Overactive bladder: symptoms, diagnosis and treatment

Urologist

Belkin

Andrey Ivanovich

20 years of experience

Urologist of the first category, member of the European Association of Urology

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An overactive bladder is a pathology with spontaneous contractions of the muscle (detrusor), which entails defecation of the organ. Such muscle impulses are accompanied by severe painful sensations.

A common concomitant pathology is urinary incontinence, which requires immediate treatment. It should be understood that the syndrome is considered a pathology and a disease that needs to be treated with medications. This condition is not an age-related norm at any age.

About the disease

Overactive bladder syndrome is a dysfunction of the organ when there is an uncontrollable urge to go to the toilet. This pathology is observed most often in women, but men are also susceptible to the disease. If you notice signs and symptoms of a pathological condition, you must immediately visit a specialist who will diagnose and prescribe appropriate medication.

A doctor should be consulted if the patient experiences incontinence, a frequent and unpleasant desire to visit the toilet, or a constant feeling of a full bladder. With timely treatment, the disease can be cured, but if left untreated, the problem worsens, leading to significant complications and associated pathologies. With the disease, the patient feels significant discomfort and limited movement, since he needs to constantly visit the toilet.

Normally, the standard number of urinations per day is up to 8 times with a norm of 2 liters of urine, depending on the volume of fluid consumed. In the presence of a pathological syndrome, the volume of urine remains the same, but the patient more often feels the desire to urinate. The disease develops due to a sharp increase in the conductivity of impulses in the nerve endings of the bladder. Therefore, even the slightest influence on the nerve endings provokes muscle contraction, then the person feels the urge to urinate.

OAB in children

The problem of OAB is not related to the age category, and children quite often outgrow this condition upon reaching seven years of age. If we are talking about incontinence or excessively frequent urinary processes in a child under three years old, this phenomenon should be treated as completely normal and not a problem.

Let's consider what factors can provoke an overactive bladder in children:

Development of infectious processes in the urinary tract.
Presence of neurological diseases.
Development of acute or chronic constipation.
The occurrence of stressful situations, especially if they are associated with the urination process.
Inability to go to the toilet for a long time.
Overactive bladder syndrome occurs when the capacity of the organ is not large enough.
Presence of foods containing caffeine in the diet. This applies to chocolate, sweet carbonated waters and tea.
Structural changes affecting the organs of the urinary system.

An allergic reaction to certain foods and irritation of the organ lining can have a negative impact. According to foreign statistics, after a child turns five years old, cases of OAB in this age category decrease, this figure reaches about 15%. As children grow older, they acquire the ability to respond in a timely manner to signals sent by the body indicating the need to go to the toilet.

Causes

This condition can be provoked by neurogenic or other causes that require timely treatment. The first category includes the following:

the main reason is brain disorders and pathologies (sclerosis, encephalitis, malignant tumors, Alzheimer's disease);
diabetes;
alcohol abuse;
traumatic brain injury, stroke;
congenital pathologies.

Other reasons include age-related changes, concomitant pathologies of the genitourinary organs, anatomical structure of organs, and hormonal imbalances. Also, patients who experience stress and depression, disorders, intestinal pathology with irritated mucosa, may suffer from bladder diseases, for which drug treatment is inevitable.

With this disease, the patient experiences general discomfort as sleep disorders, depressive states, and various urinary tract infections develop. Therefore, if even the slightest symptoms are detected, you need to visit a qualified specialist who will prescribe effective medications depending on the causes of the pathology.

Symptoms

The main symptoms of the disease include the following conditions:

an urgent urge to go to the toilet that a person cannot control. This symptom of the disease manifests itself as an urgent and suddenly appearing need to visit the toilet without preliminary urges, that is, the desire increases instantly, and not gradually. During the day, the frequency of such urges can reach 8 times or more. Conditions are also possible when various sounds, such as the babbling of liquid, provoke urges and uncontrolled urination;
frequent urination, even if the bladder is almost empty;
imperative incontinence, that is, uncontrollable leakage of urine that the patient is unable to contain;
a feeling of incomplete emptying of the bladder, even after urinating completely. Moreover, the total volume of urine per day does not exceed the norm for an adult, approximately 1.5-2 liters;
nocturia, that is, frequent night trips to the toilet (two or more). This sign is an alarm bell if observed every night, and can cause more serious pathologies.

