It is always said that children do not listen, subordinates do not listen, leading cadres do not listen, our body organs can be as disobedient, I will say that the bladder does not listen to one of the performance: urinary frequency and urgency. First of all, first understand what is urinary frequency and urgency, how to be regarded as urinary frequency and urgency Urinary frequency is a complaint, refers to the patient’s subjective feeling that the number of urination is too frequent. It is usually considered: adults urinate ≥ 8 times day and night, ≥ 2 times at night, the average volume of urine ﹤ 200ml is considered as frequent urination. Therefore, frequent urination is not equal to frequent urination, and if the volume of urine is quite large, it may be polyuria. Therefore, for patients with frequent urination, doctors often ask patients to keep a diary of urination (3 consecutive records of the time and volume of each urination within 24 hours) to understand the patient’s daily frequency and volume of urination. Urinary urgency refers to a sudden feeling of urgency to urinate, often because of the urgent need to go to the toilet. Second, what can cause urinary frequency and urgency Urinary frequency is a symptom, a variety of reasons can lead to urinary frequency. The most common cause is urinary tract infection, other causes include urinary stones, tuberculosis, interstitial cystitis, urinary dysfunction, bladder tumors, prostate hyperplasia, etc. In addition, some factors outside the urinary tract, such as pregnancy, uterine fibroids compression, and even some mental factors such as tension, anxiety, etc. can be caused by frequent urination; there are also not a few patients in the improvement of the necessary examination is still unable to specify the cause, it is necessary to consider the bladder. There are few patients who cannot identify the cause of urinary frequency even after the necessary examinations, so we should consider the possibility of overactive bladder (OAB). Diagnosis (1) Screening examination refers to the examination items that should be completed by general patients. 1, history: ① typical symptoms: including urinary diary assessment; ② related symptoms: urinary difficulties, urinary incontinence, sexual function, defecation, etc.; ③ related history: urinary and male reproductive system diseases and treatment history; menstruation, childbirth, gynecological diseases and treatment history; neurological diseases and treatment history. 2, physical examination: ① general physical examination; ② special physical examination: urinary and male reproductive system, nervous system, female reproductive system. 3.Laboratory examination of urine routine. 4, special urological examination of urinary flow rate, urinary system ultrasonography (including residual urine determination). (B), selective examination refers to special patients, such as patients suspected of having some kind of pathology exists, should selectively complete the examination program. 1, pathogenetic examination of suspected urinary or reproductive system inflammation should be urine, prostate fluid, urethra and vaginal secretion pathogenetic examination. 2, cytological examination suspected of urinary tract epithelial tumors for urine cytology. 3, urinary tract imaging, invasive urodynamics Fourth, what is the danger of urinary frequency and urgency? Urinary frequency and urgency is a common disease, although it does not threaten the patient’s life, but it seriously affects the patient’s quality of life. Symptoms such as urinary urgency and frequency can affect every aspect of a patient’s life. In particular, frequent trips to the toilet will bring great distress to the patient’s daily life and work, casting a shadow over the patient’s physical and mental health, social interactions, sex life, and career development. The quality of sleep of patients with excessive nocturia will be seriously affected, and even cause insomnia. Elderly people who go to the toilet frequently at night are also at increased risk of fractures due to falls. V. How to treat? As the saying goes, the best treatment is to address the cause of the problem. In most cases, frequent urination is only the “symptom”, the cause of frequent urination is the “root”, if we can identify the cause of the disease and treat both the symptoms and root cause, the effect will certainly be satisfactory. Such as for inflammation, should be anti-inflammatory treatment. For stones, the need for lithotripsy and other treatments. Just the problem is often not so simple, some diseases are difficult to eradicate because of the patient’s own factors, and a large number of patients who can not identify the specific cause of overactive bladder (OAB), the treatment is quite complex, including behavioral therapy, drug therapy, neuromodulation therapy, Botulinum toxin A injections, or even surgical treatment, and so on, which will need to look for a professional doctor to carry out diagnosis and treatment. 