Overactive (Active) Bladder (Urge-Congestion Syndrome)

It is the uncontrolled and sudden contraction of the bladder (urinary bladder). In other words, it is bladder dysfunction defined by the sudden uncontrollable feeling of urinating. One of the most common causes of urinary incontinence in children, especially in girls, is an overactive bladder. In these children, it is usually seen that their families are constantly warned to urinate or that they are constipated. The child urinates little and often.

These children are usually seen to hold their urine. They do not urinate and hold their urine because the toilets are not clean, suitable and sufficient at school, kindergarten or daycare center or because they cannot take off their clothes themselves. The full bladder starts to contract to empty the urine. It gains autonomy and then starts to contract even when the bladder is not full. In this case the sphincter relaxes and the child urinates. Urine is small and frequent.

It has three typical features.

• Recurrent urinary tract infection,
• Bladder -sphincter dysfunction (feeling of tightness),
• Vesicoureteral reflux.

Sometimes the cause is not known exactly, the bladder behaves like a fetal bladder and cannot switch to adult bladder behavior. Since there is no central inhibition here, the detrusor starts to contract when the bladder volume reaches a certain level. Reflexively, the sphincter relaxes and the child voluntarily contracts the sphincter to prevent this, but this is achieved up to a certain extent, eventually the contractions overcome this obstacle and urine leakage occurs.

Are There Causes of Urge Incontinence?

It occurs when the bladder muscle (detrussor) is affected or injured.

• Having constipation problems: A full large intestine presses on the bladder and causes compression.
• Frequent urinary tract infections: affect the nerves of the bladder and cause compression.
• Anxiety disorder
• Drinking caffeinated drinks or carbonated drinks
• Nerve damage; especially seen in cerebrospinal cord injuries. Sends untimely and frequent signals to the bladder.
• Avoiding emptying the bladder completely when on the toilet
• Underlying sleep apnea
• Obesity. Compresses the bladder, causing compression and incontinence.

What are the Clinical Symptoms of Urge Incontinence?

The clinical manifestations of urge incontinence are not the same in every child. The most prominent clinical finding is frequent urination. While the number of daily urinations is normally 5-7, it is more than 10 in these children. Even with water and fluid restriction to avoid urination, this number is very high. In general, these children rise on tiptoe, cross their legs, squat, move their buttocks on the floor while watching television, clench their fists, hold their penises in boys, and run to the toilet immediately when they realize that they will leak urine, but often cannot reach the toilet and leak urine, urine is small and enough to wet their panties, the child goes to the toilet frequently and urinates in small amounts. If this condition is left untreated, it causes vesicoureteral reflux because it causes increased intra-bladder pressure. Summary;

• Frequent urge to urinate
• Urination at night
• Urinary Incontinence
• Urinary tract infection.

How is Urge Incontinence Diagnosed?

It is diagnosed by history, physical examination and voiding frequency chart. If the diagnosis is uncertain, urinalysis and urodynamic examination can be performed and ultrasound can be used for differential diagnosis.

The most important thing here is the history. The family and, if possible, the child should be well listened to. A suitable environment should be created for this and patience and sufficient time should be allocated.

 

How to Treat Urge Incontinence?

The main thing in treatment is to explain the event very well to the family and the child and to motivate them. Explaining how and when to urinate and keeping a voiding schedule, treatment of constipation and urinary tract infection, if any, and antimuscarinic medication are the mainstays of treatment.

Daily Life Changes;

In bladder problems, some changes in daily life constitute an important part of the treatment. One of these changes is to avoid carbonated drinks, spices, artificial sweeteners and foods containing caffeine. In addition, cranberry juice and pumpkin seeds that are good for bladder functions can be consumed.

Bladder Training;

The aim of bladder training is to eliminate unnecessary contraction. This is usually to go to the toilet at regular intervals in line with your doctor's recommendations, whether you feel urine or not.

Drug Treatment;

A detailed evaluation should be made before starting drug treatment. Especially constipation and urinary tract infection should be carefully evaluated.

Medications prevent excessive contraction of the bladder muscle and eliminate the feeling of tightness. However, some of these medications may cause temporary side effects such as constipation, dry mouth and red cheeks.

!!!!!Overactive bladder and urinary incontinence can largely be treated with bladder training, daily life changes and medication. For the remaining small group, the group that cannot be treated with these methods, the following treatment methods can be tried.

Neuromodulation (Electrical Stimulation with Superficial Electrodes);

Although the mechanism of nerve stimulation is still not fully understood, it is accepted that stimulation of the sacral nerve roots modulates the reflex pathways between the pelvic floor, bladder and bladder outlet. Nerve stimulation therapy is applied to the sacral area and the area around the ankle where the bladder-related nerves pass. It is done using a TENS device. This is not a surgical procedure. It can be applied very easily with sticker-shaped adhesive electrodes. It has no side effects.

Biofeedback Training;

The aim here is to ensure correct and effective use of the pelvic floor muscles. Pelvic floor muscle functions should be evaluated before and after treatment.

Biofeedback can be used in all bladder problems such as dysfunctional voiding, bladder wall muscle - bladder neck muscle incompatibility disorders, overactive bladder, underactive bladder.

Biofeedback therapy alone is not enough to train the pelvic floor muscles. In addition to biofeedback therapy for an effective pelvic floor rehabilitation; different physical therapy modalities such as different exercise approaches, respiratory and posture training, relaxation training can be added to the treatment. This rehabilitation should be performed by a pelvic floor physiotherapist under the supervision of a physician.

*** The information provided here and the content of the website are designed to inform the visitor, especially families. No information should be considered as advice by visitors and should not lead to any decision or action. Families should definitely have their patient examined by a pediatric surgery specialist, consult with him/her and make a decision by consulting his/her one-on-one information.