Overactive Bladder Syndrome (in women)

Patient Information Leaflet Overactive Bladder Syndrome (in women) Produced by: Department of Obstetrics & Gynaecology Date: June 2008 Review due: July 2010

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Overactive Bladder Syndrome and Urge Incontinence Overactive bladder syndrome is common. Symptoms include an urgent feeling to go to the toilet and needing to go frequently. Urge incontinence means that when you have an urgent need to get to the toilet, urine leaks before you get there. It is usually due to an overactive bladder. Treatment with bladder training often cures the problem. Medication may also be advised to relax the bladder. What is overactive bladder syndrome? An overactive bladder is when the bladder contracts suddenly without you having control, and when the bladder is not full. Overactive bladder syndrome is a common condition where no cause can be found for the repeated and uncontrolled bladder contractions. Overactive bladder syndrome is sometimes called an irritable bladder or detrusor instability. Symptoms include: Urgency This means that you get a sudden urgent desire to pass urine. You are not able to put off going to the toilet. Frequency This means going to the toilet often more than seven times a day. In many cases it is a lot more than seven times a day. Nocturia This means waking to go to the toilet more than twice at night. Urge incontinence This is a leaking of urine before you can get to the toilet when you have a feeling of urgency. 3

How common is overactive bladder syndrome? About 1 in 6 women report some symptoms of an overactive bladder. Symptoms vary in their severity. About 1 in 3 women with an overactive bladder have episodes of urge incontinence. What causes overactive bladder syndrome? The cause is not fully understood. The bladder muscle seems to become overactive and contract when you don t want it to. Normally, the bladder muscle (detrusor) relaxes as the bladder gradually fills up. As the bladder is gradually stretched, we get a feeling of wanting to pass urine when the bladder is about half full. Most people can hold on quite easily, for some time after this initial feeling, until a convenient time to go to the toilet. However, in people with overactive bladder, the bladder muscle seems to give wrong messages to the brain. The bladder may feel more full than it actually is. The bladder contracts too early, when the bladder is not very full and not when you want it to. This can make you suddenly need the toilet. In effect, you have much less control over when your bladder contracts to pass urine. In most cases, the reason why an overactive bladder develops is not known. This is called overactive bladder syndrome. Symptoms may get worse at times of stress. Symptoms may also be made worse by caffeine in tea, coffee, cola, etc, and by alcohol and smoking. 4

In some cases, symptoms of an overactive bladder develop as a complication of a nerve-related disease such as following a stroke, or with Parkinson s disease. Also, similar symptoms may occur if you have a urine infection. These conditions are not classed as overactive bladder syndrome as they have a known cause. What are the treatments for overactive bladder syndrome? There are some general lifestyle measures that can help: Bladder retraining is usually the main treatment. This can work in up to 50% of cases. Medication may be advised in addition to bladder retraining. Pelvic floor exercises may also be advised in some cases. 5

Some general lifestyle measures which can help Caffeine This is in found in tea, coffee, cola, and is part of some painkiller tablets. Caffeine has a diuretic effect (will make urine form more often). Caffeine may also directly stimulate the bladder to make urgency symptoms worse. You should limit the times that you have a caffeine-containing drink and if possible try to use decaffeinated drinks. Alcohol Alcohol may make symptoms worse. The same advice applies as with caffeine drinks. Drink normal quantities of fluids It may seem sensible to cut back on the amount that you drink so that the bladder does not fill so quickly. However, this can make symptoms worse as more concentrated urine can cause more irritation in the bladder muscle. Aim to drink normal quantities of fluids each day. This is usually about two litres of fluid per day (about 6 8 cups) but more in hot climates and during hot weather. Go to the toilet only when you need to Some people get into the habit of going to the toilet more often than they need. They may go when their bladder only has a small amount of urine so as not to be caught short. This again, may sound sensible as some people think that symptoms of urgency and urge incontinence will not develop if the bladder does not fill very much and is emptied regularly. 6

However, again, this can make symptoms worse in the long-run. If you go to the toilet too often the bladder becomes used to holding less urine. The bladder may then become even more sensitive and overactive at times when it is stretched just a little. So, you may find that when you need to hold on a bit longer (for example, if you go out), symptoms are worse than ever. Bladder retraining (sometimes called bladder drill ) The aim is to slowly stretch the bladder so that it can hold larger and larger volumes of urine. In time, the bladder muscle should become less overactive and you become more in control of your bladder. This means that more time can elapse between feeling the desire to pass urine and having to get to a toilet. Leaks of urine are then less likely. You will need to keep a diary. When you first start the diary, drink what you normally do and go to the toilet as usual for 2 3 days. In the diary make a note of how much you drink, what you drink, the times you pass urine, and the amount of urine that you pass each time. Also make a note of the times you leak urine. Keep an old measuring jug by the toilet so that you can measure the amount of urine you pass each time you go to the toilet. You can then start retraining our bladder. The aim of bladder retraining is to hold on for as long as possible before each time you go to the toilet. This will seem difficult at first. For example, if you normally go to the toilet every hour, it may seem quite a struggle to last one hour and five minutes between toilet trips. When trying to hold-on, try distracting yourself. 7

For example: Sitting straight on a hard seat may help. Try counting backwards from 100. Try doing some pelvic floor exercises (see leaflet). With time it should become easier, as the bladder becomes more used to holding larger amounts of urine. Gradually extending the time between toilet trips will help train your bladder to stretch more easily. It may take several weeks, but the aim is to pass urine only 5 6 times in 24 hours (about every 3 4 hours). After several months you may find that you just get the normal feelings of needing the toilet, which you can easily put off for a reasonable time, until it is convenient to go. Whilst doing bladder retraining, it can be helpful to continue to keep the diary for a 24 hour period every week or so. Recording like this will show your progress over the months, even if it only a few minutes each week. It is important that you continue to drink normal amounts of fluids when doing the training. Bladder training can be difficult, but becomes easier with time and perseverance. 8

Medication Medicines can also help. They work by blocking certain nerve impulses to the bladder which relaxes the bladder muscle and so increases the bladder capacity. The medication starts working within a week of starting treatment but may take up to 6 weeks to have the maximum effect. It is often helpful to continue the medicines this long to determine how useful they can be in your particular case. Side-effects are quite common with these medicines, but are often minor and tolerable. Common side effects are: Dry mouth Dry eyes Constipation Blurred vision The most common side effect is a dry mouth and simply having frequent sips of water may counter this. However, all medicines have differences, and you may find that if one medicine causes troublesome side-effects, a switch to a different one may suit you better. Discuss this with your doctor. Read the information sheet which comes with your particular medicine for a full list of possible side-effects. If you combine a course of medication with bladder retraining and general lifestyle changes, the long-term outlook may be better and symptoms less likely to return when you stop the medication. 9

Pelvic floor exercises Strengthening the pelvic floor muscles that support the bladder and other pelvic organs can often help. It is important that you exercise the correct muscles (see information leaflet on pelvic floor exercises). Your doctor may refer you to a physiotherapist for advice on the exercises. It takes time, effort and practice to become good at these exercises. You should start to see benefits after a few weeks. However, it often takes 8 20 weeks for most improvement to occur. You will need to continue exercising as a part of your everyday routine for the rest of your life to stop the problem recurring. 10

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