Irritable bladder

Bladder function

The bladder stores urine produced by the kidneys. Under normal circumstances, the bladder sends signals several times a day that it is almost full and needs to be emptied soon. The capacity of the male bladder is 400 to 600ml, compared to 400 to 500ml for women. A healthy person empties his or her bladder every few hours, generally between four and six times a day.

Development of irritable bladder symptoms

Studies show that from the age of 50 one in eight men and one in seven women suffer from irritable bladder symptoms. The signs of an irritable bladder are frequent, pronounced urge to urinate, frequent urination during the day and waking up several times at night because of an urge to urinate. The urge to urinate is so strong that the individual is compelled to empty his or her bladder quickly. Women and men who are affected also complain that once they feel the urge they only have a short time before they have to empty their bladder. If this short warning time is not sufficient to allow them to reach a toilet, urge incontinence may occur.

Frequent urination develops gradually. If the gap between two episodes of bladder voiding is much less than two hours, frequent urination starts to have a negative effect on professional and private life. The person affected starts to adapt to the situation, initially largely unconsciously: the amount of liquid consumed is restricted, and the person starts to look around where he or she is to see whether a toilet is present and can be reached easily. Once bladder voiding takes place every hour, frequent trips to the toilet become a real problem for many people that can no longer be easily integrated into the normal daily routine. At this point frequent urination becomes the symptom of a possible bladder disorder. Individuals affected react very differently to this problem: some seek medical advice straightaway and try to have the problem cleared up, but the vast majority try to cope for years.

Causes of irritable bladder

Irritable bladder can develop without any identifiable cause, or can be the symptom of another disease, such as many neurological diseases, diabetes, benign prostate enlargement, bladder and uterus prolapse in women or as the result of cystitis.

Investigation of irritable bladder symptoms

The first step in the investigation is to rule out cystitis as a cause. The purpose of further tests is to distinguish between the two main forms of irritable bladder:

• Firstly the motor form, based on spasms of the bladder wall muscles, and
• Secondly the sensory form, caused by a hypersensitive bladder mucous membrane.

Treatment options in cases of irritable bladder

It is important to distinguish between the two forms as the approaches to treatment may also be different. The treatment options considered in the first instance are changes to lifestyle and diet, the use of medication to control irritable bladder, or pelvic floor therapy. If these simple measures do not lead to significant relief of the symptoms, instillation of medication into the bladder, the injection of botulin toxin below the bladder wall or sacral neuromodulation can be considered.