Are you experiencing symptoms of an overactive bladder?

Only a doctor can accurately diagnose the disease. Don't delay your consultation - call

Before contacting a specialist, answer the following questions

1. Do you experience frequent urination (>8 times during the day, >1 time at night)? 2. Do you have urgent (sudden) urges that are difficult to control? 3. Do you experience involuntary urinary discharge? 4. Do you use urological pads? 5. Do you have neurological or other diseases that can affect bladder function (consequences of stroke, neuropathy due to diabetes mellitus, osteochondrosis, herniated discs)? 6. Have you had brain/spinal cord or pelvic surgery? 7. Do you have inflammatory diseases of the genitourinary area that are difficult to treat with antibiotics? 8. Are there any discomfort or pain in the bladder, genitals, or perineum?

If you answered yes to 2 or more questions, you should contact a specialist.

Diagnostics: how it goes, what procedures are performed

Diagnosis of overactive bladder syndrome begins with informing the doctor about the patient’s complaints and medical history. One of the key elements of diagnosis is the analysis of the number of urinations during the day and at night. Monitoring is carried out using the patient's diary, in which it is necessary to enter data on urination for three days.

A diagnosis of pathology in the bladder is made if the patient urinates more than 8 times a day, with uncontrollable urges occurring at least twice a day. The doctor also prescribes laboratory tests, which include the following studies to determine the causes of the pathological condition:

bacteriological tests to detect the presence of infection in the genitourinary system;
cystoscopy and urethroscopy;
Ultrasound, which examines the kidneys, bladder, and prostate gland.

Through these procedures, during an outpatient examination, the doctor identifies various pathologies of the genitourinary system that arise along with the symptoms that characterize an overactive bladder. In order to fully confirm the diagnosis and prescribe appropriate treatment, a urodynamic analysis with fullness cystometry is performed. That is, the Doctor records an increase in detrusor pressure during urgency when the bladder is full.

It is also necessary to inform the specialist about the medications you are taking, since some of them may worsen the symptoms of incontinence.

It is necessary to come for diagnostics with a slightly full bladder, since this way a more detailed ultrasound examination can be carried out, on the basis of which effective treatment will be prescribed. It is also recommended that you first fill out a urination diary for three days, which will allow the doctor to get a complete picture of the patient’s medical history. The following data must be entered into the diary: volume of urine, muscle tension during urination, degree of leakage and intolerance of urge, volume of fluid drunk.

Causes of OAB in women

Overactive bladder is often more common in women than in men. This is due both to objective physiological reasons and to health problems, which are also typical for men. Some of the problems that cause hyperactivity are:

Weak pelvic muscles. A woman's pelvic floor muscles support her uterus and bladder. The stress of pregnancy and childbirth sometimes stretches them and makes them weak. In addition, the anatomy of the vagina changes (prolapse appears), a cystocele develops;
Diuretic drugs. They are also called diuretics and are often prescribed for high blood pressure. They help the body get rid of salt and water, so the bladder quickly fills and incontinence may even occur;
Aging and menopause. Your bladder changes after menopause. Doctors aren't sure whether this is due to a lack of estrogen, which has receptors in the bladder, or simply due to the natural aging process. Most likely, each of the factors plays a role;

Which doctor should I contact?

For treatment of a disease such as overactive bladder, it is necessary to contact a urologist who can conduct qualified diagnostics and establish a competent diagnosis, taking into account the causes and symptoms of the disease that the patient has. It is wrong to contact a gynecologist with this disease, since this specialist can only indirectly treat the pathology, but will not be able to prescribe competent treatment.

It is often necessary to initially visit a therapist, who will refer you to a specialist who treats a specific problem. Patients can undergo examination at the JSC Meditsina clinic in Moscow, where qualified specialists work to help cope with problems of varying severity. On the clinic’s website, visitors can get acquainted with the doctors who see them, their certificates and specialization.

