinary retention.
– Faecal incontinence
According to a number of research studies, faecal incontinence is a risk factor of hyperactive bladder development and very often combines with this syndrome.
– Recurrent infections of urinary tracts
Infections of urinary tracts, such as cystitis in case of recurrent character of its progression may lead to activation of sensor nerve endings of urinary bladder with their subsequent inadequate reaction during the phase of bladder filling which is clinically accompanied by hyperactive bladder syndrome.
According to epidemiologic research studies devoted to incidence of hyperactive bladder in women, the connection between menopause and this syndrome was not proven. Nevertheless, some experimental works testify that long-term deficit of estrogens may result in detrusor contractility disorder and its hyperactivity.
– Administration of medicinal products
There are several groups of medicinal products which may influence contractive function of bladder and explain hyperactive bladder symptoms occurrence:
- Inhibitors of angiotension-converting enzyme;
- Alpha-adrenergic agonists and antagonsts;
- Anticholinergic drugs;
- Calcium channel inhibitors;
- Medications for urinary incontinence;
- Narcotic drugs;
- Sedative and hypnotic remedies;
– Increase of prostatic gland, infravesicular obstruction
60 per cent of patients with benign prostatic hypertrophy-derived infravesicular obstruction during cystometry appear to have detrusor hyperactivity.
In case of any hyperactive bladder symptoms, administration of medicines is the only form of therapy. The most efficient group of medications contains anticholinergic drugs. These remedies’ efficiency doesn’t admit of patients or doctors’ doubts.
The most widely spread drugs are:
- Oxybutrin (two-three times as day);
- Smazmex (from five to fifteen mg a day);
- Tolterodine (four mg a day);
- Vezicar (up to ten mg).
Treatment of hyperactive bladder by means of these medicines is standard. It is noteworthy that therapy course is efficient for a patient for six-eight months. Upon termination of this period, relapse occurs. Thus, a patient will have to repeat a therapy course.
Home medicines improve organs functioning and cause restoration of its functions. This type of treatment promotes regeneration of affected tissues.
- It is useful to drink herbal tutsan infusion instead of tea. In order to prepare this remedy, 40mg of dry leaves should be infused in a liter of boiled water for a couple of hours and then filtered.
- Tutsan may be combined with centaury. 20g of each plant should be infused in 1 liter of boiled water for several hours and afterwards filtered. This infusion should be applied instead of tea 1-2 glasses a day.
- Its leaves are used for therapy: 1 tablespoon per glass of boiled water. This remedy is infused within one hour and then filtered. Take it in small portions 3-4 times a day before food intake.
- Red bilberry. Bladder disorders may be treated with infusion of bilberry leaves. 2 table spoons are infused in one liter of boiled water. Put the infusion in the warm place and then filter it.