Many people think that frequent urination, urinary urgency and urinary incontinence are natural manifestations of aging that occur with age, but in fact, mental anxiety, sleep disorders, endocrine abnormalities and declining estrogen levels can also cause urinary discomfort, called overactive bladder disorder, which is not a major disease and does not pose a threat to one’s life, but often puts patients into embarrassing scenes and seriously affects their quality of life, such as Frequent trips to the toilet, forced to reduce drinking, afraid to participate in social activities and fear of urine leakage to avoid sex, etc., so that many patients have been living under pressure, seriously affecting the work and life of patients, bringing anxiety, embarrassment and frustration to patients and other adverse emotions, easy to produce a sense of loneliness, and even depression, but also cause a lot of physical discomfort, it is likely to hold urine, leakage and other conditions leading to incontinence It becomes more and more serious and can lead to other complications such as recurrent urinary tract infections and hydronephrosis.
Overactive bladder disorder is actually a common and frequent disease, manifested as a sudden, strong, difficult to be delayed desire to urinate, often accompanied by urinary frequency and urge incontinence, is a syndrome characterized by symptoms of urinary urgency caused by overexcitation of the bladder and overactivity of the detrusor muscle. According to incomplete statistics, the overall prevalence of overactive bladder in people over 40 years of age in China reached 11.3%, the incidence of overactive bladder increases with age, reaching its first peak at the age of 50, followed by a downward trend with increasing age, rising again at the age of 80, with women significantly higher than men. Insomnia, living alone, and obesity have a high prevalence; habitual constipation, chronic pulmonary obstructive disease, stroke, Parkinson’s disease, fractures, and diabetes are all associated with overactive bladder disorder. In contrast to the prevalence, the consultation rate is extremely low, with 74% of patients not choosing to seek medical attention. The lack of awareness of the disease, in addition to the lack of understanding of the disease, is related to the shyness of seeing it as a natural phenomenon.
The bladder is located in the pelvis and the lower part is connected to the urethra, which has two main functions: urine storage and urination. The capacity of the bladder is 300 to 500 ml, and urine is stored until 400 ml. Storage and voiding are neurological reflex activities under conscious control. Storage and voiding are coordinated processes controlled by local reflexes and higher centers of the bladder. Sympathetic nerves act through the hypogastric and pelvic nerves on adrenergic alpha receptors in the smooth muscle of the bladder base and posterior urethra and inhibit parasympathetic nerves to contract, while parasympathetic centers release acetylcholine through the pelvic nerves, which act on the force acetylcholinergic receptors (M receptors) in the detrusor muscle to contract the detrusor muscle and also to relax the bladder base and posterior urethra. The relationship between bladder capacity and the sensation of urination is affected by lower urinary tract pathology such as infection and stones, in addition to the fact that once the nerves that govern bladder contraction are damaged, the pressure receptors of the bladder are overly sensitive and may store less than 100 ml before sending a signal to urinate, there is a compulsive desire to urinate and it is difficult to hold urine in. Of course, the consciousness of urination is also controlled by mental factors, which manifests itself in frequent urination during mental stress.
The main cause of overactive bladder syndrome is due to overactivity of the M receptors of the bladder’s forceps, which manifests as overactivity of the forceps, but can also be other forms of urethral-cyst dysfunction. Prostate enlargement, prostatitis, bladder stones, and neurological disorders such as spinal cord injury or diabetes mellitus with peripheral neuropathy can all cause overactive bladder disorder. Estrogen has a stabilizing effect on the bladder and bladder activity can become hyperactive when estrogen decreases. This does not include symptoms caused by acute urinary tract infections or other forms of localized lesions of the urinary tract of the bladder. If the patient does not have symptoms of urinary urgency, but only urinary frequency and incontinence, a clear etiology cannot be diagnosed as OAB. frequency of urination is related to the amount of water drunk, hot and cold weather, how much sweating, the presence or absence of diuretics, and the presence or absence of diabetes. It is normal to drink 1500~2000ml of water, urinate at intervals of 2 hours or more, go to the toilet up to 8 times a day normally, and get up at night to go to the toilet up to 1 time, if you exceed this number per day you need to be alert.