OAB in men

Overactive bladder, according to various sources, occurs in 15-16 percent of men, and symptoms of the disease more often appear with age.

One of the most common causes of OAB symptoms in men is an enlarged prostate. The prostate may simply increase in size as you age, or it may be a sign of a serious disease, such as prostate cancer. If the prostate becomes large enough, it interferes with the flow of urine from the urethra. In addition, hyperactivity occurs due to a number of other factors:

Urinary tract infections;
Prostate and bladder stones;
Uncontrolled diabetes;
Poor nutrition and sedentary lifestyle;
Taking certain types of medications (caffeine, diuretics;)
Neurological conditions such as Parkinson's disease, etc.

Symptoms of OAB can affect every aspect of a person's life. People usually perceive this problem as personal, so they often do not seek medical help until the last minute. The doctors at our clinic understand the sensitivity of this problem and will provide the most comfortable treatment possible. Fortunately, there are several effective treatments available.

Treatment: modern techniques

Several treatment approaches have been developed. The chosen technique depends on how severe the symptoms are and the stage of the disease.

Treatment methods

There are several options to help you manage your bladder. These include:

Behavioral therapy: Often the first meaningful steps towards treatment. The patient can and should make some changes to his lifestyle and diet (avoiding caffeine, alcohol and spicy foods).

Quitting smoking and losing excess weight can also improve the patient's condition. Your healthcare provider may ask you to keep a daily voiding diary to track your trips to the toilet. Behavioral changes may include going to the bathroom on a schedule throughout the day and doing "quick motion" Kegel exercises to relax the bladder and pelvic floor muscles. Unfortunately, most patients will not be able to get rid of their symptoms completely with lifestyle changes. But many of them note a reduction in symptoms with this type of treatment.

Medication: There are several medications available to relax the bladder muscles. Patients are prescribed medications in tablet form. Some drugs are used in the form of skin gels or patches.

Neuromodulation therapy: Professionals use this harmless treatment method only for a subset of patients in whom drug and behavioral therapies do not work or when patients have serious side effects from medications.

Botox injections: Some experts believe that botulinum toxin injections, better known as Botox®, can help patients who do not respond to other treatments.

Conservative treatment

Treatment of an overactive bladder is carried out by prescribing medications that help relax the muscles in the bladder. These medications are prescribed by the doctor after diagnosis on an individual basis, depending on the reasons that caused the unhealthy condition and the symptoms that the patient complains about. The following techniques are used:

For women during menopause, when observing atrophy of the vaginal mucosa and incontinence, the most effective treatment method is considered to be local use of vaginal estrogens in the form of cream or vaginal suppositories. If the technique is ineffective, it can be treated with injections of botulinum toxin type A directly into the overactive bladder;
stimulation with electrodes of nerve endings that are responsible for relaxation of the organ. Electrical stimulation is performed through skin electrodes or by inserting a needle into a nerve in the ankle. This procedure does not cause discomfort, but makes it possible to significantly reduce the symptoms of an overactive bladder;
surgical intervention - augmentation cystoplasty is used only in extreme cases, when an overactive bladder bothers the patient excessively, urinary incontinence is constantly observed, which interferes with the patient’s normal life.

Diagnosis and treatment

The first step in any treatment method is diagnosis by a qualified physician. He will conduct a short survey about the person's urinary tract and any medical interventions or procedures he has had. A physical examination will then be performed. Typically, these examinations include:

General urological (examination, tests, ultrasound);
Special methods (X-ray, urethrocystoscopy, urodynamic diagnostics);

The doctor will also likely take a urine sample for testing. In addition, a cough test will likely be performed. All of these methods are designed to determine the exact cause of the disease and prescribe the correct treatment for overactive bladder.

