The Overactive Bladder
Can you help other people with an overactive bladder? To
find out how click here
Normally the bladder expands gently as it fills, sending the brain
a message in good time to look for an appropriate time and place
for the process of emptying. Then the brain sends two signals: one
to the muscles in the bladder wall (the "detrusor muscles")
to contract and the other to the outlet valve ("sphincter") to open,
and the bladder squeezes the urine out. The bladder relaxes again
for the process of refilling.
Some people find that their bladders do not work like this. Instead,
the muscles may contract uncontrollably at the wrong time. This
is called having an "overactive bladder". If you have
one, you may feel very little warning of the need to pass urine
(this is called urgency) and you may need to urinate very frequently
- in exceptional cases as often as every half hour (this is called
frequency).
Some people have difficulty in making it to the toilet on time
because their bladder gives them so little warning, which may result
in urine leaking (urge incontinence).
You may also find that you wake during the night to pass urine
(this is called nocturia).
(It is normal to pass water up to eight times a day and once or
twice a night: if you are consistently emptying your bladder more
frequently than this or being woken more than twice at night you
may want to seek information and advice. Of course, if you are drinking
abnormally large amounts - whether it is ten pints of lager or 20
cups of tea - you will naturally need to empty your bladder more
frequently.)
An overactive bladder (sometimes referred to as an unstable bladder
or as detrusor instability) can occur at any age and is the second
most common type of bladder problem - and the commonest in men and
in older people. (The most common in women and overall is stress
incontinence in which you leak urine when you cough, laugh or
take exercise.)
Most often it has no known cause, although it can occur following
a stroke or as a result of Multiple Sclerosis.
TREATMENTS
An overactive bladder can usually be cured and at worst can be
managed so that it does not to interfere with your ordinary life.
These are the main types of treatment:-
- Bladder retraining
- Drug Treatments
- Pelvic
Floor Exercises - which may be supplemented by electrical
stimulation. (The effectiveness of pelvic floor exercises to cure
an overactive bladder has not yet been fully researched or proven.)
OTHER POINTS
- In severe cases of overactive bladder you may be referred to
a specialist for investigation and possibly for surgery, although
surgery is not the preferred option, since it leaves many people
needing to use a catheter to empty their bladders. (A catheter
is a small flexible tube that you routinely pass through your
urethra into your bladder to drain it.)
- If at any time you experience a burning pain when passing water
or your urine is cloudy and smells unpleasant, it is possible
that you have an infection. You should see your doctor as soon
as possible.
- Avoid drinks which contain caffeine or fizzy drinks (such as
coffee, strong tea and cola drinks) as these may irritate your
bladder.
- Never cut down on your fluids to avoid the symptoms of any bladder
problem. This will only increase the risk of developing an infection
or, by making your urine more concentrated, risk irritating your
bladder into greater overactivity. You should aim to drink about
3-4 pints of fluid a day (about 2 litres).
- People who maintain a healthy, balanced diet are less likely
to suffer from this type of bladder condition.
Remember your Healthy Bladder Habits.
Bladder Retraining
The purpose of bladder retraining is to learn to suppress or ignore
the desire to pass water, so that you can get back to a more normal
pattern of going to the toilet. What you are doing is making the
bladder tolerate being stretched as it fills. This should mean you
do not need to go to the toilet so often or with such urgency and
should mean an end to any incontinent episodes.
Your aim, assuming an average intake of 3-4 pints (2 litres) of
liquid a day, is to get back to a normal pattern of emptying your
bladder no more than six to eight times a day. (The bladder should
be able to hold between three-quarters of a pint and a whole pint
(400-600 ml) before it needs to be emptied, and the first sensation
of a need to empty it usually comes when it is only half full.)
Bladder retraining is best done with the help of a physiotherapist
or a continence nurse specialist (your GP will put you in touch
with your local one or else you can phone the
Continence Foundation Helpline for details of local services)
- but it is possible to go it alone.
To start bladder retraining, you need to keep a record of how often
you pass water during the day. This record should be kept initially
for one week. Click
here for an example of a suitable blank bladder chart, which
you can print out. It also allows you to record any accidental episodes
of incontinence. You may also measure the amount you drink and the
amount of urine you pass, using a measuring jug, and record this
on a more detailed chart.
Once the record is completed you can work out how often, on average,
you pass water (and, if you have recorded it, the average amount
passed). You can then set your first target. Suppose you have been
passing urine about every hour: your first target might be to go
to the toilet only every hour and a half. You can aim also to increase
the average amount you pass each time.
You may wonder how you are going to manage to hang on for that
extra half hour. There are various techniques which may help. When
you get the urge to pass urine:-
- Sit on a hard seat or across a tightly rolled towel. This puts
pressure on the pelvic floor muscles.
- When your bladder contracts, and you feel an urgent need to
empty it, do five quick squeezes of your pelvic floor muscles.
Squeezing the muscles in the pelvic floor sends a message to your
bladder which helps calm it down.
Drug Treatments for Urge Incontinence
Your doctor may prescribe tablets which help to reduce the overactive
contractions of your bladder. There are several drugs which can
help, including oxybutinin (sold as Lyrinel and under other names),
propiverine (sold as Detrunorm), tolterodine (sold as Detrusitol),
trospium chloride (sold as Regurin) and solifenacin (sold as Vesicare).
These drugs are available in longer acting preparations which may
suit some people better and only need to be taken once a day. All
of these tablets may give you a dry mouth, heartburn, headaches
or constipation but these effects may be mild or lessen over time
and trials of the newer drugs suggest less severe side effects.
If the drug you are prescribed does not agree with you, ask your
doctor if it would be sensible to try an alternative.
It is important once you start taking drugs for your bladder that
you take them for several weeks, as it can take this long before
you really notice a difference in your bladder symptoms.
Surgery for Urge Incontinence
In very rare cases your doctor may suggest surgery to help with
urge incontinence. There are two types of surgical procedure which
might help – the first involves adding a piece of bowel wall
into the bladder wall to calm down the contractions. This often
means that the bladder can’t empty fully and requires you
to put in a catheter to do this for it. The alternative procedure
which is just starting to be used is botox injections (the same
material used for getting rid of wrinkles) into the bladder wall
via a telescope into the bladder This hasn’t been done for
very long and it is difficult to know what the long term effects
are but it certainly does help many people who are very hard to
treat using other methods. Before consenting to an operation, you
should discuss it fully with your surgeon. Make a list of questions
you want to ask, such as the following:
- what exactly is he or she going to do?
- what cut will he or she make, what stitches will there be, and
what sort of scar will be left?
- how long will you be in hospital, how long will you be off work
or convalescing?
- what permanent changes in your lifestyle will result - maybe
improvements, maybe limitations?
- how often has your surgeon performed the operation? with what
results?
- what are the chances of a complete cure for your incontinence?
of a substantial improvement?
- will the change be permanent? if not, how long will it last?
- what adverse effects may there be? how likely are they? are
they treatable? how?
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