Consultant Gynaecologist and Specialist in Pelvic Floor Surgery

Bladder problems

Overactive Bladder

Normal bladder function
The bladder stores urine and acts like a balloon and fills up gradually and should hold around a pint (500ml) of urine. The kidneys produce urine and the amount depends on the volume of fluid consumed and activity.

It is normal to pass urine up to 6-8 times during the day and once at night. The amount of fluid you drink will effect how often you need to pass urine. For most people the average fluid intake should be approximately 1.5 – 2 litres a day.

Normal bladder muscle called detrusor muscle remains relaxed when filling up and the small muscles at the outlet of the bladder (urethra) remain contracted with extra support from the pelvic floor muscles to maintain continence and avoid leakage of urine.

Normally one goes to pass urine when it is socially appropriate and at this time, the bladder muscles contracts and the small muscles at the outlet (urethra) and pelvic floor muscles relax and the bladder is emptied. This mechanism is maintained by complex messages between the brain, bladder and pelvic floor muscles. Any disruption to this mechanism may result in problems with bladder control and urinary leakage.

What is an overactive bladder?

Sudden bladder muscle contractions without warning associated with an urgent need to pass urine (urgency) and little or no time to get to the toilet.
There is often a desire to pass small amounts of urine more frequently during the day and at night. If the bladder muscle contractions are large and the pelvic floor muscles are weak then leakage of urine can occur and this called urge incontinence.

How is it diagnosed?
The diagnosis can be made from your complaints and by completing a bladder diary
Tests to assess the bladder function (urodynamics) may be required.

What treatment options are available?

Lifestyle changes
Lifestyle changes such as drinking between 1.5-2 litres of fluid per day, avoiding drinks that irritate the bladder and avoiding nicotine may be helpful.

There are many drinks that irritate the bladder such as

Bladder retraining
Learning to hold off rushing to the toilet as soon as you get the urge to pass urine.
Going to pass urine too often toilet makes the problem – as the bladder does not stretch to hold normal amounts of urine and this results in a vicious cycle.
You MUST avoid ‘just in case’ visits to the toilet.

Bladder retraining is a gradual process so if you find you are going to the toilet every half an hour, try extending the time by 10 minutes for a week, then by 15 minutes for a week, and then 30 minutes till you can ideally hold on for 3-4 hours.
Performing pelvic floor exercises (which you can learn) is quite useful to suppress the feeling of urgency and avoid rushing to the toilet.

Medical treatments:
There are a number drugs that help to suppress the feeling of urgency by a number of mechanisms such as inhibiting the bladder muscle contractions (anti-cholinergics) or relaxing the bladder muscle (beta-adrenoceptor agonist).
The resultant effect is an increase in the interval between voids and also a reduction in the urgency and leak episodes.

The tablets may not work or may need to be discontinued due to side effects such as dry mouth or constipation.

Botox Bladder Injections
Botox is a bacterial toxin that can help in the treatment of an overactive bladder. It works by relaxing the bladder muscle by temporarily paralysing nerves within in the bladder muscle.

It is an invasive procedure involving injections into the bladder and is only performed as a last resort. Only women who have failed on at least 3 drugs will be considered for Botox therapy. Complications include urine infection and urinary retention (inability to pass urine) that may require self – catheterisation for a few months.

For more information visit – www.bladderandbowelfoundation.org/

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