However, before diagnosing OAB, the doctor must exclude the possibility of other diseases accompanied by similar symptoms. The list of such pathologies includes bladder neoplasms, infection of the urinary system, urolithiasis, diabetes, interstitial cystitis and impaired functionality of the pelvic muscles. The mandatory stages of the examination include:

Conducting a general analysis of urine, including sediment microscopy.
Measuring the volume of residual urine, especially in the presence of neurological pathologies or in cases where the patient has undergone surgery to eliminate incontinence.
For three days, you are required to keep a diary of urination, which takes into account the volume of fluid drunk and excreted, and the number of visits to the toilet.
If there are traces of blood in the urine, suspicion of neoplasms in the bladder, or the presence of foreign bodies, cystoscopy is recommended.
In case of neurogenic urinary disorders, a complex of urodynamic studies is necessary, since they make it possible to assess both the functionality of the lower tracts of the system and the risk of negative effects on the kidneys with the selection of the most effective therapy.
If OAB is diagnosed in a female patient, a consultation with a gynecologist and examination on a chair is required, which makes it possible to identify prolapse of the pelvic organs and atrophic changes.

As for the treatment of overactive bladder, it consists of successive stages from simple to more complex. But drug therapy remains the main way to eliminate OAB, regardless of the form of the pathology. Drugs for overactive bladder prescribed by specialists include M-anticholinergics, tricyclic antidepressants and myotropic antispasmodics. Typically, medication courses are carried out in parallel with behavioral therapy and neuromodulation. With tibial neurostimulation, the tibial nerve is treated using a thin needle electrode, the procedure is carried out in an outpatient clinic once a week, the course lasts three months. Then a maintenance course is required at intervals of 30 days throughout the year.

If there is no positive result from drug therapy, they proceed to tests using cold water and Lidocaine, which makes it possible to identify the form of OAB. Then they determine how to treat overactive bladder in women and men. The effectiveness of the use of botulinum toxin has also been proven, which serves as a blocker of acetylcholine release and promotes relaxation of smooth muscles located in the walls of the organ. As a result, urgency incontinence disappears, the frequency of urination and the urge to urinate decrease. The duration of the positive effect of such injections, in which the drug is injected into certain areas of the bladder, lasts from 6 to 9 months, then it may be necessary to repeat the course of treatment for overactive bladder in men and women. How to treat overactive bladder with surgery? Surgical intervention becomes necessary extremely rarely, and the bladder is replaced with a piece of the large or small intestine. It is also possible to perform a myectomy, when the volume of the bladder is increased.

Our clinic provides diagnostics by qualified doctors at an affordable cost, as well as the prescription of effective treatment for men and women, which will help to forget about the unpleasant problem forever.

Code	Name	Price
03.00	Initial appointment with a urologist (candidate of medical sciences)	2,000 rub.
03.04	Repeated appointment with a urologist (candidate of medical sciences)	1,200 rub.
03.60	Initial appointment with a urologist (MD)	5,000 rub.
03.61	Repeated appointment with a urologist (MD)	3,000 rub.
All prices of the men's and women's health clinic

Indications for the disease

To prevent and effectively treat overactive bladder, you must follow certain recommendations:

give up strong coffee and tea, carbonated water, since these drinks irritate the organs of the genitourinary system;
If you have frequent urges at night, it is recommended to stop drinking liquids 3 hours before bedtime. However, the daily fluid intake must be met;
if the patient has an overactive bladder, it is necessary to completely empty the organ when urinating to the maximum, which will reduce the urge to further frequent visits to the toilet;
for incontinence, it is recommended to use pads or diapers for adults, which will allow you to maintain personal hygiene and save people from inhaling an unpleasant odor;
Doing Kegel exercises will help relax your pelvic floor muscles and make your overactive bladder less of a problem. It is necessary to perform gymnastics several times a day to achieve significant effectiveness of treatment.

An important aspect that allows you to effectively treat an overactive bladder is maintaining normal body weight and following a diet, adhering to the principles of a healthy diet. As practice shows, with a weight loss of 5-10%, the manifestations of diseases of the genitourinary system are significantly reduced, since significantly less pressure is placed on the bladder.

Treatment of overactive bladder and urge urinary incontinence in women

Overactive bladder (OAB), the manifestations of which are symptoms of frequent urination, urgency and urge urinary incontinence, is a frequent reason for visiting gynecologists and urologists. The condition requires long-term treatment, the first line of which experts unanimously consider behavioral therapy [1].

