Opening up about Overactive Bladder Syndrome…
For must of us, planning out our toilet trips and our bladder’s daily functions is not something we really think about. But for some women it is ALL they think about, it is at the forefront of their mind and it governs their life, which can cause distress, anxiety and depression. Frequent daily toilet trips, accompanied by a strong feeling of urgency with or without urinary leakage may indicate an overactive bladder. Read on to find out more about Overactive Bladder Syndrome, what it is and how it can be treated. Don’t ignore your bladder symptoms, there is help out there!
What is Overactive Bladder Syndrome?
As we drink throughout the day, the bladder fills and in normal healthy adults, it is able to hold around 400-600mls of fluid [approximately one pint]. When the bladder is about half full, the muscle that surrounds it [the Detrusor muscle] starts to become stretched, and this sends signals to the brain telling it that the bladder is becoming full and it is nearly time to empty. At this point we get the feeling that we may need to pass urine – also referred to as a sense of urgency. We can normally put this feeling off for a little while, until there is an appropriate time to go, or until the bladder fills to the point whereby we can’t put it off any longer. When the time is right, the pelvic floor muscles relax, the Detrusor contracts, the bladder empties and we can go on our way until the next time, normally 2 to 3 hours later.
However in Overactive Bladder syndrome, things work a little differently. The bladder contracts involuntarily as it fills, resulting in a frequent feeling of urgency and need to pass urine without the bladder being full, which may be as often as every 20 minutes throughout the day, and often at night. The sense of urgency and desire to pass urine may be very difficult to defer and control, and an involuntary leakage of urine may occur at these times. This has an uncomfortable and distressing impact on the person’s quality of life and is strongly linked with depression and anxiety.
What causes it?
There are several factors that may cause Overactive Bladder Syndrome or may make it worse.
- Urinary tract infections may inflame and irritate the lining of the bladder, which can make it more sensitive and prone to being overactive.
- Caffeinated and carbonated drinks and some citrus and spicy foods may cause irritation of the bladder.
- Certain neurological conditions including Multiple Sclerosis may disrupt normal bladder function.
- Sometimes the bladder may fail to empty completely. If there is an obstruction or if there is a prolapse blocking the flow of urine, this can lead to an overactive bladder as there is not enough storage space available.
- Certain medications may disrupt bladder activity.
- Bladder abnormalities such as tumors or bladder stones.
- Sometimes there is no known cause for Overactive Bladder Syndrome.
What are the main signs and symptoms of Overactive Bladder?
- A frequent need to pass urine throughout the day which is difficult to defer
- Leakage of urine may occur with the feelings of urgency
- Having to get up in the night at least once to pass urine
- Small volumes of urine are passed
- Symptoms may be consistent with Cystitis, but there is an absence of actual infection.
- The brain and bladder may get used to you passing urine at certain times and may link particular activities with having to go. ‘Key in lock’ and running water can be examples of this.
- Many women ‘toilet-map’ when they are out in preparation of episodes of urgency.
- Normal toilet trips for a healthy adult bladder are around 7 times a day depending on how much you drink. You should be able to space out your toilet trips to at least every two hours. Having to get up in the night to pass urine isn’t usually normal. Ladies over menopausal years may get up once a night but any more than this is not usually normal.
- The brain is strongly linked to how the bladder functions. Stress and emotions may exacerbate symptoms of urgency.
- You may have a dysfunction of your Pelvic Floor muscles. Underactive and Overactive pelvic floor muscles have been linked with altered Bladder function and overactivity.
How may it be diagnosed?
If you suspect you may have an Overactive Bladder, seeking some help through your GP and/or Women’s Health Physiotherapist may help to confirm this. You may also be referred to your local Urogynaecology team, who may perform some urodynamic investigations of your bladder function during filling and emptying to determine if you have an Overactive Detrusor muscle, or if there are any problems with the flow of urine.
You may be asked to complete a bladder diary, which is a useful tool to establish how much fluid input and output is occurring throughout the day, how many times and at what intervals you are going to the toilet, periods of urgency and leakage episodes.
A Women’s Health Physiotherapist may be able to assess how your Pelvic Floor muscles are functioning which may also affect your overactive bladder.
How is it treated?
Once Overactive Bladder Syndrome has been diagnosed the first line of treatment is to undergo Bladder retraining, which may be under the supervision of a Women’s Health Physiotherapist. Training will be based on the outcome of your bladder diary and will normally be undertaken for at least 6 weeks.
The intervals between your toilet trips will be gradually spaced out, with the aiming of stretching your bladder and training both bladder and brain, to enable larger volumes of fluid to be stored, to teach the bladder to function more normally. This training may be very difficult to begin with and leakages of urine may occur whilst training, however over time, the intervals between toilet trips may be increased, aiming to reach every 2-3 hours.
Timed voiding is another strategy that can be used, whereby you have set intervals throughout the day that you are can pass urine.
Pelvic floor rehabilitation is often undertaken in tandem with bladder retraining.
If bladder training and pelvic floor rehab does not improve your symptoms, there are medications available which may be prescribed.
Self-help strategies for Overactive Bladder
There are several strategies you may be able to try yourself which can help with Overactive bladder;
- Cut out caffeine, carbonated drinks, spicy foods and citrus fruits from your diet
- Don’t limit your intake of fluid. You should aim to take in 2 litres of water a day. If your urine is more concentrated this can make your bladder more irritable.
- There is a strong link with being overweight and Overactive Bladder. Trying to reduce your weight and undertaking regular gentle aerobic exercise such as walking daily may help.
- The brain is strongly linked to how the bladder functions and several areas of the brain including emotional centres are active in the process of passing urine. There may be a link with increased bladder urgency and stressful situations or emotional states. Trying to reduce your stress levels may help reduce episodes of urgency. Bringing joy into your world through activity, relaxation, meditation, sex and any other activity that brings calm or happiness along with it, is very therapeutic for this condition.
- The pelvic floor muscles can inhibit detrusor activity. When the pelvic floor contracts, the detrusor must relax and vice versa. Therefore Pelvic floor contractions may help to control feelings of urgency.
- Pressing up and down onto your toes, or squeezing your bottom muscles may also help to control feelings of urgency by inhibiting neural activation of the bladder muscle. Practising these exercises during an urge episode may help to switch off the bladder muscle, thus reducing the sense of urge. Distraction techniques may also help, such as counting backwards from 100 in 7’s, or focusing on deep breathing to help relax the body and mind. Once the sense of urgency has passed, try to continue with your daily activity as normal, until the next urge comes along.
- Try to start stretching out your toilet trips by 5-10 minutes initially, increasing this time over time. This can be difficult when you first start and you may find using a pad may be beneficial to help manage leakage episodes.
For further help with Overactive bladder Syndrome, bladder retraining or how Women’s Health Physiotherapy can help with Overactive Bladder, feel free to send us an email – we are here to help!