A significant proportion of the population suffers from an overactive bladder disorder. What are the symptoms? Are there specific risk factors? What are the possible treatments? Explanations by Professor Véronique Phé, Professor of Urology at Tenon Hospital (Paris).
Overactive bladder is a common problem in the population. The result is an urgent need to go to the toilet. There are appropriate treatments and solutions.
What is overactive bladder syndrome (OAB)?
An overactive bladder is characterized by a specific symptom, urgency, that is, a sudden and urgent desire to urinate. “This symptom is different from incontinence or leaking urine. It is really a sudden and uncontrollable urge to urinate. points out professor Véronique Phé, professor of urology at Tenon Hospital (Paris).
If the urgency itself is characterized by an overactive bladder, other symptoms can sometimes accompany it. “This is especially the case with frequent urges to urinate (pollakiuria), whether during the day or at night, as well as with leakage of urine. continues the specialist.
Overactive bladder syndrome affects approximately 15% of the general population. Prevalence increases as the population ages. “It is a common disease that affects the quality of life, whether on a physical, psychological or social level, and which is more pronounced than diabetes.adds Professor Véronique Phé.
Various possible causes of an overactive bladder
In the vast majority of cases, the cause has not been determined. Natural aging of the bladder plays a major role. Certain neurological diseases, such as Parkinson’s disease or Multiple sclerosis, however, can be the cause of an overactive bladder. “An overactive bladder can be a symptom of a more serious condition, such as bladder cancer or detect presence stones in the bladder or a urinary tract infection For example. That is why it is very important to consult a doctor at the first symptoms.”warns the expert.
In women, menopause can also lead to an overactive bladder. Indeed, genitourinary menopausal syndrome (GUMS), caused by a drop in estrogen and characterized by mucosal atrophy and dryness, can sometimes be responsible for an overactive bladder.
Several risk factors
While menopause and age are important risk factors for overactive bladder, overweight and obesity, as well as excessive consumption of tea, coffee, soda and other carbonated beverages also play a role.
Diagnosis of overactive bladder
First of all, it is necessary to consult a specialist doctor. The urologist suggests that the patient complete a urination calendar for three days. “Each time you go to the toilet, you must report the time and amount of urination. These data will enable a more accurate assessment of bladder function. points out the urologist.
It is also important to have a flow rate measurement and a residual measurement after emptying. At the urologist, the patient urinates into a small device that will record the stream of urine.”An ultrasound is then performed to check the emptying of the bladder. Remnants of urine can cause overactive bladder.specifies professor Véronique Phé.
The doctor must also take into account the patient’s specific risk factors: smoking, age, menopause in women, exposure to dyes, hydrocarbons or other toxic products during professional life, etc.
Depending on the patient and their risk factors, bladder fibroscopy may also be offered. This painless test involves inserting a small camera into the bladder. Very quickly, the examination can be performed without the need for general anesthesia. “With this fibroscopy, it is possible to detect a bladder tumor, bladder stones or other diseases. explains professor Véronique Phé.
Finally, this examination can be completed with an ultrasound of the urinary tract (kidney and bladder).
Different types of treatment adapted to each patient
An overactive bladder is not inevitable. There are many effective treatments that must be tailored to each patient’s profile.
Rules of hygiene
First of all, it is necessary to follow certain health and dietary rules. After 6 p.m., it is recommended to reduce fluid intake and avoid soups or salads for dinner, as these foods are full of water and can increase the frequency and volume of nighttime urination. “But it’s about finding an acceptable compromise between this medical problem and everyday pleasures. explains the urologist.
Exercises to rehabilitate the perineum and bladder may also be considered. “Rehabilitation allows you to learn, with the support of a practitioner, to delay the urgent need to urinate and to schedule urination”, specifies the specialist. For postmenopausal women, the prescription of a topical hormone cream is generally effective.
Medicines and botulinum toxin
Certain medications, most commonly in the class of anticholinergics, aim to reduce the urge to urinate, space out urination, and reduce urine leakage. These drugs have a moderate effectiveness, about 30%, and are poorly tolerated due to side effects: constipation, indigestion, dryness of the mucous membranes (mouth, eyes, etc.). “These drugs are not recommended for elderly people or patients who are already taking drugs from the same group of anticholinergics.”specifies the specialist.
Other drugs from another class of drugs, beta 3 agonists, will work by relaxing the bladder muscles. Their advantage is that they have fewer side effects. However, social security does not reimburse them.
Furthermore, injections of botulinum toxin (as well as Botox, which is used in aesthetic medicine against wrinkles) can be done under local anesthesia…”We’ll insert a small camera and then inject botulinum toxin to work on the bladder muscle.” explains professor Véronique Phé. It is a very effective therapeutic solution, but the therapeutic effects are transient. Depending on the case, the doctor will need to give a new injection every 6 to 8 months. Another disadvantage: in 6% of patients, this practice can cause urinary retention. “This requires teaching the patient to probe on his own so that he can solve his retention problem on his own. If the patient does not accept this risk, it is preferable to offer him another treatment. summarizes Professor Véronique Phé.
Stimulation of the tibial nerve
Another possible treatment: the so-called “electrical” treatment, which involves stimulation of the tibial nerve. This treatment consists of placing two small electrodes on the ankle, where the tibial nerve passes. Every day the patient has to practice 20 minutes of stimulation at home with a small box. “It is a simple, effective treatment and completely without side effects. For the elderly, it is a good alternative to medication.”, adds professor Véronique Phé. The only limitation: the treatment must be carried out every day, especially during the first three months of treatment. If you forget, even for a day, the therapeutic effects are called into question.
In case of therapeutic failure or treatment refusal, other more invasive therapeutic solutions can be offered.
Surgery: sacral neuromodulation
Finally, sacral neuromodulation can be considered. “It’s a bit like a bladder pacemaker., summarizes the urologist. This procedure is generally performed in two stages, under local or general anesthesia. The first operation consists of introducing a small electrode through a puncture in contact with the sacral nerve of the bladder (S3). Connected to a portable stimulator, this electrode will modulate the urge to urinate by sending impulses to the sacral nerve. After two weeks, the practitioner evaluates the therapeutic effectiveness of the device with the patient. “If the results are satisfactory, we will proceed to the final implantation of the device, under local anesthesia.”explains the specialist.
There are different types of devices depending on the lifestyle of the patient. Some devices are rechargeable and can last more than 15 years, while others can be kept in place for a limited number of years without recharging. “The solution must be considered on a case-by-case basis. We best adapt to the needs and profile of the patient,” summarizes the urologist.
Some prevention measures
To prevent an overactive bladder, fluid intake should be limited to less than two liters per day. In patients with obesity or overweight, lifestyle and dietary measures aimed at reducing body weight are recommended. Finally, it is recommended to stop smoking (a proven risk factor for bladder cancer), tea and coffee, drinks that stimulate the bladder.