Zystalgie, overactive bladder: what helps with an overactive bladder?
There are two main symptoms that describe the concept of the irritable bladder: a constant urge to urinate with only small amounts of urine, which is followed by involuntary loss of urine, especially during physical exertion. Pain or burning sensation when urinating as well as persistent diffuse pain sensation in the lower abdomen are less common. As much as the symptoms of cystitis are similar, there are no bacteria or other signs of infection in the urine.
A brief overview
A distinction is made between the primary irritable bladder with no tangible organic background and the secondary one, which can develop in the context of organic disorders or as a result of other diseases such as tumors, inflammation or stones. Here is a brief overview of the symptoms of an overactive bladder:
- Synonyms: Zystalgie, overactive bladder, bladder irritation, overactive bladder (OAB).
- Symptoms: Constant urge to urinate, frequent urination with small amounts (pollakiuria), urge incontinence, occasional discomfort when urinating (stranguria), diffuse to cramp-like pelvic pain.
- causes: The causes are still partly unclear. With primary zystalgia, the cause is suspected in the nervous system. The secondary form mostly occurs as a result of other diseases such as inflammation, tumors or urinary stones.
- Therapy for primary Zystalgie: Drug treatment mostly with anticholinergics, behavioral training, psychosomatic treatment, electrical muscle stimulation, sacral neuromodulation (implanting a probe), injections with botulinum toxin A.
- Naturopathy: Stress relief (e.g. through autogenic training, progressive muscle relaxation), pelvic floor training, neural therapy, acupuncture, homeopathy, phytotherapy, Schüßler salts.
The primary irritable bladder
Several million people in Germany suffer from an overactive bladder. Women are affected more often than men. The primary irritable bladder is to be understood as a symptom of a regulatory disturbance of the autonomic nervous system and as such increases with physical cooling (generally or with cold feet), after consuming cold drinks, after sexual intercourse and with psychological excitement. In women in particular, there are also poor circulation, fatigue, sexual disorders, migraines or gastrointestinal complaints. Likewise, hormonal changes and hormone imbalances in pregnancy or in menopause are suspected as the cause in women.
Other possible causes are suspected mental and emotional stress such as stress, nervousness and fear.
In psychosomatic medicine, the sexual aspects of the aging woman and suppressed anger, which is expressed as an overactive bladder, are discussed as psychological aspects of the development. This means a great social burden up to the exclusion of those affected, because the constant urge to urinate takes the joy out of activities (theater, cinema visits, walks) and incontinence is perceived as embarrassing. Many sufferers drastically reduce their drinking volume, which in turn reduces the capacity of the bladder and increases the symptoms.
The secondary irritable bladder
The secondary form can have various causes, for example:
- Recurrent infections of the bladder or urethra,
- deficiency of estrogen weakens the bladder during menopause,
- neurological diseases such as Parkinson's disease,
- Multiple sclerosis,
- a stroke,
- Foreign body in the bladder,
- Bladder stones,
- certain medications (e.g. diuretics such as diuretics).
A narrowing of the bladder outlet, caused for example by enlarged prostate in men or a narrowing of the urethra in women, promotes the formation of bladder stones, which in turn can lead to irritable bladder. Tumors in the bladder or in the small pelvis, previous radiation or drug side effects are also possible. Interstitial cystitis, an inflammation of the bladder wall of unclear cause, leads to a reduction in the capacity and thus also to the typical symptoms of the irritable bladder.
Irritable bladder symptoms
A Zystalgie manifests itself primarily by a sudden and extremely urgent urge to urinate. Despite the violent urge, only small amounts of urine are released, which can also escape uncontrolled if those affected do not immediately go to a toilet. The bladder is overactive if the person regularly has to urinate more than ten times a day (more than eight times a day and more than twice a night). Stress incontinence can also occur, in which the bladder empties uncontrollably as a result of sudden movements or physical exertion such as coughing, sneezing, laughing, lifting or carrying. Other possible symptoms include burning or painful urination (stranguria) and diffuse to cramp-like pain in the lower abdomen.
If there is a physical or organic cause, one speaks of a secondary irritable bladder. The primary form is diagnosed when all physical and organic causes are excluded. Possible procedures to determine physical causes are:
- Urological or gynecological examinations,
- Blood and urine test,
- Urethral swab,
- Ultrasound examination,
- X-rays of the bladder and urinary tract,
- Measure bladder pressure.
