50-year-old Ms. Wang is a high school teacher and a head teacher in a key high school class. She is very busy at work, so she often needs to work at her desk, but she has always had an old problem. has to go to the toilet several times a day. Every time she thinks it is urinary tract infection , so she buys some antibiotics orally to take , and the symptoms can be temporarily relieved.
In the past month, Ms. Wang has been busy with work and more stressed because she has to prepare for the final exam for students. Unfortunately, her urination rate has begun to increase significantly again. In severe cases, she even has to go there once in one hour, but the amount of urine is very small each time, and she can hardly sleep at night, which seriously affects her normal life and work, so she came to the hospital for consultation. The doctor improved Ms. Wang's routine urine, renal function and urinary tract color ultrasound. The results of found that Ms. Wang's urine was not bacterial , and the renal function and urinary tract color ultrasound were also normal. When further asked Ms. Wang whether she had symptoms such as uncontrolled urination and urinary incontinence , Ms. Wang was embarrassed to answer, , so the doctor diagnosed that it was not a urinary tract infection, but was suffering from overactive bladder .
Ms. Wang was puzzled when she heard the strange name of overactive bladder disease, so she asked what kind of disease it was. Doctor explained that overactive bladder is actually one of the common urinary system diseases in middle-aged and elderly women. It is mostly clinically manifested as frequent urination , urgency, urinary incontinence, etc., which is often confused with urinary tract infections and other diseases. However, this disease is actually very harmful and needs to be treated as early as possible. Try to preserve the function of bladder as much as possible. Otherwise, it may develop into urinary retention , renal edema and other serious complications . So the doctor prescribed a new drug called Solina to Ms. Wang and asked her to take it regularly and regularly. After taking the medicine as directed by the doctor, the symptoms of frequent urination, urgency, and excessive nocturnal urination improved significantly.
1. Pathogenesis and characteristics of overactive bladder
Overactive bladder is a common urinary system disease. Its clinical urgency, frequent urination, dysfunction of urination, and increased nocturnal urination are the main characteristics. In severe cases, urinary incontinence may even occur, which seriously affects the patient's quality of life. Epidemiological study shows that about 15% of people over 40 suffer from overactive bladder, but because their clinical symptoms are very similar to urinary tract infection, they are often misdiagnosed clinically. is worth mentioning that the prevalence rate of women aged 50 is much higher than that of men , so menopausal women are one of the common people with overactive bladder.
The pathogenesis of overactive bladder is not clear at present. It is clinically believed that the following three factors may be the causes of overactive bladder. First of all, the bladder detrusor instability caused by various causes. Bladder detrusor muscle is one of the main muscles that control the bladder to empty urine. Under normal circumstances, the bladder detrusor muscle will contract under the pressure after the bladder is stored in a certain amount of urine. However, inflammation, infection, hormones and other reasons will affect the function of the bladder detrusor muscle, resulting in unstable function, and even contract at will, which will lead to multiple clinical symptoms such as frequent urination and urgency urination.
Secondly, has multiple causes that cause hyperreflexia of the bladder detrusor muscle . The bladder detrusor muscle is mainly innervated by the nerves emitted by the pelvic plexus, , but if multiple causes cause hyperfunction of the pelvic plexus, it is easy to reflexibly induce excessive activity of the bladder detrusor muscle, thereby creating a strong urge to urinate, which in turn causes symptoms such as frequent urination and incontinence .
Finally, Oversensitive bladder caused by multiple causes .The bladder of normal adults can store 300-500ml of urine . In this amount of urine will stimulate the pressure receptors on the bladder wall, causing the human body to urinate, and then trigger a urinary reaction. , but various pathological factors will lead to increased sensitivity of the bladder, which will lead to obvious urination even if only 100ml of urine in the bladder will cause an increase in urination, which will cause an increase in the number of urination, but there are very few urination each time.
2. How to distinguish between hyperactivity of bladder and urinary tract infection?
Frequent urination and urgency are clinical symptoms that both bladder hyperactivity and urinary tract infections. Clinically, these two diseases can appear at the same time, so they are often confusing clinically. However, if you carefully distinguish them, these two diseases have different clinical characteristics, specialized examinations and treatment plans. . I hope you can distinguish them.
