Retraining an overactive bladder

Transcription

1 Retraining an overactive bladder What is an overactive bladder? Three factors make up the diagnosis of an overactive bladder. You can have all three, just one or various combinations or degrees of each factor. Going to the toilet too often urinary frequency Urgency to pass urine which is abnormal to you urinary urgency Leaking urine if you don t get to the toilet on time urge incontinence. A diagnosis of an overactive bladder is usually made: From symptoms as identified above From a bladder chart or diary Following investigations such as ultrasound, urinalysis and urodynamics. What is bladder retraining? Bladder retraining is a behavioural (self-help) treatment for people with overactive bladders. It aims to increase the gaps between visits to the toilet and increase the amount you pass each time. The treatment has no side-effects and when combined with medication, research has shown it can be very effective. Bladder retraining may not be so effective in people who have had life long bladder problems and in the elderly. Your bladder health Your bladder structure is important for your bladder to be healthy. Your bladder is a muscular bag, which needs to shrink and expand to allow you to store and pass urine when you wish to. To allow this to happen you need a good blood supply to your bladder muscle and a working nervous and immune system. The main tasks of your bladder are to store and pass urine. Your bladder has to store enough urine (between 250 and 500ml) to allow you to do daily activities and have enough sleep. At night it is normal to pass urine once. This usually increases over the age of 60 years, and you can pass urine up to four times a night by the age of 90. If you make your bladder hold too much urine, that is more than 600ml, it can damage your bladder. Your bladder also has to pass urine. You learnt to control this as a child. You need to empty your bladder completely and regularly every three to four hours during the day. Some bacteria will be able to get into your bladder and this is normal. Regular and complete emptying of your bladder will prevent you developing a urinary tract infection by flushing out these bacteria. It is not normal for you to have to strain to empty your bladder. Your bladder empties best when you are standing (men) or sitting (women). Urine is produced by your kidneys and helps to maintain a healthy bladder. Your urine contains waste products and chemicals not required by your body. Some can be toxic, such as nicotine (from smoking), which may affect bladder health in the long term (e.g. increased risk of bladder cancer). Your urine is acidic and this creates a bladder environment where bacteria cannot survive. You need a good urinary flow to flush out bacteria and this needs to be over 200mls each time to be effective. Finally, think about your bladder and how it works. Are you doing all you can to keep your bladder healthy?

2 What causes an overactive bladder? Prostate enlargement in men Diseases which affect the nervous system such as dementia, stroke, Parkinson s disease, multiple sclerosis, spina bifida, diabetes, spinal cord injury Sometimes we do not know why it develops (idiopathic) It is more common in women It is more likely with advancing age. What will bladder retraining achieve? Reduce the total daytime visits you make to the toilet to under 8 each day Increase the time between toilet visits to about three hours Reduce severe urgency to pass urine and make it more controllable Make your bladder hold more urine When you pass urine it should be over 250mls and under 600mls at a time Reduce the number of times you pass urine at night Reduce or stop urinary leakage you get when you don t make it to the toilet in time. Reduce your anxiety about your bladder and increase your confidence. Our bladder retraining programme In this programme you will: Be asked to fill in a self assessment questionnaire Be asked to fill in a symptom questionnaire Be asked to fill in a bladder chart Be assessed to check if bladder retraining is appropriate for you Be given a copy of this leaflet to read Be invited to do pelvic muscle exercises in conjunction with bladder retraining Be given a leaflet on pelvic floor muscle exercises and an explanation on how to carry them out Have your progress reviewed at agreed intervals. Methods for bladder retraining Bladder retraining requires you to hold on and not go to the toilet so often. You may need to do pelvic muscle exercises to help you hold on. If you wake up at night with a strong urge to pass urine, then use the toilet. As you progress you may be able to go back to sleep without getting up. Start to avoid going just in case or every time you are near the toilet. Start to miss the occasional toilet stop. When you have an urge to pass urine, sitting down often helps. Be prepared that leakage may be a little worse when you start bladder retraining. Watching the television or counting back from 100 may take your mind off thinking about the toilet. Always try to avoid going to the toilet on a strong urge.

