Overactive bladder
| Classification according to ICD-10 | |
|---|---|
| N32.8 | Other specified diseases of the bladder |
| ICD-10 online (WHO version 2019) | |
The term overactive bladder (also overactive bladder , formerly irritable bladder ) is defined as a functional disorder of bladder function without organic pathology. This leads to frequent emptying of the bladder ( pollakiuria ) with or without involuntary leakage of urine ( urinary incontinence ). The overactive bladder appears in men more and more according to age and in women mainly in the 3rd to 5th decade of life.
Symptoms
Constant urge to urinate and excessive urination ( pollakiuria ) are in the foreground, in some cases (urge) incontinence . There is no burning sensation when urinating, but the constant need to urinate can be felt as suprasymphyseal pain.
causes
In addition to an estrogen deficiency, chronic infections and psychosomatic causes that cannot be found are discussed. The cause of the symptoms can also be an overactivity and malfunction of the bladder muscle (the so-called detrusor, Latin detrusor vesicae ). The muscle, which should actually be relaxed during the filling phase, so that the bladder can expand, tenses too easily in people who suffer from an overactive bladder. This means that the detrusor can contract while it is still being filled, i.e. even with small amounts of urine, triggering the urge to urinate, which some sufferers cannot suppress.
Diagnosis
The overactive bladder is ultimately a "diagnosis of exclusion" (no objectifiable organ pathological findings). Be recommended to next history (a nocturnal continuing pollakiuria , ie an excessively frequent urination, has, for example an organic cause back) and physical examination an analysis of Vaginalfluor and urine, residual urine , urethral wide examination and smears and additionally optionally urodynamics including -flowmetrie, Urethrogram in double balloon technique and urethrocystoscopy .
Theses to explain
From a neurophysiological and psychological point of view, the symptoms of those affected can be described as a disorder of the autonomic nervous system and as a nervous sensitization . Pathophysiologically, a disturbed interaction between the bladder and pelvic floor muscles is assumed. A chronic subepithelial inflammation in the area of the trigonum of the bladder is postulated as a further explanation.
therapy
Spasmolytics , alpha blockers , tricyclic antidepressants and, in the case of an estrogen deficit (e.g. in seniors ), topical therapeutic agents containing estrogen can be tried symptomatically . Psychosomatic treatment can also be helpful for further therapy . Antibiotics should be avoided.
Prevalence
In Europe and Canada, 13.9% of people over 40 are said to have symptoms of an overactive bladder.
See also
Individual evidence
- ↑ RS Eapen, SB Radomski: Review of the epidemiology of overactive bladder. In: Research and reports in urology. Volume 8, 2016, pp. 71-76, doi : 10.2147 / RRU.S102441 , PMID 27350947 , PMC 4902138 (free full text) (review).
- ↑ a b c d e J. Sökeland et al.: Pocket textbook urology. Thieme Verlag, 2007, ISBN 978-3-13-300614-9 , p. 396.
- ↑ a b c d e f R. H. Eichenauer: Clinic Guide Urology. Urban & FischerVerlag, 2003, ISBN 3-437-22790-4 , p. 306. (online)
- ↑ a b S. Krautzig: Basic textbook internal medicine with student consultancy access. Urban & FischerVerlag, 2008, ISBN 978-3-437-41053-6 , p. 949. (online)
- ^ WS Reynolds, R. Dmochowski, A. Wein, S. Bruehl: Does central sensitization help explain idiopathic overactive bladder? In: Nature reviews. Urology. Volume 13, Number 8, 2016, pp. 481-491, doi: 10.1038 / nrurol.2016.95 . PMID 27245505 , PMC 4969200 (free full text) (review).
- ↑ DE Irwin et al .: Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. In: Eur Urol . 50, 2006, p. 1306.
