Overactive bladder: a real handicap to be treated

A very disabling condition in everyday life, overactive bladder manifests as urgent urges to urinate, or even urinary incontinence. It affects approximately 15% of the population but remains, for many, taboo. "It is nevertheless important to consult a doctor," insists Dr. Olivier Alenda, urologist at the Fleurs Clinic in Ollioules (Var). "On the one hand, to rule out any pathology that might be the cause, and on the other hand, because there are solutions—sometimes very simple!—to overcome it."

A real handicap

Equally common in men and women, overactive bladder manifests as pollakiuria (frequent urination, at least eight times a day), urgency (urgent or urgent need), and nocturia (at least one awakening per night to go to the bathroom). "It's not a disorder reserved for elderly patients; it also affects young people," the specialist comments. "And it has a real impact on social life."

The urination calendar

To assess the degree of overactive bladder, it is sometimes necessary to carry out a voiding diary to assess the frequency of urination, the quantities urinated, but also the quantities and types of liquids absorbed.

"Sometimes it's a question of lifestyle. By changing certain behavioral parameters – dietary for example – and working on reassuring the patient, everything returns to normal!" reassures the urologist,

But first, it is necessary to be certain of the diagnosis and eliminate any pathological cause.

Diagnosis: Eliminate other causes

Prostatic obstructive syndrome in men, prolapse in women, cystitis (acute, interstitial or chronic inflammatory), a neurological disorder or disease or even a bladder tumor can cause this symptom.

Once these potential causes are eliminated, idiopathic overactivity – without an identified cause – can be diagnosed. This is also referred to as detrusor bladder overactivity: "It is in fact the detrusor, the muscle that controls the bladder, that is irritated for various reasons and contracts too strongly and too often, causing the urge to urinate even if the bladder is not very full. This tends to happen in stressed and anxious people," notes the doctor.

Progressive treatments

In the specific case of overactive bladder without underlying pathology, treatment is very gradual.

"Before considering drug treatment, we can take lifestyle measures – starting with stopping smoking and reducing the consumption of diuretics such as tea and coffee – and behavioral measures: not waiting too long but also not rushing to the toilet. Relaxation exercises to reduce stress can help resolve the problem and rehabilitation can be useful. Electrical stimulation of the posterior tibial nerve – located below and above the medial malleolus – limits, at the cortex level, the stimulation messages to the bladder. Daily sessions of 15 to 30 minutes for about three months give very good results."

If these simple measures aren't enough, the doctor can prescribe two types of medication. "An anticholinergic limits unexpected bladder contraction, but there are significant side effects: dry mouth, constipation, urinary retention, and cognitive impairment," warns the specialist. "Another option: a beta-3 agonist that acts on the detrusor receptor, relaxes the muscle fiber, and increases bladder capacity, with limited side effects."

As a last resort

If idiopathic overactive bladder resists medical measures and treatments, urodynamic testing becomes essential. "The test requires the insertion of a very fine catheter," the urologist reassures, " and is completely painless."

He will clarify the diagnosis and guide the choice of a more serious treatment. The first solution: endoscopic Botox injections to paralyze the detrusor muscle. "This increases bladder capacity. The effect lasts about twelve months, but the more you repeat it, the less effective it becomes. There is also a risk of urinary retention after the injections."

Another option: sacral neuromodulation, which is possible in the absence of any neurological disorder. "We first place a temporary electrode at the S3 sacral root. If it's successful, we insert a device that works like a pacemaker. It's adjustable and allows us to regulate the stimulation based on the symptoms."

Dr. Alenda concludes by emphasizing the importance of prioritizing treatments. "You have to proceed step by step, taking the time to reassure the patient."

Special case

Bladder hydrodystension, a surgical technique that distends the bladder—when its capacity does not exceed 150 ml instead of approximately 600 ml—is not an option for idiopathic overactive bladder. "It is reserved for very specific cases of painful overactivity such as interstitial cystitis," explains the urologist.