Constant urge to urinate is a symptom of an overactive bladder

Overactive bladder syndrome is characterized by the urgent need to urinate. It is accompanied by an increase in the frequency of going to the bathroom, stimulated by a sudden urge that also occurs at night, causing those who suffer from this problem to wake up.

In a third of cases, women may experience urinary incontinence. The diagnosis of the so-called idiopathic overactive bladder (with no known origin) is made in the absence of urinary infection.

The problem manifests itself when there is hypercontractility of the detrusor muscle that lines the bladder. That is, this greater internal pressure makes you have a constant urge to urinate, even when there is little liquid to be expelled. Thus, it is common for the patient to need to go to the bathroom more than eight times during the day and more than once at night.

In a normal situation, the bladder is always relaxed and, when there is a need to urinate, a contraction and emptying command is given. In overactive bladder, it is as if this command is triggered out of control.

According to Emerson Oliveira, assistant professor and responsible for the sector of urogynecology and pelvic floor disorders at FMABC (ABC School of Medicine), one in four women over 40 years old who go to see gynecologists has an overactive bladder.

“The prevalence increases with age and has a negative impact on daily activities. Overactive bladder greatly impairs several domains of quality of life, promoting restrictions in social and professional life, in addition to demanding greater use and resources from the health system “, highlights Oliveira.

Assessment of the patient’s history, in addition to physical and urine exams, are the first steps in reaching a diagnosis of overactive bladder. To rule out other causes of urinary symptoms, such as infections, bladder stones, bladder tumor, and diabetes, renal and urinary tract ultrasound, urodynamic evaluation, cystoscopy, and other tests may be ordered.

Overactive bladder can result from inaccurately transmitted nerve signals from the brain to the bladder. In addition, diseases that affect the brain and/or spinal cord, neurological disorders, muscle spasms and hormonal changes can be triggers. These are cases called neurogenic bladder, with behavior different from idiopathic.

It is still possible for women to develop symptoms of overactive bladder, such as urinary incontinence, during pregnancy. It is due to the increased production of urine, as well as the pressure that the uterus exerts on the bladder. Consequently, it is more difficult to control and hold the flow.

Gynecologist Cássia Raquel Teatin Juliato, professor at the Faculty of Medical Sciences at Unicamp (State University of Campinas) and vice-president of the National Specialized Commission of Urogynecology at Febrasgo (Brazilian Federation of Gynecology and Obstetrics Associations), explains the treatment of overactive bladder .

“A first line refers to behavioral interventions, such as smoking cessation, weight adjustment, obesity and diabetes control”, he says.

Juliato states that items that stimulate the bladder detrusor muscle, such as caffeine, alcohol, pepper, chocolate, soft drinks and foods rich in potassium, should be avoided.

“Pelvic floor muscle training also improves the condition. Another aspect includes drug treatment with anticholinergics or B3 adrenergics. In postmenopausal women, vaginal estrogen can be used associated with these medications”, he also says.

For more serious cases, in which previous treatments have failed, “the application of botulinum toxin [botox] intravesical, sacral neurostimulation and percutaneous tibial nerve stimulation”.

When noticing high urinary frequency (interval less than two hours), urinary urgency, nocturia, incontinence and the desire to go to the bathroom even with an empty bladder, the patient should seek help, because, as Juliato emphasizes, overactive bladder is a syndrome with great impact on the quality of life of women.

“Don’t be ashamed of the symptoms,” he says. “All gynecologists are able to carry out the diagnosis and the appropriate treatment. But, if there is a failure in the treatment, one should seek a specialist, which is the urogynecologist”, he adds.

Oliveira reinforces that the impact of having an overactive bladder occurs in the physical, social and psychological fields. “So, if you have or know someone who shows symptoms, talk to a doctor. Overactive bladder has treatment and that makes all the difference in quality of life”, he concludes.