Overactive bladder disorder is not an inevitable result of childbirth or aging, it is a disease and a treatable one, and more than 90% of treated patients have significant improvement or cure of their symptoms. Middle-aged and elderly people who find themselves with frequent urination and urinary incontinence should be treated as soon as possible, the earlier the treatment the better the recovery effect, choose to suffer in silence, but delay the treatment. There are many effective treatment modalities, including behavioral therapy and medication, with mild patients mainly treated with behavioral therapy, which is a very simple and effective method that includes lifestyle interventions, bladder training and pelvic floor muscle training.
Lifestyle interventions include controlling the amount and timing of water intake, evenly distributing water intake throughout the day for 24 hours, avoiding large amounts of water at once, generally drinking in 6 to 8 bouts, reducing fluid intake after 6 pm or 3 to 4 hours before bedtime, and not drinking before going to bed. It should be noted that drinking too little water will increase the concentration of urine, stimulating the bladder mucosa, causing urinary tract infections; secondly, to limit the intake of alcohol, carbonic acid, sweeteners and caffeinated foods and beverages; furthermore, to develop good bowel habits, more dietary fiber intake, keep the bowels open, regular bowel movements, constipation relief can effectively reduce the symptoms of frequent and urgent urination; finally, to maintain a reasonable weight, avoid being overweight, and also to quit smoking and alcohol. Also quit smoking and alcohol; keep the perineal area and feet warm.
The purpose of bladder training is to suppress unstable bladder contractions, increase bladder capacity, drink more water during the day, urinate regularly, establish a regular urination schedule, and try to prolong the interval between urination, and achieve distraction by slow deep breathing or simple self-motivation when the urge to urinate is obvious, and then urinate when the urge disappears or is reduced. Delay urination appropriately for a short period of time, then slowly extend it, gradually making the interval between urination close to 2 hours, and each time the volume of urination is more than 300 ml.
Pelvic floor muscle training Also called kegel exercise, contract the muscles of urethra, anus and perineum for 5~10 seconds and then relax, repeat the above action after 5~10 seconds interval, contraction and relaxation time should be consistent, avoid too fast or too slow. Enhance the tone of the pelvic floor muscles and urethral muscles and improve the contraction force of the muscles in response to the action of pressure, thus improving the function of the urethral sphincter. In order to avoid overworking the anal raphe, you need to exercise 150~200 sets per day, divided into 10 time periods to complete, each time period to complete 15~20 sets, to be consistent, generally 6~8 weeks will take effect, adhere to more than a year can significantly improve the symptoms. If the patient is poor compliance can not be persistent, the effect is not good. This training is easy to do, non-invasive and painless, effective and without side effects. Sitting, standing or lying down can exercise, exercise thighs, abdominal and back muscles to remain relaxed and maintain normal breathing, urinary incontinence is obvious exercise before you can empty the urine, the intensity of the exercise can vary from person to person, the beginning of the more difficult to do a few groups, to be exercised for a period of time and then slowly increase the intensity.
Although behavioral training is a very effective treatment, severe symptoms need to be combined with drug therapy. There are two main types of medications: one is an M-cholinergic receptor blocker, which acts on the M receptors on the detrusor muscle, thereby reducing the frequency of detrusor activity and relieving the symptoms of overactive bladder syndrome, urinary frequency, urgency and urge incontinence. Since M cholinergic receptor blockers act on the intestinal tract and salivary glands at the same time, they may produce adverse effects such as mild constipation and dry mouth. There is also flavone permethrin, which relieves the spasm of the smooth muscles of the genitourinary system, decreases the efficiency of the contractions that cause bladder emptying, increases the capacity of the bladder, and eliminates the symptoms of urinary frequency and urgency.
Bladder pacemaker When conservative treatment is ineffective or drug side effects are too great and there is no mechanical obstruction (prostatic hyperplasia, stricture, tumor), patients who are effective in experiencing treatment and can self-regulate the implantation system can be fitted with a bladder pacemaker, which regulates the neural reflexes of the bladder, sphincter and pelvic floor associated with voiding by stimulating the sacral nerve with electric current, so that abnormal neural reflexes can be rebalanced to control the symptoms of voiding dysfunction .
Some patients with overactive bladder have other diseases that must be treated at the same time. For example, symptoms of urinary frequency and urgency may be related to a decrease in estrogen levels in the body, and topical estrogen ointment can be applied vaginally under the guidance of a doctor. For patients with more severe symptoms, a combination of several drugs can be used to strengthen the inhibition of the bladder forced urinary muscle, which can achieve more satisfactory results. Active treatment of chronic diseases such as emphysema, asthma, bronchitis, etc.