Treatment to help an overactive bladder

An overactive bladder can occur at any age. It is common and not simply a part of getting older. One in five women and almost one in five men in the UK have this condition.

If you get very little warning about the need to pass urine, or have to go very often - in some cases perhaps even leaking because you can’t get to the toilet in time, you may have an overactive bladder.

Fortunately an overactive bladder can usually be managed so that it does not get in the way of your everyday life. This leaflet explains the various methods that can be used to gain control of an overactive bladder.

Normally a bladder needs to be emptied about four to eight times a day. Once empty, it begins to fill again and starts to expand. The sensation of needing to go to the toilet increases as the bladder becomes fuller. Then, at an appropriate time and place, the muscles in the bladder contract and squeeze urine out. But an overactive bladder tends to contract uncontrollably at the wrong time.

Often there is no known cause for this problem. The situation may be made worse if you also have a condition called ‘stress incontinence’.

A good indication of this is if you leak when you cough, laugh, sneeze or lift a heavy weight. For more information about stress incontinence ask for our Only When I Laugh! leaflet (details below).

The symptoms of an overactive bladder

Urgency is when you feel very little warning of the need to pass urine and it is not possible to delay the need to go. Frequency is when you need to pass urine very often (more than eight times a day). Urge Incontinence is when you have so little warning that you can’t always make it to the toilet in time, and sometimes leak.

You may also find that you wake more than twice a night to pass urine. This is called Nocturia. For more information about this condition ask for our Nocturia factsheet. These symptoms can be caused by other conditions, so always consult a health professional if you experience problems.

Treatments

There are various different types of treatment:

Conservative measures (lifestyle changes and bladder retraining);
Medicines and electrical stimulation;
Unless your condition is particularly severe, lifestyle changes are usually the first type of treatment offered for an overactive bladder;
Lifestyle changes;
Losing weight if you are too heavy, stopping smoking and making sure you don’t drink too little or too much are often recommended to help make the symptoms better;
It is important to balance your fluid intake. If you drink too little you could possibly be concentrating your urine, which risks irritating your bladder into greater activity;
You also increase the risk of developing an infection. But drinking too much can make the problem worse. Generally, you should try to drink about six to eight large glasses of fluid a day - water is best!
Avoid having too many drinks containing alcohol or caffeine (for example coffee, strong teas, chocolate or colas), especially before bed. Cut down on fizzy drinks, which can also irritate your bladder.

Bladder retraining

The aim of bladder retraining is to learn to ‘hold on’ and ignore the urge to pass urine;
Eventually a more normal pattern of going to the toilet is achieved, so you don’t have to go so often, or in such a rush;
Bladder retraining is best done with the help of a continence nurse or specialist physiotherapist (call our Helpline for details of your local NHS Continence Service). But it is possible on your own, using our guidelines.

To start bladder retraining you should use a chart to keep a note of how much you drink and how often you pass urine each day. You also need to measure the amount you pass (using a measuring jug) and record any leakages. This chart should be kept for at least a week. Once the record is completed you can work out how often, on average, you pass urine and the average amount passed. Then you can set your first target for retraining your bladder. If, for example, you have been passing urine about every hour, your goal might be to go to the toilet only every 90 minutes. You can also aim to increase the average amount you pass each time. It will help your doctor or continence specialist to give the right treatment if you complete a chart before visiting them. A note of all the medicines you are taking will also be useful.

Useful tips

Various techniques can help you to ‘hold on’:

Sit on a hard seat or across a tightly rolled towel;
Do five quick squeezes of your pelvic floor muscles (for more information about pelvic floor exercises ask for our Only When I Laugh! leaflet);
Try counting backwards from 50 to distract you from the urge to go;
Once you have achieved your first goal (for example only going to the toilet every 90 minutes) you should set a new one. Continue like this until you are only visiting the toilet every three to four hours and the amounts you are passing have increased to an average of 250-350 mls (about 81/2-12 fluid ounces). You should find that improving your daytime problem also leads to an improvement in frequency and urgency at night;
Stick at it - persistence is rewarded!
Bladder training requires considerable willpower and determination, but giving in will make things worse. ‘Mind over matter’ really can help your problem, but only if you make it work. It may take several weeks or months to take effect, so don’t give up.

For further information please contact the Continence Foundation Helpline, open Monday to Friday 9.30am - 1.00pm on: 0845 345 0165

Spirometry - the importance of accurate measurements

Chronic lung disease (COPD) is the fifth leading cause of morbidity and mortality worldwide. COPD is predicted to be the third biggest killer by 2020, and it is almost entirely due to smoking.

COPD has a low profile and in many subjects goes undiagnosed. Diagnosis cannot be made from the history and pattern of symptoms alone and needs to be confirmed by objective lung function testing using a spirometer. Spirometry is the best standardised measurement of airways obstruction available.

The Association for Respiratory Technology and Physiology (ARTP), British Thoracic Society and British Lung Foundation want to emphasise the importance of correctly calibrated/verified spirometers as the only means of accurate, reliable and safe measurements in spirometry.

Failure to use appropriately calibrated and prepared equipment could lead to misleading results and incorrect diagnosis.

Vitalograph, leading manufacturer of spirometers, enables clinicians to perform over ten million lung function tests annually.

Our measurement equipment ranges from simple Peak Flow Meters to Windows based computerised systems.

The Alpha 111 enables calculation of key parameters in diagnosing COPD. They are Forced Vitality Capacity (FVC), forced Expiratory Volume in one second (FEV1) and the FEV1/ FVC ratio.

The degree of spirometric abnormality helps clinicians to to establish the diagnosis and the seriousness of the condition.