What is an Overactive bladder?
Overactive bladder (OAB) is a relatively common condition. Typical symptoms include frequent urination, frequent night time urination, the persistent urge to urinate and urine leakage or incontinence. About 12% of the total adult population suffer from OAB and usually the cause is unknown, although anxiety can make it worse. People with neurological disease such as multiple sclerosis or Parkinson’s disease are at particular risk of OAB because of nerve damage resulting in incorrect signals sent to the bladder.
Symptoms of OAB
Several symptoms are commonly associated with OAB and someone can have one or all of them. The most common symptom is an urgent need to urinate, including nocturia, which is the need to urinate at least twice overnight. Sometimes the urge to urinate is so strong that it can’t be controlled, causing urine to leak before making it to the bathroom. It can also occur when laughing, sneezing, coughing, or during exercise.
OAB and the prostate
Many cases of OAB in men are caused by an enlarged prostate gland, especially in later life as around 50% of men will have an enlarged prostate by the time they’re 60, and 90% by the age of 85. The prostate can block the flow of urine by pressing on the urethra – the tube that releases urine, causing the symptoms.
An infection in the urinary tract or bladder can cause the bladder to become ‘irritable’ and spasm. It’s also possible for temporary factors to cause symptoms for example drinking a lot of fluids, especially those that are caffeinated or contain alcohol, taking medications like ‘water tablets’ that increase urine output.
- weak muscles near the bladder
- bladder stones
- uncontrolled diabetes
- mobility issues
The first test will be a urine sample to check for the presence of infection or kidney stones. If there is an infection, then a short course of antibiotics can be prescribed, but the doctor will also want to know why the infection is present. Women get more frequent urine infections as their urethra is relatively short, so external bacteria can make their way up the urethra and into the bladder. In men however, the urethra is much longer, so urine infections in men are taken more seriously as there may be another underlying factor.
Another test will be to complete a 4-day frequency/volume chart to record the time of voiding and volumes of urine passed. At this stage there may also be a ‘flow’ test where urine is passed into a special machine to measure the strength of the flow and to check whether the bladder is emptied completely.
Treating OAB with lifestyle changes
Changing drinking habits
There are number of drinks that may irritate the bladder such as caffeinated drinks, carbonated drinks, drinks containing aspartame (artificial sweetener found in diet drinks), hot chocolate, green tea, alcohol, blackcurrant juice and citrus fruit juice. Drinks which don’t irritate the bladder are: water, herbal and fruit tea, milk and diluted fruit juice. People with OAB are advised to think carefully about their fluid intake.
Around 1-1.5 litres a day should be drunk; adjust the amount according to need; being thirsty is a guide that the body needs water. So if exercising, or in a hot climate, there will be sweating and water loss, which will need to be compensated for. Remember also that food contains water, particularly fruits and vegetables; which can be up to half a litre each day. It’s recommended with OAB, to reduce the fluid input by 25%.
If having to get up at night to pass urine, then reduce evening fluid intake, particularly for four hours before going to bed and also avoid caffeine and alcohol.
The purpose of bladder training is to help regain control of the overactive bladder by suppressing its contractions. Instead of rushing to the toilet as soon as there is an urge (strong desire) to pass urine, it is important to try to hold on. If this is difficult, try distraction techniques such as crossing the legs or sitting on a rolled up towel. The aim should be to gradually increase the capacity of the bladder and the time interval between voiding (passing water).
Start by passing urine every hour on the hour whether there is a need to go or not from first thing in the morning until bedtime.
Try hard not to void outside the set hourly times.
Practice this for 3-4 days and then when this has been mastered, gradually increase the time between voiding.
1 & 1/4 hours for 1 week or until mastered
1 & 1/2 hours for 1 week or until mastered
1 & 3/4 hours for 1 week or until mastered
2 hours for 1 week or until mastered
2 & 1/4 hours for 1 week or until mastered
2 & 1/2 hours for 1 week or until mastered
2 & 3/4 hours for 1 week or until mastered
3 hours for 1 week then may be longer if you feel able.
It’s important to note that bladder training takes time and needs full commitment as it can take up to 3 months to show any lasting benefit.
If diagnosed with OAB, the doctor will likely recommend lifestyle changes to begin with and they may advise:
- keeping a record of bathroom habits
- sticking to a regular bathroom schedule
- the use absorbent pads to manage leaks
- diet adjustments to maintain a healthy weight
Many men can also improve their bladder control with the help of the right exercises. Pelvic floor exercises, also known as Kegel exercises can help prevent, reduce or manage urine leakage problems.
Find your pelvic floor muscles
Pelvic floor muscle exercises improve the strength of the pelvic floor muscles and help control of the bladder and therefore urine flow. A good way to find the pelvic floor muscles is to try to stop or slow down the flow of urine whilst urinating.
However – stopping and slowing down the flow of urine is not a pelvic floor exercise in itself and should NOT be used as an exercise, as it could disrupt the normal emptying reflex. It’s simply a way to locate the right muscles.
It’s best to do the exercises lying down at first as to begin with, the muscles aren’t strong enough, and won’t be able to work against gravity. Lying down also makes it easier to feel that the right muscles are working and that they’re clenched to the maximum. Clench the muscles and count to ten, and then try as many repetitions as possible. It may only be possible to do three or four lots to begin with, but if done at least three times a day, it won’t take long for the muscles to become stronger.
If lifestyle changes aren’t enough to control symptoms, the doctor may recommend medications. If the OAB is caused by an enlarged prostate, alpha blockers can help relax the surrounding muscles to improve urine flow. Other drugs can also help treat symptoms, including drugs that reduce bladder spasm which can help reduce the urge to urinate.
In some cases, you might develop OAB when nerves in the body send inappropriate signals to the bladder. Nerve stimulation can help to regulate the signals. A small device can be placed under the skin near the tailbone. It will deliver electrical impulses to the nerves running the bladder. Like a pacemaker in the heart, these impulses will help control bladder contractions. This treatment is reversible, and the device can be easily removed.
In the meantime, whilst waiting for any interventions to yield results, some people like the reassurance of pads in case of any leaks. Tena offer free samples for people to try. Follow the link below
OAB is not something you should be embarrassed about or try to hide. Seek help if and when you need it. Join or start the conversation about OAB in the comment section below.