The use of behavioral therapy for OAB is based on the assumption that this condition is caused by the loss of childhood cortical control over the micturition reflex or the presence of a pathologically formed reflex. It is known that more than half of patients with OAB have severe mental and social problems, and in 20% of them, hyperactivity is associated specifically with abnormal urination patterns. To restore this control, establish a certain rhythm of urination and gradually increase the intervals between them. Before starting treatment, the patient is explained that normal diuresis is 1500–2500 ml/day, the average volume of urination is 250 ml, the functional capacity of the bladder is 400–600 ml, and the permissible number of urinations is an average of 7–8 times a day. If this volume exceeds the norm, it is necessary to teach the patient to avoid drinking liquid unless necessary: drink only during meals, give up coffee and tea, especially in the evening, limit the consumption of spicy foods and salt, which cause thirst. The exception is patients taking diuretics. It is also important to justify the need to give up “bad” habits: urinate “just in case,” before eating or leaving the house. The goal of bladder training is to gradually lengthen the intervals between urinations (at the beginning of treatment, the intervals between urinations should be short, for example 1 hour, gradually increasing them to 2.5–3 hours) and increasing the functional capacity of the bladder. Thus, the patient “trains” her bladder to empty itself only voluntarily. At night, the patient is allowed to urinate only when she wakes up due to the urge to urinate.

The main tool for this method of treatment is a urination diary, which should record not only the volume of urine excreted and the time of urination, but also episodes of urinary incontinence (UI) and changes in pads. The diary must be studied and discussed with the doctor during scheduled regular examinations.

Behavioral therapy is particularly effective for idiopathic detrusor overactivity. The prognosis, of course, is determined by how accurately the patient follows the doctor’s recommendations. High effectiveness of treatment of OAB is observed with a combination of bladder training and drug therapy.

Exercises to strengthen the pelvic floor muscles are of great importance not only in case of stressful urinary incontinence, when they can be used to increase urethral pressure. The clinical use of exercises for OAB is based on the effect of reflex inhibition of detrusor contractions during voluntary and sufficiently strong contractions of the pelvic floor muscles [2].

The Kegel exercise system involves alternately contracting and relaxing the levator ani muscles. Exercises are performed 3 times a day. The duration of contractions is gradually increased: from 1–2 s, 5 s, 10–15 s and from 30 s to 2 min. Sometimes a perineometer is used to monitor the correct execution of exercises. It consists of a canister connected to a pressure gauge. The patient inserts a balloon into the vagina and determines the strength of muscle contractions during exercise using a pressure gauge. “Functional” exercises further imply their implementation not only in a position of relaxation, but also in situations that provoke UI: when sneezing, standing up, jumping, running. Despite their simplicity and widespread popularity, Kegel exercises are rarely used today. Sometimes the doctor advises the patient to interrupt and resume urination several times a day. However, such exercises not only eliminate urinary incontinence, but also lead to urination problems.

The main condition for the effectiveness of therapy is regular exercise and medical supervision with constant monitoring and discussion of the results.

Figure 1. Vaginal cones

For patients who cannot identify the necessary muscle groups, as a result of which they are unable to perform exercises correctly, it is recommended to use special devices: vaginal cones, balloons, etc. (Fig. 1). The cones have the same size and different weights (from 20 to 100 g). The patient inserts the smallest cone into the vagina and holds it for 15 minutes. Then heavier cones are used [3].

According to various researchers, the number of patients who are unable to reduce m. pubococcygeus, reaches 40% [4]. This was one of the reasons for the widespread use of the biofeedback (BFB) method, the purpose of which is to teach the skills of contracting specific muscle groups and provide feedback to the patient. The effectiveness of the technique is due to the active role of patients in the treatment process through the involvement of visual (pictures, films, animation) or auditory (voice support) analyzers. Feedback can be carried out mono- and multi-channel by recording the activity of the pelvic floor, abdominal and detrusor pressure.