1. The clinical manifestations of bladder hyperactivity and urinary tract infection are different.
Urinary tract infection is essentially a disease caused by bacterial infection of the urinary system. In addition to frequent urination, is also accompanied by stinging urinary urination and yellowing, and may even be accompanied by infectious symptoms such as fever and high fever. ; bladder hyperactivity is a type of Diseases caused by abnormal bladder function, does not have obvious symptoms of urination pain, fever, high fever, etc., but is characterized by frequent urination, but small amount of excretion each time, and it takes a long time to urinate. There is another thing that can distinguish between two diseases, , that is, excessive bladder activity during sleep at night will still occur, resulting in frequent nocturnal urination, and even urinary incontinence. Urinary tract infection itself will not experience increased nocturnal urination due to the compensatory effect of the bladder.
2, specialized examinations for bladder hyperactivity and urinary tract infections, different
The most specific examination results of urinary tract infection are routine urine and urine culture . Regular urine can see whether there are white blood cells , red blood cells , bacteria and other microorganisms , and urine culture can determine whether there are bacteria and specific types of bacteria in the urine, so that To facilitate the next anti-infection treatment; has almost no specific examination methods. Patients' routine urine, urine culture, urinary color ultrasound, etc. may not have positive expression . The only possibility is that a small amount of residual urine can be seen in the color ultrasound of the bladder, but the specificity of this examination is not high. Therefore, in clinical practice, it is mostly after eliminating infectious diseases and other factors, and then considering whether it is urinary hyperactivity .
3. The treatment plans for overactive bladder and urinary tract infection are different. Anti-infection is the main means of clinical treatment of urinary tract infection. If necessary, non-steroidal anti-inflammatory drugs can be used in combination to reduce the patient's pain. Most patients' symptoms can be significantly improved after treatment; the essence of overactive bladder is bladder dysfunction, so does not require anti-infection treatment, but buy by regulating bladder function and reducing the sensitivity of the bladder detrusor muscle. Patients often take a longer period of time and the treatment effect is slow.
3. The following four drugs are commonly used in clinical practice to treat overactive bladder
The main principle of clinical treatment of overactive bladder is to control clinical symptoms and improve the quality of life of patients. Antimuscarinic drugs, β3 receptor agonists and other drugs are commonly used for treatment. Among them, the following four drugs are the most commonly used drugs in clinical practice. It should be noted that these four drugs have more side effects . It is recommended that everyone take them in standardized manner under the guidance of a clinician.
1, Solinaxin
Solinaxin is a common medicine for treating bladder hyperactivity. Its essence is an muscarinic receptor antagonist , which can bind to muscarinic receptors on the surface of the bladder, inhibit excessive contraction of the bladder detrusor muscle, and enhance the urine function stored in the bladder.Clinical studies have shown that after taking Solinasin, symptoms such as frequent urination, urgency, nocturia and urinary incontinence have improved significantly, and long-term use of symptoms can be well controlled. , but it should be noted that oral administration of solinaxin can easily cause symptoms such as , dry throat, constipation, etc., because solinaxin can inhibit gland secretion, so patients with constipation should use it with caution; secondly, solinaxin can easily stimulate the digestive system, resulting in symptoms such as abdominal pain, indigestion, nausea and vomiting; finally, long-term oral administration of solinaxin can easily cause symptoms such as urinary retention, limb edema, etc., and it is necessary to monitor liver and kidney function regularly.
2, toterodine
Toterodine is a specific muscarinic receptor antagonist. It has a strong sensitivity to the M2 receptor on the bladder smooth muscle and has a stronger affinity for the bladder smooth muscle. It has weaker M3 receptor blockade on other organs, so there are fewer clinical side effects. Clinical studies have shown that toterodine can reduce the number of urination in bladder overactivity, improve bladder storage, and increase the amount of urination per time. , but it should be noted that toterodine has a certain inhibitory effect on gastrointestinal function, so abdominal distension, acid reflux, constipation and other symptoms may occur during the medication; secondly, toterodine has a certain impact on the function of the central nervous system of , and is prone to headaches, dizziness and other symptoms; finally, toterodine has a certain impact on the liver and kidney function, and long-term medication requires regular monitoring of liver and kidney function .
