Over-active bladder

Background

An overactive bladder (OAB) is a fairly common and inconvenient problem that can cause distress to both men and women or all ages. It can cause you to rush to the toilet and not always make it without some leakage, this can happen several times a day and/or night.

OAB may also be called spasmodic bladder, irritable bladder, incontinence urge and detrusor instability amongst other names, and describes the collection of the following symptoms:

Urge incontinence. An urgent and sudden need to urinate, even when your bladder is not full, often resulting in urinary leakage before making it to the toilet.
Waking up more than once in the night to go to toilet.
Going to the toilet more than 7 times during the day–the usual number of times you should urinate during the day is 4-7.

The workings of the bladder

The bladder can store between 350-550ml of liquid. At around 200ml most people will feel the urge to go to the bathroom.

To store urine, the nervous system and the urinary tract must work together. When urine is produced, the bladder fills up, and rather like a balloon, the bladder stretches to contain the extra fluid. The urethral sphincter acts like a valve and stays shut until the bladder is full and you feel the urge to empty it.

The pelvic floor muscles engage and tighten when you go to sneeze/cough/jump etc and support the bladder to ensure there is no leakage.

As the bladder fills up over a 6 hour period, you may be aware it is getting full but are able to hold on. Once you decide to go to the toilet, your nervous system signals the detrusor or bladder muscle to squeeze and empty completely and for the bladder sphincter valve and the pelvic floor muscles to relax allowing you to urinate.

Causes of OAB

If the bladder muscle squeezes to empty out urine when the bladder is not full or at an inappropriate time, and frequently, then this causes OAB.

OAB can be caused by a Urinary Tract Infection or UTI which are very common and often occur at a low level. An untreated UTI can remain for years. A UTI is not a sexually transmitted disease and can be contracted through poor diet, stress, being run down, as a reaction to medication, by faeces entering the urethra (when you wipe back to front) and through sexual activity. You can easily get a urine test with your GP – often done by the nurse- and can treat a UTI easily and effectively.

Ensuring good flora throughout your digestive tract, the vagina and urethra is wise. Probiotics are a good source of the ‘good’ bacteria and can be purchased from chemists and health food stores, be sure to ask for one that is beneficial to the urethra/bowel/vagina.

Drinks containing caffeine aggravate OAB, so reducing your intake of coffee, tea, energy drinks and colas, as well as drinks with high sugar content such as alcohol, fruit juice and fizzy drinks.

Not drinking enough fluids, particularly water will not reduce the symptoms of OAB and if you don’t drink enough your urine becomes concentrated, further irritating the bladder.

Spread your daily intake of fluids across the whole day so that there are no peaks, as a large fluid intake will make you want to go to the toilet.

Bad habits, such as going to the toilet ‘just in case’ can also lead to increasing the urge to urinate frequently, and you can retrain yourself.

Retraining your Bladder

Retraining your bladder can reduce the urge and frequency to urinate and help to eliminate leakage.

You can retrain your bladder to increase the time between going to the toilet, to control the feeling of urgently needing to go and increase the amount of urine your bladder can hold. You will become aware of the brain/bladder connection and be able to control or overcome the urgent messages being sent to your bladder.

As you may have developed these patterns of going to the toilet frequently over a number of years, you need to be patient and allow for incremental improvements, which may take 3-12 months. However once you have developed good patterns of bladder control, you are likely to maintain them for life.

Strong pelvic floor muscles assist in the process of eliminating the urgency and frequency associated with and overactive bladder. Doing daily Kegel exercises or using Natratone or SmartBalls to tone and strengthen your pelvic floor muscles will help.

How to retrain your bladder

It can be useful to assess how frequently you are going to the toilet, and many professionals recommend starting a urinary diary. This will help you to identify if you are going to the toilet more than 7 times per day.

You urinary diary will:

Be a daily record of the times you go to the toilet each day
Record the time and amount of fluid intake each day
The fluid intake is important as it will helpful to identify if you are not drinking enough fluids and what time of fluids. ie; do you have 6 cups of coffee per day and one glass of water.
Remember insufficient fluids (of the right kind) can contribute to an overactive bladder. Regulating your fluid intake, to small amounts more often, can help reduce urgency caused by drinking large amounts infrequently.

How to overcome the urge to urinate

Try these at home first so that you feel more confident when you are out and about.

When you feel the urge to urinate you can:

Contract or squeeze your pelvic floor muscles hold them tight for as long as you can. Repeat this until the feeling of urgency goes away
Contract/squeeze your pelvic floor muscles hard for short bursts and repeat the contractions
If you are in an uncomfortable position, change to one that has less pressure on the bladder, such crossing your legs, this can send a signal to the brain that you do not need to go right now.
Stay still when you feel the urgency to urinate as movement may trigger leakage-do not move around as this will increase the intensity of the feeling
Breathe deeply and slowly and try to think about something else –distract yourself so you are not concentrating on the sensation
You can force yourself to wait at least 1 to 1 1/2 hours between trips to the toilet, you are likely to have an urge to urinate or have some leakage in between these times, however you are not sending the message to let go. Gradually increase the time by 5 minutes each time or each day until you can comfortably wait for 4-6 hours

Initially you may be very aware of your bladder and the actions you are taking, as you have more success, your response will become automatic and you can consistently y maintain good bladder habits

You will need maintain good pelvic floor strength throughout your adult life to ensure there is good support for your bladder and to help prevent and correct bladder weakness

Retraining your bladder can be effective for at least 2/3rds of all women who practice the techniques.