Figure 2. Video-computer complex

We have accumulated experience in conducting pelvic floor muscle training (PFMT) in biofeedback mode on the video-computer complex “UROPROCTOKOR” (Fig. 2), which is a stationary device equipped with peripheral equipment necessary for the treatment of disorders of the pelvic floor functions, and with the capabilities of motivational reinforcement .

The technology for using the device consists of inserting a special sensor into the vagina that measures the electromyogram (EMG) of the surrounding muscles, which is made of gold-plated porcelain. It can be used repeatedly after pre-sterilization. The EMG signal is analyzed by a computer, which produces graphs on the monitor screen, informing the patient about how the perineal muscles work. The patient periodically tenses and relaxes the pelvic floor muscles (“retraction” of the anus) according to the commands of the device. In this case, the size of the curves on the monitor increases and reaches an individually set threshold. For maximum effectiveness of the procedure, the technology of motivational reinforcement is used: each correctly performed exercise is accompanied by the showing of a film, slides, etc. If the task is performed poorly, all rewarding factors are minimized, which stimulates the patient to more active muscle work. The course of treatment consists of 15–20 half-hour sessions.

After carrying out TMTD in the biofeedback mode, we noted: a decrease in the number of micturitions from 14 to 8 times a day, episodes of urinary incontinence - from 4 to 1 time a day; the abdominal pressure threshold increased from 38 to 59 cm; H2O, the average volume of urine loss decreased from 52 to 8 ml. When analyzing myography data, the following results were obtained: the percentage of correct work of the pelvic floor muscles at the first session was 60.1% + 10.2%, at the 8th session - 73% + 8.7%, and by the 15th session this figure equaled 82.8% + 7.3% (p < 0.05). When analyzing the obtained clinical data, the effect of biofeedback therapy on both the symptoms of overactive bladder and the condition of the pelvic floor became obvious.

The promise of biofeedback therapy lies not only in its high efficiency and absence of side effects, but also in the possibility of conducting therapy at home using individual portable devices. Biofeedback remains the method of choice for patients with severe concomitant somatic diseases when other types of treatment, including medications, cannot be used [5].

Electrical stimulation (ES) is also an effective treatment for OAB. It is used to reduce the sensitivity of the bladder and increase its functional capacity, which is achieved by direct or indirect irritation of nerve fibers with a weak electric current [6]. The electrode is inserted either into the vagina or rectum; external patch electrodes can be used. Electrical impulses are supplied continuously or periodically. Points of application are: urethral and anal sphincters, pelvic floor muscles, sacral roots of the spinal cord. Recently, a popular method is tibial ES. Stimulation of the afferent fibers of the somatic peripheral nervous system, which are part of the nerve trunks, causes inhibition of the parasympathetic activity of the pelvic nerve and an increase in the sympathetic activity of the epigastric nerve, resulting in a decrease in the contractile activity of the detrusor.

In case of severe neurogenic overactivity of the detrusor, ES is performed by surgical implantation of a system for ES of the anterior sacral root S3. Side effects may include discomfort during the procedure, pain and discomfort [7].

Drug therapy, like behavioral therapy, is one of the most common methods of treating OAB. This therapy is aimed at eliminating disturbing symptoms and improving urodynamic parameters, i.e. reducing detrusor activity and increasing the functional capacity of the bladder. The central targets of therapy are the areas of voiding control in the spinal cord and brain, and the peripheral targets are the bladder, urethra, peripheral nerves and ganglia. The following drugs can affect these “targets”:

drugs that affect ion channels of cell membranes;
antimuscarinic/anticholinergic drugs, including dual myotropic antispasmodic action;
antiadrenergic;
tricyclic antidepressants;
prostaglandin synthesis inhibitors;
vasopressin analogues;
afferent inhibitors.

One of the modern classifications of drugs that reduce the symptoms of OAB suggests dividing such drugs into four types [8]:

Type 1 - drugs that reduce efferent stimulation of the detrusor (M-anticholinergics, α1-blockers);

Type 2 - drugs that increase inhibitory control, polysynaptic inhibitors (antidepressants);

Type 3 - drugs that reduce bladder sensitivity (toxins);

Type 4 - drugs that reduce urine formation (for example, vasopressin analogues).