3, miraberon
miraberonmi is a highly selective β3 receptor agonist, which is a first-line drug for treating bladder hyperactivity. It can bind to the β3 receptor on the bladder to activate the bladder β3 receptor, and at the same time it can reduce the conduction function of the nerve fibers innervated the bladder detrusor muscle, thereby allowing the bladder detrusor muscle to relax and reduce its spontaneous contraction. Clinical studies have shown that miraberon can significantly increase symptoms such as frequent urination, urgency, and incontinence in patients with overactive bladder, and will not produce obvious adverse reactions such as urinary retention and dry mouth. , but it should be noted that long-term oral administration of miraberon is likely to cause urinary tract infection; secondly, clinical research reports have shown that oral administration of miraberon is likely to cause cardiovascular reactions such as increased blood pressure and accelerated heart rhythm. Therefore, use with caution for patients with coronary heart disease , hypertension , tachycardia and other diseases.
4, propelavirin
propelavirin is a compound drug. It can not only antagonize the muscarinic receptor , but also has a significant blocking effect on calcium ion channel , thus having a significant and rapid effect on relieving bladder spasm , and can effectively treat various diseases such as neurobladder, neurouric incontinence, and bladder hyperactivity. , but it should be noted that the efficacy of propelavirin is too strong, so it is very easy to cause urinary retention; secondly, propelavirin has a significant impact on the function of the digestive tract, which can easily inhibit the peristalsis of the smooth muscle of the gastrointestinal tract, causing adverse reactions such as bloating, indigestion, constipation, etc.; thirdly, propelavirin is prone to cause heart arrhythmia and myocardial pulsation, so is prohibited for patients with coronary heart disease, arrhythmia, and other diseases.
4. In life, you should pay attention to the following 5 points
There is currently no way to cure overactive bladder. Drugs are only to alleviate the clinical symptoms of patients. On the basis of drug treatment, it is the key to actively cooperate to cultivate good living habits. We can start from the following 5 points to effectively delay the development of the disease.
First, establish an optimistic and cheerful spirit
Many patients with overactive bladder are more private and difficult to speak to outsiders, so they often bear it silently, which leads to excessive mental stress and even adverse mental states such as anxiety and depression. This is very unfavorable for preventing and treating overactive bladder. recommends that patients with overactive bladder can consult more professional doctors to fully understand and understand this disease, and at the same time establish information to overcome the disease, cultivate their own optimism, communicate more with family and friends, or actively participate in outdoor activities .
Second, reduce the intake of irritating food
Patients with overactive bladder should consciously control the intake of liquids, Daily intake of liquids between 1500-2000ml, and at the same time, try to avoid intake of liquids after dinner, thereby reducing the number of nocturnal urine; second, avoid intake of coffee, alcohol , tea and other irritating liquids to avoid symptoms worsening ; finally, restrict the intake of sodium salt, should not exceed 3g.
Third, moderate bladder function training
Bladder training is a kind of exercise method that passively increases bladder capacity and regulates involuntary contraction of detrusor muscles by actively inhibiting the sensation of urination and extending the interval of urination, thereby passively increasing the bladder capacity and regulating the involuntary contraction of the detrusor muscle. The characteristic of this method is that patients actively reduce the number of urination times and try to extend the time interval between each urination, thereby effectively improving the patient's ability to control urination.
Fourth, Actively exercise Pelvic floor muscle function
Clinical research shows that Actively exercise the function of pelvic floor muscle, increase the tension and contraction of pelvic floor muscle, can effectively increase the resistance of the urethra, inhibit the involuntary contraction of the bladder detrusor muscle, , but this exercise method requires to have obvious effects for a long time, and is not suitable for people with Knee and hip joint diseases .
Fifth, reduce the cause of disease
Most patients with overactive bladder have previously had chronic pelvic inflammatory disease , urinary tract infection, urinary stones, prostatitis and other diseases. Therefore, it is necessary to actively treat these causes, and regularly perform functional examinations on the bladder, kidney, ureter, etc., so as to effectively reduce the adverse factors that induce overactive bladder .
5. Summary
To sum up, overactive bladder is a common urinary system disease in middle-aged and elderly women. The clinical manifestations are mainly manifestations of urgency, frequent urination, incontinence, etc., so it needs to be acutely identified from common urinary tract infections; secondly, although there are drugs that can effectively control the symptoms of overactive bladder, because they need to be taken for a long time, they need to pay attention to possible adverse reactions and respond to doctors in a timely manner; finally, drugs are only part of the treatment, actively improve living habits, cultivate a good mental state, and actively carry out bladder function exercises, so as to achieve the purpose of fundamentally preventing and treating overactive bladder.
