Medically Reviewed By William C. Lloyd III, MD, FACS
— Written By Erin Azuse, RN
Updated on May 7, 2022
我们都经历过这样的感觉，当膀胱充满尿液后，会反射到大脑，告诉我们需要往厕所跑了。美国有3300万膀胱过度活动（也叫OAB）的患者。这种感觉频繁，迫切的出现，似乎无所不在。一些膀胱过度活动的患者尿急时，同时也会伴有尿失禁。虽然治疗令人不满意，但是这里也有许多办法可以考虑。治疗膀胱过度活动有很多选项，从居家药物治疗到手术治疗。那么哪项治疗适合你呢？
一．改变生活习惯
如果你被诊断膀胱过度活动症，你的大夫通常建议你，治疗从改变生活习惯开始。包括以下方面：
1. 避免一定食物和饮料：你的饮食中最好避免这些可刺激膀胱过度活动的东西，最常见的，如咖啡，酒精，碳酸饮料。辛辣食物；含枸橼酸，水果，饮料；含番茄的食物及番茄酱，这些也可以刺激膀胱过度活动。同时要限制一天的饮水量，保持身体需要的足够的饮水量，饮水太少，浓缩尿液也会刺激膀胱。
2. 锻炼，使自己保持健康的体重。过重可增加膀胱的压力，加重尿急，尿频。
3. 戒烟。吸烟可刺激膀胱，同时咳嗽会导致尿失禁。
4. 膀胱训练。定时排尿，大夫会建议你一开始，抑制排尿，有尿意时，延时几分钟排尿，然后逐步增加排尿间隔时间。这可以帮助你的膀胱逐步适应储存多一些尿量。
5. 盆底功能训练。凯格尔运动可以增加盆底肌肉的力量。这些盆底肌肉参与控尿功能。你可以自己锻炼，或大夫建议通过生物反馈来训练盆底肌肉。生物反馈，通过无痛电极，可以更好的识别及训练你的盆底肌肉。
二．药物治疗
1.如果通过改变生活习惯仍然不能治疗膀胱过度活动，那么可以用药物治疗。最常用的是抗胆碱能的药物。这类药物可松弛膀胱，降低膀胱收缩，来抑制膀胱有排尿的感觉。
酒石酸托特罗定（德托罗）
奥昔布宁
索利那新（卫喜康）
弗斯特罗定
这些药物，有的是药片，或凝胶，或贴在皮肤上的贴片。他们的副作用各自不同，口干，便秘是最常见的副作用。
2.如果抗胆碱能药物仍然对你没有效果，可用一种新的药物，米拉贝隆。它是另外一种机理来松弛膀胱肌肉，增加膀胱容量，可使你储存较多尿量。
3.其他治疗膀胱过度活动的药物，注射肉毒素A，也被叫做保妥适，肉毒杆菌毒素。小剂量的肉毒素A，直接注射到膀胱壁，可有效松弛膀胱肌肉，即使是症状很严重的患者都有效。这种效果可持续6月，6月后需再次注射。副作用是有少数患者会排尿困难，需要导尿处理。
三．神经刺激治疗膀胱过度活动症
在排尿过程中，需要神经将信号传导至大脑，告诉大脑你的膀胱尿量满了，需要排尿了。一些微创手术操作，可刺激神经，参与排尿控制，缓解膀胱过度活动症状。包括如下：
1. 骶神经刺激，用一些小的金属线埋在你后背的皮下，它可以发射电脉冲刺激你的骶神经，来影响你的膀胱控尿功能，这个治疗可降低你的排尿频率，改善尿失禁。如果有效果，可以植入一个小的永久性骶神经刺激装置。
2. 经皮胫神经刺激，需要在你的近脚踝皮下放一个小的电极，传导电脉冲至胫神经或其他负责控尿的神经。每周进行电脉冲刺激一次，每次30分钟，连续12次。以后需每月维持治疗一次。
四．手术治疗
在极少见的严重膀胱过度活动症的患者，对其他治疗无效的情况下，可考虑手术治疗。膀胱扩大成形术是一种治疗选择。尿流改道也是一种治疗选择。通过截取的回肠等管道，穿过腹部皮肤造口，将尿液引出。需佩带造口袋收集尿液。
在找到正确有效的治疗方法过程中，要理解你的大夫采用的阶梯式的治疗方法，先用常用的方法，再逐渐按需要增加其他方法。告诉你的大夫，你的治疗目标，你愿意采取什么治疗措施，然后和大夫一起制定一个最好的治疗计划。
Medically Reviewed By William C. Lloyd III, MD, FACS
— Written By Erin Azuse, RN
Updated on May 7, 2022
We’ve all experienced the feeling of a full bladder signaling our body that it’s time to run to the bathroom. But if you are one of the 33 million Americans with overactive bladder, also called OAB, this feeling comes on frequently and urgently, often seemingly out of nowhere. Some people with OAB will also experience urinary incontinence, or leaking of urine, when this urge appears. Dealing with these symptoms can be frustrating, but there are several treatment options to consider. Overactive bladder treatments run a spectrum—from simple things you can do at home to to medications to more invasive options, such as surgery. So, which one is best for you?
