Overactive bladder

What is an overactive bladder?

An overactive bladder (also known as irritable bladder) is a condition that causes a sudden, strong urge to urinate, although the bladder is only slightly full. Medically speaking, an overactive bladder is a bladder storage disorder.

What are the causes of an overactive bladder?

• spine
• psychosomatic
• menopause

Overactive bladder can be caused by many different factors, and it is not always easy to find a single definitive cause.

One of the main causes is nerve disorders. Neurological diseases such as Parkinson's, multiple sclerosis or even a stroke impair the function of the nerves that regulate both the sensation of the urge to urinate and urination itself. Diabetes mellitus or excessive alcohol consumption also damage the neurogenic function and can thus contribute to the development of an overactive bladder. In certain cases, tumors of the brain or spinal cord can damage the areas responsible for sensing bladder fullness and urination (micturition).

In addition, spinal conditions like herniated discs can affect the pathways that transmit signals from the bladder to the spinal cord and back.

Another significant cause are the anatomical and hormonal changes that occur as part of the menopause in women. A lack of estrogen and a prolapse of the uterus or vagina due to pelvic floor weakness can contribute to the development of an overactive bladder. Multiple births, abdominal surgery, obesity and prolonged physical exertion also contribute to the condition.

Additionally, bladder infections play a role, as they can increase the nerve sensitivity of the bladder wall, causing even a small amount of urine to trigger the urge to urinate. Bladder stones, tumors, or prostate enlargement in men can also contribute to the development of an overactive bladder.

Psychological factors also play an important role: emotional stress, anxiety, and nervousness often promote the occurrence of symptoms. Certain medications can also have side effects that affect urination behavior.

What are typical symptoms of an overactive bladder? 

In medicine, there is a classic symptom triad of the overactive bladder: patients suffer from pollakisuria, nocturia, and imperative urinary urgency with or without urge incontinence. Typical complaints include a frequent urge to urinate, with only small amounts of urine being expelled (pollakisuria). Additionally, patients need to go to the bathroom more frequently at night (nocturia) and experience an acute, uncontrollable urge to urinate, even when the bladder is only slightly full (imperative urge). In some cases, there may also be urinary incontinence, meaning involuntary loss of urine, but this is not necessarily the case for every overactive bladder.

The first step in diagnosing an overactive bladder is generally a detailed consultation with the patient. All the symptoms and illnesses are discussed. The patient is often advised to keep a diary of their symptoms, drinking habits and urination.

Typically, the urine is examined for pathogens, elevated inflammatory levels and other abnormalities.

Inspection and palpation of the internal and external genital organs as well as the rectum is also part of the diagnosis, because changes in these organs can impair the urinary tract and its function.

An ultrasound scan can be used to visualize the kidneys and bladder. Kidney stones, tumors, changes in the position of the organs, prostate changes and the filling status of the bladder or congestion in the kidneys can be assessed. The measurement of residual urine after passing urine is an important diagnostic step.

Urologists can carry out a urodynamic examination, which uses special pressure sensors and electrodes to determine the function of the urinary tract. This allows the storage capacity and emptying function of the bladder to be examined before, during and after urination.

In cases of abnormalities or specific questions, additional diagnostic procedures such as a urethrogram (x-ray examination) or a cystoscopy (bladder scope) may be considered.

A preliminary neurological examination can provide clues to a cause in the brain, spinal cord, or certain nerve pathways.

An overactive bladder is often a diagnosis of exclusion when no other organic cause for the reported symptoms can be found.

How is an overactive bladder treated?

• what helps immediately with an overactive bladder?
• surgical interventions: bladder augmentation, cystectomy

There are several different approaches to treating an overactive bladder. These range from lifestyle changes to surgical interventions.

It is generally recommended to lose weight if overweight, to drink enough fluids, and to train the pelvic floor and bladder. Through some simple exercises and measures, the patient aims to develop a sense of healthy urination and better control over their actual urge to urinate.

The pelvic floor muscles can also be specifically strengthened and better controlled through electrostimulation and biofeedback therapy.

Psychological counseling or certain psychosomatic therapies can also have a positive effect on the symptoms if there are underlying causes.

Certain medications can also be used in some cases to treat an overactive bladder. Examples include the group of anticholinergics, which reduce the activity of the bladder muscle (detrusor muscle). However, the possible side effects of these medications should not be ignored, and their use should therefore be monitored constantly by a doctor.

Treatment with Botox is also possible if medications and conservative approaches are unsuccessful. Botulinum toxin can be injected directly into the bladder muscles to reduce their contraction function.

For women, local estrogen products can be used to correct hormonal imbalances after menopause.

In the case of a urinary tract infection, the infection should always be treated, using antibiotics for example. Certain measures to prevent such infections, such as avoiding hypothermia and moisture, should be followed. Nowadays, the implantation of a bladder pacemaker is also possible, which stimulates the sacral nerves that control the bladder.

A bladder augmentation can be used to surgically treat an overactive bladder. In this procedure, the bladder is enlarged using bowel segments. The bladder can also be completely removed (cystectomy), and a new bladder can be constructed using bowel tissue if the conditions are right. A supravesical urinary diversion is another option. This involves passing urine through a small opening in the abdominal wall. The patient can empty the urine themselves by catheterizing the surgically created reservoir or by emptying an attached urine collecting bag, similar to an artificial bowel outlet.

Surgery as a treatment for overactive bladder syndrome should always be carefully considered and should only be used as a last option if all other treatment measures have not been successful.

Can an overactive bladder be cured?

The prognosis for an overactive bladder varies greatly. In some cases, the symptoms can be quickly and easily alleviated with basic measures. However, there are also cases that do not respond well to treatment and whose symptoms do not disappear completely. Comprehensive medical care is important in the context of an overactive bladder to control physical causes, enable adequate therapy, and prevent chronicity. A visit to the doctor early in the course of the illness significantly improves the chances of recovery.

Additionally, the outlook for recovery also depends on the cause of the overactive bladder. If the symptoms were triggered by a bladder infection that can be effectively treated with antibiotics, the patient's prognosis is significantly better than, for example, in the case of an underlying chronically progressive neurological disease.

Which doctors and clinics specialize in overactive bladder?

Generally, an overactive bladder is diagnosed and treated by a urologist, i.e. a specialist in diseases of the urinary organs. Depending on the severity and planned treatment steps, this can be done in a urology practice or a urology hospital department with surgery. Collaboration with psychiatrists and psychosomatic physicians, physiotherapists and gynecologists can be beneficial.

Anyone in need of a doctor would expect the best possible medical care for themselves. Therefore, patients are looking for the most suitable clinic for their needs. Since this is not an objective decision and a respectable doctor would refrain from claiming to be the best, patients must trust the experience of a doctor.

We can help you find an appropriate expert for your condition. All the doctors and clinics listed have undergone extensive review and have been verified by us for their outstanding expertise in the field of overactive bladder. They are looking forward to and are ready to address your questions and treatment requests.