M-anticholinergic drugs (oxybutynin, tolterodine, trospium) are recognized as one of the most effective drugs used to treat OAB. Extensive experience in their use has been accumulated, and safety and effectiveness have been assessed in many comparative, placebo-controlled, multicenter studies. Selective M-anticholinergic blockers are used. The drug atropine, which is not selective, is currently rarely used due to its pronounced systemic effect (only administration by electrophoresis).

The recommendations of the European Association of Urology on OAB and urge urinary incontinence suggest M-anticholinergics as the first line of therapy, and in terms of evidence, drugs in this group are classified as category “A” (high degree of evidence). In Russia, drugs from the group of M-anticholinergics, approved for use and widely prescribed, are oxybutynin, tolterodine, trospium (non-retarded forms). Aspects of the safety and effectiveness of these drugs in various groups of patients were studied.

The main trend characterizing the modern approach to the use of oxybutynin (driptan, oxybutin) is a change in dosage and dosage regimen in order to reduce the number of side effects. The drug is successfully used at a dose of 3 mg/day; a regimen of oxybutynin is proposed at a dose of 5 mg/day, if well tolerated, followed by an increase of 2.5 mg every 2 weeks until a clinical effect is achieved. In order to achieve maximum effectiveness and improve tolerability, intravesical or transdermal use of oxybutynin is recommended. Clinical studies are being conducted on the effectiveness and safety of sustained-release oxybutynin, which, while equally effective, demonstrates a more favorable safety profile.

Recent clinical studies on the drug tolterodine (detrusitol) have confirmed its high clinical effectiveness for OAB symptoms. The drug is used in a standard dosage of 2 mg 2 times a day. The practice of using delayed-release tolterodine can also be considered promising, which also has higher effectiveness in relation to increased frequency of urination and urge urinary incontinence compared to standard non-retarded forms of the drug.

Trospium (spazmex) also deserves special attention, which, being a quaternary ammonium compound, with good clinical efficacy, has no side effects from the central nervous system. Thus, in a study on volunteers, side effects different from the placebo group appeared only at dosages exceeding 180 mg, which is at least 4 times higher than the standard dosage (HP Breuel, S. Bondy). Our comparative study of two dosages of trospium chloride (spazmex, PRO. MED. CS, Praha) - 15 mg/day and 45 mg/day showed that, against the background of the predominant effectiveness of the dose of 45 mg/day, the frequency of side effects was comparable, and side effects there were no central nervous system effects.

In addition to the well-known M-anticholinergics, modern selective drugs are appearing on the European market, which have recently undergone large-scale placebo-controlled studies. Among them is solifenacin, which effectively reduces the number of episodes of urge incontinence and the frequency of urination. The drug has been proven to be highly effective and safe (dosage: 5, 10, 20 mg once a day). There was a minimal percentage of dropouts from the study due to side effects. Studies have also shown good pharmacokinetic and pharmacodynamic parameters of this drug against the background of a high safety profile when used once a day. The pharmacokinetics of solifenacin does not change with food.

For OAB, drugs that act on sympathetic receptors can also be successfully used. It is known that α1-blockers: tamsulosin (omnic), terazosin (cornam, setegis, hytrin), doxazosin (zoxon, kamiren, cardura), alfuzosin (dalfaz) - reduce symptoms of urinary disorders associated with the presence of prostatic hyperplasia in men, have an effect on detrusor hyperactivity that occurs against the background of bladder outlet obstruction. In an open prospective study (S. Serels, 1998), a comparative analysis of the effectiveness of an α1-blocker and an anticholinergic drug in women was carried out. The use of an α1-blocker for symptoms of urgency has been shown to be highly effective. Drugs in this group can be used to treat symptoms of OAB in both men and women, especially in cases of symptoms of OAB against the background of urodynamically confirmed functional bladder outlet obstruction (IVO). The data obtained (A.V. Sivkov, 2001; D.Yu. Pushkar, 2002) indicate the reliable effectiveness of α1-blockers for symptoms of OAB in women against the background of functional IVO. Thus, in the observation group, the frequency of urination per day decreased by 25–30%, and nocturnal pollakiuria by 50%. The prescription of α1-blockers is based on vasoactivity. In young patients, the drug of choice is tamsulosin (0.4 mg/day). When prescribing vasoactive α1-blockers, dose titration is necessary.