3 Method one: When you have the urge to pass urine, go to the toilet and get ready to pass urine. Count to 60 before you pass urine. If you leak some urine this will not be a problem as you are over the toilet. Continue to count to 60 until you do not leak urine Now start to count to 60 before going to the toilet and when you get there again count to 60 Now start to extend the time from 60 seconds. Remember it is easier to control your bladder if you sit down Continue this until you can wait for 15 minutes without any leakage Remember you are in control of your bladder. Method two If you get urgency when you arrive home and put your key in the door, the next time you arrive home start by: Putting the key in the door and before opening it count to 60 As you master this and the urge gets less, after counting 60, open the door and go inside Go to the toilet and get ready to pass urine. Count to 60 before you pass urine. If you leak some this will not be a problem as you are over the toilet Continue to count to 60 until you do not leak urine Now start to count to 60 before going to the toilet and when you get there again count to 60 Now start to extend the time from 60 seconds. Remember it is easier to control your bladder if you sit down. Once inside the house, now put the kettle on, wait for it to boil, make a drink and then go to the toilet Continue this until you can wait for 15 minutes without any leakage Remember you are in control of your bladder. General information about fluid intake You should drink about eight teacups or five mugs of mixed fluids each day (1.5 litres or 2¾ pints) Drinking more than this e.g. over two litres (3½ pints), may cause you to pass water frequently or get up to the toilet at night Drinks taken on an empty stomach may be absorbed and passed as urine quickly A rough rule of thumb is one drink = one urine Adults should produce over a litre (1¾ pints) of pale yellow urine each day. If you do not drink at least one litre (1¾ pints) per day: You will produce concentrated urine that may irritate your bladder It may increase the risk of urinary infection particularly in women Your bladder may not work as well as it should because it has less urine to store You may become dehydrated with some of the following symptoms: headache, dry mouth, thirst, sunken cheeks, pale face, cold skin, weight loss and passing small amounts of urine.

4 To prevent dehydration ensure you: Drink enough (water is best) throughout the day, not only when you feel thirsty Drink at work, but if access is limited take some with you, especially water Increase the amount you drink during hot weather and exercise because you sweat more Drink more if you have a temperature or fever Visit your doctor if you continue to be thirsty all of the time. It is sensible to drink less: If going on a long journey or an outing, but make sure you drink 1.5 litres at some time during the day If your bladder does not empty properly, drinking over 1.5 litres daily can make your bladder symptoms worse If you have lots of problems with your bladder, have your drinks when it is easier to get to a toilet. If you get up to the toilet more than once at night: Try avoiding caffeine-based drinks for five hours before bedtime as they can keep you awake Cutting down your total evening drinks may help Just take sips if you are thirsty during the night When you wake in the morning and have a drink you produce some of your largest volumes of urine. This is due to hormonal activity on your kidneys and is normal. Grapefruit juice Grapefruit and grapefruit juice are known to interact with some medicines, increasing or decreasing the desired effect. To be safe it is not advisable to take any medicines with either of these. Please read the leaflet that comes with your medication to check if it is affected by grapefruit. Herbal teas It does not always follow that herbal drinks or teas are healthier than conventional ones. If you have high blood pressure, avoid Jasmine and Blackcurrant. Many herbal teas should be avoided during pregnancy and while breast feeding. Chamomile tea may help with some bladder problems, but have no more than three cups per day. Chamomile tea should not be taken if you have any allergies, are asthmatic, have eczema, are on blood thinning tablets (anticoagulants), are pregnant or while breast feeding. Coffee and caffeine Caffeine is found in coffee, tea, chocolate, cola and many painkilling tablets (prescribed or bought). You can become used to the effects of caffeine so may not notice those mentioned in this booklet. Very rarely tea or coffee may cause allergy. A maximum of 6 cups of coffee a day is advised. Caffeine is best avoided during pregnancy or while breast feeding. You should also avoid caffeine or have fewer than six cups of coffee a day, if you have high blood pressure, high cholesterol or kidney, liver or heart disease. When using decaffeinated drinks, ensure the

