One in six people in the UK suffer from an overactive bladder and need to visit the toilet many times a day, often with great urgency. This distressing condition can lead to social isolation, an inability to work and great embarrassment. It is surprisingly common but the underlying causes are not well known. It can affect anyone as they get older but this is a purely physiological problem, not an effect of dementia. An overactive bladder often responds well to lifestyle changes and coping strategies but medical and surgical treatments are available for the most severe cases.
This article on an overactive bladder is by Kathryn Senior, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.
What it means to have an overactive bladder
The kidneys produce a constant flow of urine as the body rids itself of toxic waste products. Producing more or less dilute urine also regulates the body’s fluid levels. If you drink two pints of water, for example, you naturally need the loo more often over the next couple of hours. Normally this is not a problem; urine accumulates in the bladder, which expands to accommodate it, until it’s convenient to pass water. Most people visit the toilet around five or six times a day and pass around 250-350ml of urine each time.
Overactive bladder syndrome occurs where the bladder muscles contract involuntarily before they need to, producing a sudden urgent need for the toilet. The problem makes those affected need to be near a toilet as they have to go very frequently and with little warning. In severe cases, an overactive bladder causes leaking, or urge incontinence, before reaching the toilet.
1 in 6 UK adults report some of the symptoms of overactive bladder and half experience urge incontinence. While overactive bladder increases with age, it should not be confused with urination problems related to dementia, Parkinson’s disease, or problems following a stroke, as in these cases there is an identifiable cause. Overactive bladder has no known cause.
In many cases, a few basic lifestyle changes can go a long way towards improving the symptoms of an overactive bladder. Some dos and don’ts include:
- DO make getting to the toilet as simple as possible. This will stop anxiety building up and making you feel worse about your overactive bladder. If you don’t have an ensuite toilet, keep a commode in your bedroom.
- DON’T drink too much alcohol or coffee. Both act as diuretics and make you produce more urine; they are likely to make an overactive bladder much worse.
- DO drink normal amounts of fluid – at least 2 litres a day. It may seem logical to cut down your fluid intake but this only concentrates the urine and irritates your overactive bladder.
- DON’T be tempted to go the toilet more often ‘just in case’. This trains an overactive bladder to hold less urine and makes it more sensitive when called on to hold more for longer.
Training an overactive bladder
The next step in treating an overactive bladder is training. This simple process is designed to extend the time between toilet visits and increase the amount of urine your overactive bladder can comfortably hold.
Like any training programme, it involves making small steps in the right direction so that you build up the capacity of your bladder. It is unrealistic to expect to see a difference overnight and it takes work and commitment. For this reason, many overactive bladder specialists recommend keeping a bladder diary. This helps you appreciate how much progress you are making over time. In your bladder diary, you should record how many times you visit the toilet each day and the amount of urine you produce. Over the following days and weeks, the idea is to gradually extend the time between toilet visits and produce larger volumes of urine each time.
Another form of bladder training is to try and set specific times for toilet visits. Again, the amount of time between these scheduled visits can then be gradually increased to train your overactive bladder to hold on for longer. Pelvic floor exercises may help with bladder training, but the evidence is inconclusive for cases of overactive bladder that don’t occur with other complications, such as stress incontinence.
Lifestyle changes and bladder training, with the support of your GP, continence nurse or other specialist, will often be enough to bring an overactive bladder under control. If not, there are medical treatments. One therapy you are likely to be offered involves taking drugs that are known as antimuscarinics or anticholinergics. These block the nerve impulses to and from the bladder and can be successful at calming an irritable and overactive bladder. These medicines help to relax the bladder and expand its capacity but they should not be seen as a long-term solution. They are usually prescribed for a few months to ‘kick start’ bladder training or to build confidence and the self-help and training techniques should also be adopted.
In extreme cases of overactive bladder, where none of the above treatments have worked, surgery may be offered as a last resort. This can take several forms, including:
- Bladder implant – similar to a heart pacemaker, this implant stimulates the sacral nerve to create a more natural pattern of bladder contraction.
- Bladder augmentation – in this operation, a small section of the intestine is used to increase the size of the overactive bladder. This can impair overall function and a catheter may be needed to completely empty the bladder.
- Botox – there is evidence that Botox can relax the muscles of an overactive bladder. BOTOX has not been licensed in the UK for this purpose but it can be used ‘off-label’.
- Urinary stoma – in the most extreme cases of overactive bladder, if all else fails, the urine is diverted away from the bladder completely to an opening in the side of the body where a urinary stoma bag is attached to collect it.