The first thing to be determined is whether it is a primary or secondary form. The secondary form focuses on the treatment of the underlying disease. In the primary form, a variety of conventional and naturopathic treatments are available, which must be individually adapted to those affected. The most common measures include:
- Correctly applied pelvic floor training,
- Continence training,
- Medicines (e.g. anticholinergics, antispasmodics, herbal preparations),
- Relaxation exercises,
- warm hip baths,
- Reduction of overweight and obesity,
- quit smoking,
- Refrain from excessive alcohol and coffee consumption.
There are a number of medications that can reduce the symptoms of an overactive bladder. These include in particular so-called anticholinergics or spasmolytics. The anticholinergics act on the bladder muscles and the nervous system and are supposed to relax the bladder muscles. The antispasmodics reduce the willingness to contract of the bladder muscle, which is to achieve less frequent emptying. In women, hormone therapy with estrogen-containing drugs is recommended. Herbal medicines also relieve urge to urinate. Preparations containing cranberry or pumpkin ingredients are suitable. Bearberry leaf extract, for example, also works against the symptoms of a urinary tract infection.
Naturopathy for the primary irritable bladder
Naturopaths and naturopaths have a large arsenal of treatment options, especially if it is a primary cystia, which usually responds well to naturopathic measures. This is especially true when psychological-advisory elements are integrated in the treatment. The following options are only given as examples and should be discussed with a naturopathic specialist before carrying them out.
As a first general measure, the amount of drinking in the evening should be reduced to a minimum, and any fluid intake should be avoided about two hours before going to bed. Drinks that are diuretic (coffee, alcohol, diuretic teas) should be completely avoided. Under no circumstances should however be drunk in general. A lot of drinking with irritable bladder can reduce the urge to urinate, since the kidneys produce a highly concentrated urine when there is a lack of fluid, which irritates the bladder and increases the urge to urinate. Overall, attention should be paid to a regular daily and work routine.
Mental and physical training
Appropriate stress relief methods such as autogenic training, yoga, meditation or progressive muscle relaxation can have a positive effect on the course of the disease. Regular pelvic floor training, supplemented by “toilet training”, in which water is left at specified times, can in particular reduce or even eliminate urge to urinate and incontinence.
For some people, Schüßler salts have proven their worth in treatment. The exact dosage should be discussed with a specialist naturopath. At the beginning of the intake, only the Schüßler salt number 6 potassium sulfuricum is often recommended. Other salts can be added in the further course. The following are suitable for this:
- Schüßler Salt Number 1 - Calcium fluoratum,
- Schüßler Salt Number 3 - Ferrum phosphoricum,
- Schüßler salt number 8 - sodium chloratum,
- Schüßler salt number 9 - sodium phosphoricum.
Neural therapy and acupuncture
Neural therapy is used in naturopathy. A local anesthetic (mostly procaine) directly relaxes the bladder muscles. Treatment using ear acupuncture, which includes vegetative, organ-related and psychotrophic points, can also have a relaxing effect on the entire organism and the muscles of the bladder.
Homeopathy and phytotherapy
Homeopathy is also an alternative healing method. A complex remedy from "Winterlieb" (Chimaphila umbellata), "American aspen" (Populus tremuloides) and "dwarf saw palmetto" (Serona repens) is often used for healing support, unless a homeopathic constitutional treatment is given. In phytotherapy, medicinal herbs are used that are psycho-vegetative, effective, that strengthen the bladder tissue, improve the metabolism and are antispasmodic. Often used:
- Johannis herbs,
- Flowers of lavender,
- Saw palmetto fruits,
- Goldenrod herb,
- Horsetail herb,
Hypnotherapy is also sometimes used for zystalgia. Hypnosis can be extremely beneficial when used regularly. An improvement can also be achieved with symptoms such as high blood pressure, sleep disorders, irritable bowel syndrome, anxiety and other nervous disorders. If there is a tendency towards inner restlessness and constant feeling of stress, the regular use of self-hypnosis can support the healing process. (jvs, vb)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Graduate editor (FH) Volker Blasek
- W. H. Jost et al .: Diagnostics and therapy of neurogenic bladder disorders, S1 guideline, German Society for Neurology, (accessed August 22, 2019), AWMF
- Guideline group S2K guideline for interstitial cystitis (IC / BPS), long version, 1st edition, version 1, 2018, (accessed 22.08.2019), AWMF
- DGU guideline program: Interdisciplinary S3 guideline: epidemiology, diagnostics, therapy, prevention and management of uncomplicated, bacterial, community-acquired urinary tract infections in adult patients. Long version 1.1-2, 2017 AWMF register number: 043/04, (accessed 22.08.2019), AWMF
- Thomas Gasser: Basic knowledge of urology, Springer Verlag, 6th edition, 2015
ICD codes for this disease: N31, N32ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.