5 caffeine has not been extracted by chemical methods. Caffeine increases acid secretion in your stomach and can cause or aggravate ulcers, heartburn or indigestion. Caffeine can affect your bladder by: Slightly increasing the amount of urine you produce Reducing the length and depth of your sleep, so indirectly increasing the number of times you might pass water at night Increasing urinary urgency, frequency and getting up to the toilet at night (nocturia) if you have an overactive bladder Slightly reducing pelvic muscle tone which may mean you leak urine more. We recommend that all patients on our bladder retraining programme try to cut out caffeine to see if their bladder symptoms improve. Cutting down on caffeine If you stop taking coffee and caffeine do it gradually over two weeks to avoid the following withdrawal symptoms: Headache / drowsiness / stomach upsets / irritability / muscle pain / sweating / a runny nose Some facts about cranberry juice It may be helpful if you have repeated urinary tract infections or cystitis. If taken regularly it may reduce the frequency or severity of urinary infections or cystitis. Tannins, not the acidity, in cranberries have been found to stop some bacteria from growing and multiplying in the bladder, so helping to prevent urinary tract infection. The benefits may not be seen for up to eight weeks when taking this juice so it should be taken regularly to be effective. Cranberry capsules may not contain tannins so we are not sure how effective they are. Cranberry juice may be helpful if you have: Cystitis caused by infection as it may stop or reduce the attacks Smelly urine as it may reduce the smell Recurrent urinary infections as it may reduce these An indwelling catheter or undertake intermittent self-catheterisation as it may reduce urinary infection and catheter blockage A reconstructed bladder made out of bowel as it may reduce mucus production, stone formation and urinary infections A urostomy as it may reduce mucus production and reduce the risk of infection. How much cranberry juice should you drink? 200mls (a large mug or glass) twice a day Drink it with your meals so as not to upset your stomach Buy the brand which contains most pure juice. Some supermarket own brands can be cheaper but may have a lower juice content If you dilute your cranberry juice or mix with something else it may be less effective so you will need to drink more.

6 Remember when drinking cranberry juice: It is not a cure-all for all bladder problems It may harm your teeth It may increase your weight because of its calorie content Diabetics should consult a dietician before taking even the low sugar variety Arthritis may be aggravated by any acid based drink It may cause heartburn or upset a hiatus hernia May cause diarrhoea if you have Irritable Bowel Syndrome, diverticular disease or colitis During attacks of cystitis the acidity of cranberry juice may cause bladder pain It is not known whether cranberry juice reacts with medication, so avoid taking them together When travelling abroad it is not always available. Fluids and your bowels Taking a hot or very cold drink in the morning may stimulate your bowels to work. If you increase the fibre in your diet you also need to increase your fluids, although research does not indicate that constipation is improved by increasing fluid alone. Drink more if you have an episode of diarrhoea to prevent dehydration. If you have a loose stool, but no diarrhoea, consider the type of fluid you are drinking, e.g. artificial sweeteners such as sorbitol may cause this. Cutting down on fizzy drinks may help to avoid excessive wind. Coffee stimulates bowel activity so can have a laxative effect. Its action starts within minutes of taking it and lasts for about an hour, affecting men and women equally. Decaffeinated coffee has the same effect, indicating that caffeine is not involved. If you are constipated coffee may stimulate a bowel movement. If you have heartburn, indigestion, stomach ulcers, itchy bottom, diarrhoea, irritable bowel syndrome or poor bowel control, stop drinking coffee and see if your symptoms improve. Caffeine can also cause your motions to be loose. Acid based fruit drinks, including cranberry juice, may cause diarrhoea if you have irritable bowel syndrome (IBS), diverticular disease or colitis. Some facts about alcohol It can be part of your total fluid intake for the day Take in moderation Avoid taking medication with alcohol, read the leaflet with your medication carefully It can dehydrate you Do not drive or operate machinery if you have taken alcohol Beer may help to make your bowels work Sherry may stimulate your appetite Alcohol can be protective in heart disease if taken in small amounts A small alcoholic drink at bed time may help you to relax Red wine or grape juice may help to thin your blood. How much alcohol is it advisable to drink? Women are advised to limit themselves to under 14 units per week and men under 21 units per week One unit = one small glass of wine or half a pint of weak beer or one measure of spirits.