Tricyclic antidepressants (imipramine, amitriptyline) have central and peripheral anticholinergic and α-adrenergic effects, as well as an inhibitory effect on the central nervous system. They are effective when administered orally (150 mg/day) in elderly patients with symptoms of OAB. The group of antidepressants also includes duloxetine, a combined serotonin and norepinephrine reuptake inhibitor. It affects the urinary control centers in the lumbosacral spinal cord (Onuf's nucleus). These nuclei integrate the activities of the sphincter and bladder. When norepinephrine is inhibited, sphincter tone increases, and when serotonin is blocked, bladder activity decreases. The possibility of using the drug for stress urinary incontinence is currently being considered. A conclusion about the advisability of its use in overactive bladder can only be made after the completion of large-scale clinical studies.

In recent years, there has been interest in the use of toxins in OAB. Botulinum toxin (trade names botox, dysport), used in aesthetic medicine, can normalize muscle tone by inhibiting the release of acetylcholine from the nerve ending. Indications for its use are sphincter dysfunction and neurogenic detrusor hyperactivity. The toxin is prescribed in the form of intravesical injections (an average of 30 points) under cystoscopic control. Contraindications include urinary tract infection and hypersensitivity to the drug, although only 2% of patients develop antibodies to botulinum toxin.

Analogues of vasopressin (type 4 drugs), such as desmopressin (minirin, emosint), have a very limited scope of application. The main indication for their use remains a shift in diuresis towards the night hours (nocturia) and associated urinary disorders. Currently, a study is being conducted on the use of vasopressin analogues for the correction of urge urinary incontinence.

Hormone replacement therapy occupies a certain place in the treatment of older women with OAB. Estrogen deficiency leads to a number of changes in a woman’s genitourinary system in the form of vaginal atrophy, decreased sphincter tone and increased sensitivity of the bladder [9]. However, many of the positive effects of estrogen therapy, with the exception of the effect on signs of osteoporosis, have not yet been sufficiently substantiated, and opinions on this matter should be considered contradictory [10]. The effectiveness of estrogen therapy in the treatment of OAB can be considered controversial. Researchers defend the feasibility of conducting research in accordance with the principles of evidence-based medicine and quality clinical practice.

When choosing a method of drug treatment for OAB, it is necessary to take into account the presence of concomitant diseases, the results of previous treatment, and the patient’s ability and ability to follow the doctor’s prescriptions. This will help to select the correct drug and ensure high effectiveness of treatment.

After selecting adequate and effective therapy for OAB, follow-up clinical observation and control examinations are required at intervals of 3–6 months.

V. V. Romikh I. A. Apolikhina, Candidate of Medical Sciences V. M. Andikyan NTsAGiP RAMS, MMA named after I. M. Sechenov, Research Institute of Urology, Moscow

Literature

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Contraindications for illness

When treating the syndrome it is necessary:

stop eating citrus fruits, pineapples, chocolate, sweets, spicy and sour foods, dairy products, since these products cause irritation to the mucous membrane of the genitourinary system;
avoid excessive consumption of water and any liquid in general; excessive reduction of the daily water intake is also contraindicated;
Minimize the consumption of alcohol and energy drinks.

By following these recommendations, you can cope with hyperactivity syndrome, reduce pain to a minimum and increase the effectiveness of drug treatment.

Advantages of treatment at the clinic of JSC "Medicine"

Treatment in the hospital of the clinic of JSC "Medicine" takes place in comfortable conditions - patients are provided with rooms with all amenities.

The competitive advantage that the clinic has is cooperation with insurance companies. The modern clinic provides medical services at the highest professional level, providing effective treatment for patients even with complex forms of the disease.

Treatment and diagnostics are carried out by qualified specialists of our clinic using modern equipment, using effective medications, in order to completely relieve patients from pain and discomfort.