If you’re diagnosed with OAB, your doctor will likely suggest you start with making some lifestyle changes. This includes:
· Avoiding certain foods and drinks: It’s best to stay away from things in your diet that can irritate your bladder. Caffeine, alcohol, and carbonated drinks are common culprits. Spicy, citrus-y, or tomato-based foods can be irritants as well. And though you may be tempted to limit how much liquid you drink overall, it’s important to stay sufficiently hydrated. If your urine is too concentrated due to dehydration, it can further irritate your bladder.
· Working towards a healthy weight: Extra weight puts extra pressure on your bladder, exacerbating your symptoms.
· Quitting smoking: Cigarette smoke bothers your bladder, and coughing can lead to incontinence.
· Bladder training: Urinating at specific times during the day may help. Or, your doctor may recommend you try resisting the urge to urinate— only for a few minutes at first, but gradually increasing over time. This can help your bladder get used to holding more urine.
· Pelvic floor exercises: Kegel exercises help strengthen your pelvic floor, the muscles involved in controlling urination. They may be performed on your own or your doctor may suggest adding in biofeedback sessions. During biofeedback appointments, you are attached to painless electrodes, which can help you better identify and train your pelvic floor muscles.
If lifestyle changes aren’t enough, several medicines are available to treat overactive bladder. A class of medications called anticholinergics are commonly prescribed. They help relax the muscles of your bladder, decreasing bladder contractions that make you feel like you need to urinate. Some examples are:
· Tolterodine (Detrol)
· Oxybutynin (Ditropan XL, Oxytrol, Gelnique)
· Solifenacin (Vesicare)
· Fesoterodine (Toviaz)
Depending on the medicine, it may come as a pill, a gel, or a patch you apply to your skin. Side effects can vary between these OAB meds, but dry mouth and constipation are most common.
If anticholinergic medications don’t work for you, a newer option called mirabegron (Myrbetriq) is available. It works in a different way to relax your bladder muscles and also increases your bladder capacity, allowing it to hold more urine.
Another treatment for OAB is an injection of onabotulinum toxin A, more commonly known as Botox. Injecting small amounts of this medication directly into the bladder wall is often very effective at relaxing your bladder muscles, even in severe cases. The effects can last for up to six months before another injection is needed. A small number of people may have difficulty urinating after this treatment and may need to be catheterized as a result.
Your nerves are responsible for delivering messages to your brain, such as letting your brain know that your bladder is full. Some minimally invasive procedures have been developed to stimulate nerves that play a role in your bladder control and improve OAB symptoms. These include:
· Sacral nerve stimulation (SNS): A small wire is inserted under your skin near your lower back. It sends electrical impulses to your sacral nerve, affecting the way it controls your bladder. This procedure can reduce how often you need to urinate and improve incontinence. If successful, a small device can be permanently implanted for long-lasting nerve stimulation.
· Percutaneous tibial nerve stimulation (PTNS): A small probe is placed under your skin near your ankle that delivers electrical impulses to your tibial nerve and other nerves responsible for your bladder function. It’s performed as weekly, 30-minute sessions for 12 weeks. Monthly maintenance treatments will be needed after that.
In rare cases of severe OAB that doesn’t respond to other treatments, surgery may be considered. Augmentation cystoplasty, surgery to enlarge your bladder, is one option. Urinary diversion is another alternative. In this procedure, the tubes that carry urine are rerouted from your bladder to an opening in your abdominal wall. Urine is then collected in an ostomy bag that’s worn on the outside of your abdomen.
When it comes to finding the right treatment for your overactive bladder, understand that your doctor will take a step-wise approach, starting with conservative treatments and adding on as needed. But always remember, your healthcare is a partnership. Let your doctor know your treatment goals and what you’re willing to do to get there, and together, you can formulate your best plan of care.
