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OVERACTIVE BLADDER

An overactive bladder (OAB) is where a person regularly gets a sudden and compelling need or desire to pass urine. This sensation is difficult to put off (defer) and this can happen at any time during the day or night, often without any warning.

What are the symptoms of OAB?

Urinary urgency and urgency incontinence

If your bladder squeezes (contracts) without any warning it can give you an urgent need to pass urine, that is ‘when you have to go, you have to go’. This gives you a little or no time to get to the toilet. This is called urinary urgency. If the need to pass urine is so intense that you cannot hold on to it, it can lead to involuntary leakage of urine which is called urgency urinary incontinence.

Urinary frequency

If you have urinary urgency, this means that you need to pass urine often and more frequently than usual and in small volumes. The number of times people normally have to pass urine each day is very varied, but people with overactive bladders tend to pass urine more often than they would expect during the daytime.

Nocturia

Overactive bladder can also cause you to get up at night several times to pass urine. Sometimes disturbed nights can be the main problem. Urinary tract problems other than OAB can also cause nocturia, so this symptom may persist even if other OAB problems respond to treatment.

What is the cause of OAB?

OAB is common and can affect people of all ages, including children and the elderly. About 12% of the total adult population suffer from OAB. Usually the cause is unknown. Anxiety can make the problem worse. The type of fluid you drink can also influence your symptoms.

What are the treatment options?

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 are believed not to 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. Aim to drink about 1-1.5 litres a day; you can adjust the amount you drink according to your need; being thirsty is a guide that your body needs water. Remember that your food contains water, particularly fruits and vegetables; this can be up to half a litre each day. It is recommended that if you have OAB, to reduce your fluid input by 25%, as long as you drink more than one litre of fluid a day.

If you are getting up at night to pass urine, then try to reduce your fluid intake in the evening, four hours before going to bed. Avoid caffeine and alcohol before going to bed. If you feel thirsty or need to take medications, then you can have small sips of water.

Bladder training

The purpose of bladder training is to help you to regain control of your overactive bladder by suppressing its contractions. Instead of rushing to the toilet as soon as you get the urge (strong desire) to pass urine, it is important to try to hold on. If you have difficulty doing this, try to distract yourself by doing something else such as sitting on your feet, crossing your legs or sitting on a rolled up towel. You should aim gradually to increase the capacity of your bladder and the time interval between voiding (passing water).

Start by passing urine every hour on the hour whether you need to go or not from when you get up in the morning until you go to bed at night. Try hard not to void outside your set times. Practice this for 3-4 days. When you feel you have mastered this, gradually increase the time between voiding.

It is helpful to carry out pelvic floor exercises to help you suppress your urgency feeling, for example when getting up from a sitting position, when hearing running water or putting the key in the door.

It is important to note that bladder training takes time and needs your full commitment as it can take several months to show any benefit.

Medicines that help

There are various medicines that you can try. The medicines are called antimuscarinics or anticholinergics. They work by blocking certain nerve impulses to the bladder which stops it contracting when it should not contract, and therefore improve symptoms in some cases, but not all. The amount of improvement varies from person to person. You may have fewer toilet trips, fewer urine leaks, and less urgency. However, it is uncommon for symptoms to go completely with medication alone.

Symptoms may return after you finish a course of medication. However, if you combine a course of medication with bladder training, the long-term outlook may be better and symptoms may be less likely to return when you stop the medication.

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