1, the first line of treatment: behavioral therapy Recommendations: can be applied in combination with other forms of treatment. A. Lifestyle guidance: By instructing patients to change their lifestyles, such as losing weight, controlling fluid intake, reducing caffeine or alcohol intake, etc., patients’ symptoms can be improved. B. Bladder training Method 1: Delay urination, extend the interval between urination and gradually make the volume of each urination greater than 300 ml. I. Therapeutic principle: Re-learning and mastering the skill of controlling urination; interrupting the vicious cycle of mental factors; reducing the sensitivity of the bladder. II. Contraindications: low-compliance bladder, forced urethral pressure greater than 40cmH20 at the end of the filling period. III. Requirements: effective implementation of the treatment according to the plan ⅣCooperative measures: adequate ideological work; voiding diary; others. Method II: regular urination I. Objective: to reduce the number of urinary incontinence and improve the quality of life. ll.Indications: incontinence is severe and difficult to control. III Contraindication: with severe urinary frequency. C Pelvic floor muscle training D Biofeedback therapy E Other behavioral therapy: improve sleep, etc. 2.Second-line treatment drug therapy ①. Currently, M receptor blockers are commonly used in China: tolterodine (Tolterodine) and solifenacin (Solifenacin). These drugs inhibit the contraction of the forced urinary muscle during the storage phase by antagonizing the M receptor and have a highly selective effect on the bladder, and their side effects are minimized on the basis of ensuring efficacy. I. Tolterodine: Tolterodine is a highly selective M receptor blocker for the bladder, capable of blocking both M2 and M3 receptors. It has a higher affinity for the bladder than for the salivary glands. The commonly used dose is 2~4mg/day, which is divided into immediate-release and extended-release types. Solinacin: Solinacin has a higher affinity for M3 receptor subtypes and a higher selectivity for the bladder than for the salivary glands, with a half-life of about 50 hours. The dose used is 5-10 mg/day, which can be adjusted according to the condition. M-blockers have some side effects such as dry mouth, constipation, dry eyes, blurred vision, and urinary retention. Because the incidence of dry mouth caused by the extended-release form of the drug is lower than that of the immediate-release form, the extended-release agent should be considered first. M-blockers should not be used in patients with closed-angle glaucoma. Other M-blockers include Oxybutynin and Propiverine. ②.α1 receptor blockers relax smooth muscle by blocking α1 receptors (mainly α1A and α1D receptors) distributed in the prostate and bladder neck to achieve relief of bladder outlet power obstruction.The ratio of α1A, α1B, and α1D receptors in the prostate of patients with LUTS/BPH is approximately 85:1:142 ③.β3 agonistsMirabeperon is a type of β3 adrenergic agonist that acts on the forced urethral smooth muscle of the bladder. Smooth muscle β3 adrenergic receptors, so that the bladder diastole, promote bladder filling and increase the amount of urine storage, prolong the intervals between urination, while inhibiting the bladder afferent nerves, to relieve the symptoms of urinary urgency. It does not affect bladder emptying and is less likely to cause acute urinary retention. 3.Third-line treatment ① A-type botulinum toxin remote urethral muscle injection: for M receptor antagonist treatment effect is not good or can not tolerate M receptor antagonist side effects, can use A-type botulinum toxin forced urethral muscle injection treatment. ② Bladder instillation of capsaicin or heparin: bladder sensory afferents are reduced after instillation, and it can be tried for those with severe bladder sensory hypersensitivity. ③Neuromodulation: transvaginal, anal, and transcutaneous electrical neuromodulation therapy as well as magnetic stimulation therapy are effective for some patients. Sacral neuromodulation therapy, which is effective for patients with recalcitrant OAB, is more expensive. ④ Surgery Indications for surgery: should be strictly controlled, only for severe low compliance bladder, bladder safety capacity is too small, and jeopardize the function of upper urinary tract or quality of life is seriously affected, and other treatments are ineffective. Surgical methods: there are bladder enlargement and urinary diversion. ⑤ Electro-acupuncture treatment: some data show that acupuncture helps to relieve symptoms.