7 Never Sometimes Always Electrical stimulation This therapy has been used to reduce urinary urgency and frequency. At present it is only available locally from a physiotherapist. Medication A range of drugs called anticholinergics are available to help with overactive bladders. These drugs work by reducing urgency and increasing the volume of urine your bladder holds. The most common drug in this group is called Oxybutynin. Research has shown that combining bladder retraining with anticholinergics is more successful. Anticholinergic medications will not cure your bladder problem: they may only relieve your symptoms. Anticholinergics should be stopped every three months for a few days to see if they are still having any effect. Anticholinergics are prescribed by your doctor. Please read the leaflet that comes with your medication carefully. Anticholinergic drugs have a number of side effects and the following list outlines the main ones. If you are taking anticholinergics please take a few moments to answer all 19 questions. Side effect of drug 1 Dry mouth 2 Indigestion (Dyspepsia) 3 Constipation 4 Diarrhoea 5 Abdominal/tummy pain 6 Wind (flatulence) 7 Vomiting 8 Skin rash 9 Headache 10 Dry skin 11 Somnolence / drowsy / tired 12 Nervousness, restless 13 Paraesthesia (loss of sensation) 14 Blurred vision, difficulty in focusing your eyes 15 Chest pain / palpitations 16 Allergic reaction 17 Urinary retention

8 18 Confusion 19 Feeling hot/heat sensation Have you stopped the drug because of the side effects? Yes No Have you stopped the drug to see if it is having any effect? Yes No Bladder retraining Key points to remember If you display this poster (in your toilet?) it may help you to keep to your programme. Take control It s your bladder and you re the boss. Don t allow it to control you. Always hold on When you have the urge to pass urine use the inhibition techniques you have been taught. Keep a diary This will help you see how you are improving. Enjoy your fluids It's important to drink about 1.5 litres (8 cups) each day. Include water, not just tea and coffee. Carry on Don t give up. It takes time, so it may be several weeks before you see an improvement. Only day time If you are disturbed at night by the urge to pass urine, don't worry - go to the toilet. Never go just in case Don't use any and every opportunity to go to the toilet. Time yourself Keep increasing the time you can "hold on". Remember Increase the amount your bladder will hold. Decrease the number of times you pass urine. Only you Only you can take control of your bladder, so keep going, it will be worth the effort. Look back See how much progress you have made! Now, keep control of your bladder. Other sources of information are: The Bladder and Bowel Foundation SATRA Innovation Park, Rockingham Road, Kettering, Northants NN16 9JH Tel: info@bladderandbowelfoundation.org Website: foundation.org PromoCon (Continence Products) Disabled Living, St Chad s Street, Manchester, M8 8QA. Tel: Fax: promocon2001@disabledliving.co.uk Website: Who to contact if you have any questions about this information: Continence Care, Gun Lane, Strood, Kent ME2 4UL Tel: Customer care Please send any comments about Medway Community Healthcare services to: Customer care manager, Medway Community Healthcare 7-8 Ambley Green, Bailey Drive, Gillingham, Kent, ME8 0NJ p: f: medwaycustomercare@nhs.net All contact will be treated confidentially.

9 Sharing your information Your information will only be disclosed to those who have a genuine need to know and who agree to keep your information confidential. For your direct care we often share information with NHS hospitals and clinics, GPs and social care. Leaflet reference: MCH311