The Overactive Bladder
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 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 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 that 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, the risk of irritating your bladder into greater overactivity. You should aim to drink about 3-4 pints of fluid a day (about 2 liters).
People who maintain a healthy, balanced diet are less likely to suffer from this type of bladder condition.
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 liters) 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.)
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.
Other Treatments for Urge Incontinence
Your doctor may prescribe tablets that help to reduce the overactive contractions of your bladder. 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. In very rare cases your doctor may suggest surgery to help with urge incontinence treatment.