A notable proportion of the population is affected by overactive bladder disorders. What are the symptoms ? Are there specific risk factors? What are the possible treatments ? Explanations from Professor Véronique Phé, Professor of urology at Tenon hospital (Paris).
Overactive bladder is a common problem in the population. It results in an urgent need to go to the toilet. Suitable treatments and solutions exist.
What is overactive bladder syndrome (OAB)?
An overactive bladder is characterized by a specific symptom, urgency, that is to say a sudden and urgent desire to urinate. “This symptom is distinct from incontinence or urinary leakage. It really is a sudden and irrepressible desire to urinate. underlines Professor Véronique Phé, Professor of urology at Tenon hospital (Paris).
If urgency alone characterizes overactive bladder, other symptoms can sometimes be associated. “This is particularly the case for frequent urges to urinate (pollakiuria), whether daytime or nocturnal, as well as urinary leakage. continues the specialist.
Overactive bladder syndrome affects approximately 15% of the general population. Prevalence increases as the population ages. “It is a common disease having an impact on the quality of life, whether on a physical, psychological or social level, which is more marked than diabetes.adds Professor Véronique Phé.
Different possible causes of overactive bladder
In the vast majority of cases, no cause is identified. The natural aging of the bladder plays a major role. However, certain neurological diseases, such as Parkinson’s disease or multiple sclerosis, can cause an overactive bladder. “An overactive bladder can be symptomatic of a more serious illness, such as bladder cancer or reveal the presence of bladder stones or a urinary infection for example. This is why it is very important to consult a doctor at the first symptoms.”alerts the specialist.
In women, the period of menopause can also lead to overactive bladder. Indeed, genitourinary syndrome of menopause (GUMS) caused by the drop in estrogens and characterized by atrophy and dryness of the mucous membranes 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 drinks also play a role.
Diagnosis of an overactive bladder
First of all, you should consult a specialist doctor. The urologist suggests that the patient complete a voiding calendar for three days. “Each time you go to the toilet, the time and the volume urinated must be notified. This information will make it possible to more precisely assess the functioning of the bladder. points out the urologist.
It is also important to have a flow rate measurement and a measurement of post-void residual. At the urologist, the patient urinates into a small device which will record the urinary stream.”An ultrasound is then performed to check bladder emptying. Urine residue can cause overactivity of the bladder.specifies Professor Véronique Phé.
The doctor must also take into consideration the patient’s specific risk factors: smoking, age, menopause in women, exposure to paints, hydrocarbons or other toxic products during professional life, etc.
Depending on the patient and their risk factors, a fibroscopy of the bladder may also be offered. This painless test involves inserting a small camera inside the bladder. Very quick, the examination can be performed without having to resort to general anesthesia. “This fibroscopy makes it possible to detect a bladder tumor, bladder stones or other diseases. explains Professor Véronique Phé.
Finally, it is possible to complete this examination with an ultrasound of the urinary tract (kidney and bladder).
Different types of treatments adapted to each patient
Suffering from an overactive bladder is not inevitable. Many effective treatments exist and must be adapted to the profile of each patient.
Hygiene rules
First of all, certain health and diet rules must be put in place. After 6 p.m., it is advisable to reduce the consumption of liquids and avoid consuming soups or salad at dinner because these foods are full of water and can increase the frequency and volume of nocturnal urination. “However, it is a question of finding an acceptable compromise between this medical problem and daily pleasures. explains the urologist.
Perineal rehabilitation
Perineal and bladder rehabilitation exercises can also be considered. “Rehabilitation allows you to learn, with the support of a practitioner, to postpone urgent needs to urinate and to schedule urination”, specifies the specialist. For postmenopausal women, prescribing a topical hormonal cream is generally effective.
Medications and botulinum toxin
Certain medications, most often in the anti-cholinergic class, aim to reduce the urgent need to urinate, space out urination and reduce urinary leakage. These medications are moderately effective, around 30%, and can be poorly tolerated due to their side effects: constipation, digestive disorders, dryness of the mucous membranes (mouth, eyes, etc.). “These medications are not recommended in the elderly or in patients who are already taking medications from the same anti-cholinergic family.”specifies the specialist.
Other drugs from another class of drugs, beta 3 agonists, will act by relaxing the bladder muscle. They have the advantage of having fewer side effects. However, they are not reimbursed by Social Security.
Furthermore, botulinum toxin injections (just like Botox used in aesthetic medicine against wrinkles) under local anesthesia can also be performed…”We will introduce a small camera then inject botulinum toxin to act 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 have 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 perform self-probing so that they can resolve their retention problem independently. If the patient does not accept this risk, it is then preferable to offer him another treatment. summarizes Professor Véronique Phé.
Stimulation du nerf tibial
Another possible treatment: the so-called “electrical” treatment, which involves stimulation of the tibial nerve. This treatment consists of placing two small electrodes at the ankle, where the tibial nerve passes. Every day, the patient must practice 20 minutes of stimulation at home with a small box. “It is a simple, effective treatment and completely free of side effects. For the elderly, it is a good alternative to medication.”, adds Professor Véronique Phé. The only constraint: the treatment must be carried out every day, especially during the first three months of treatment. If you forget, even for a single day, the therapeutic effects are called into question.
In the event of therapeutic failure or refusal of treatment, other more invasive therapeutic solutions can then be offered.
Surgery: sacral neuromodulation
Finally, sacral neuromodulation can also be considered. “It’s a bit like a “pacemaker for the bladder”, summarizes the urologist. This procedure is generally carried out in two stages, under local or general anesthesia. The first surgery consists of introducing a small electrode by puncture into contact with the sacral nerve of the bladder (S3). Connected to a portable stimulator, this electrode will modulate the sensation of the need to urinate by sending impulses to the sacral nerve. After a fortnight, the practitioner evaluates the therapeutic effectiveness of the device with the patient. “If the results are satisfactory, we will proceed with the definitive implantation of the device, under local anesthesia”explains the specialist.
There are different types of devices depending on the patient’s lifestyle. 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 adapt as best as possible to the needs and profile of the patient”, summarizes the urologist.
Some prevention measures
To prevent overactive bladder, fluid intake should be limited to less than two liters per day. In obese or overweight patients, lifestyle and dietary measures aimed at losing weight are recommended. Finally, stopping smoking (a proven risk factor for bladder cancer), tea and coffee, drinks which stimulate the bladder, is also strongly recommended.