Overactive bladder is not a condition that occurs simply because the urinary bladder is sensitive, but an illness in which complex systems inside our body are intertwined. The deficiency of kidney and spleen qi mentioned in Donguibogam can be interpreted as the weakening of the muscles and nervous system around the urinary bladder, and the qi stagnation of the heart and lung can be understood as autonomic nervous system imbalance and psychological stress. Modern medicine views abnormal contraction of the detrusor muscle, the urinary bladder muscle, as the core cause of overactive bladder. Even before urine fills the urinary bladder, the detrusor muscle contracts on its own, sending a strong signal to the brain that one needs to urinate. It effectively makes our brain mistakenly believe that the urinary bladder storage capacity is far smaller than it actually is.
Such excessive activity of the detrusor muscle can be triggered by several factors.
First is the hypersensitivity of the bladder sensory nerve. Receptors that sense the volume and pressure of urine are distributed along the inner wall of the urinary bladder; these receptors often react excessively even to very small stimuli and send the signal to the brain that the urinary bladder is full too early. It can feel as if a smartphone alarm is going off too early.
Second is regulatory dysfunction of the central nervous system. The brain has a complex neural network that inhibits the detrusor muscle of the urinary bladder and regulates the urinary bladder sphincter. However, when there are neurological diseases such as stroke, Parkinson's disease, or dementia, or when there is a spinal cord injury, this regulatory function weakens and the ability to control the urinary bladder is lost. It is an unfortunate situation where the brain needs to tell the urinary bladder to hold it a bit more, but that command is not delivered properly.
Third, in women, the decrease in estrogen is also an important cause. After menopause, as estrogen levels decrease in women, the mucosa around the urinary bladder and urethra becomes thin and loses elasticity. Due to this, urinary bladder sensation becomes more sensitive, and the supporting structure of the urethra also weakens, which can worsen overactive bladder symptoms. This shows how significantly hormonal balance in our body has an impact.
Fourth are psychological factors and stress. Interpreting the qi stagnation of the heart and lung from Donguibogam in modern medical terms, it corresponds precisely to chronic stress and anxiety. Stress disrupts autonomic nervous system balance and activates the sympathetic nerve. When the sympathetic nerve becomes excessively activated, the activity of the urinary bladder also rises, causing the detrusor muscle to contract easily and making the sensation of needing to urinate feel stronger. It is a very common case where an uncomfortable mind leads to an uncomfortable body.
Fifth is pelvic floor muscle weakening. When the pelvic floor muscle weakens due to aging or in women with a history of childbirth, it cannot properly support the urinary bladder and urethra. These muscles play a role in firmly holding the urinary bladder; when their strength weakens, the stability of the urinary bladder decreases, which can cause urine leakage or urgent urination.
Lastly, dietary habits also exert an undeniable influence. Consuming caffeine, alcohol, carbonated drinks, or spicy and salty irritating foods can irritate the urinary bladder and further heighten urinary bladder hypersensitivity. Such external stimuli sensitize the bladder mucosa and irritate the detrusor muscle, leading to frequent urination. Just as Donguibogam emphasizes the balance of the whole body, modern medicine also approaches the treatment of overactive bladder from multiple angles, incorporating behavioral therapy, lifestyle modification, and psychological stabilization in addition to pharmacotherapy for this very reason. Rather than viewing the urinary bladder in isolation, it views the nerves, muscles, hormones surrounding the urinary bladder, and even our mind as being all connected.
