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Overactive bladder

Do you find you pass urine very frequently?
Do you find you pass water at night? You may have a common condition affecting 1 in 6 women known as an “overactive bladder” (OAB).
Most people can comfortably hold 300-400ml of urine and pass urine 4-5 times each day. However, people with overactive bladders often pass urine more than 8 times a day and usually in small amounts. It is not uncommon for people with overactive bladders to leak urine before they reach the toilet. This is called urge incontinence.

Causes

What causes an overactive bladder?
In most cases no cause is found. However, serious medical conditions may occasionally be the cause of an overactive bladder. Possible causes include the following:

  • bladder infection (cystitis)
  • inflammation
  • bladder stones
  • bladder tumours
  • neurological conditions
How can I tell if I have an overactive bladder?

One of the most useful things to do is fill out a bladder diary (also called a frequency volume chart). In the bladder diary, you record how often you have a drink, and how often and how much urine you pass. Here is an example below:

Urge incontinence
Urge incontinence is the leakage of urine preceded by a sudden urgent desire to pass urine. This common complaint affects over 6% of women. Urge incontinence can occur on its own, but some people also have stress incontinence as well.
The investigation and treatment of urge incontinence is the same as for overactive bladder.

How does the specialist know if I have an overactive bladder?
The doctor will talk to you about your urinary problems as well as carefully examining you. He will look at your bladder diary with you and do some urine tests. This is usually all that is required to diagnose the problem and initiate a treatment plan. Sometimes further tests are necessary, such as urodynamics or cystoscopy.
What can I do to help my overactive bladder?

  • Caffeine found in tea, coffee and coca-cola causes the kidneys to produce more urine. Caffeine may also irritate the bladder. Try cutting out all caffeine for two weeks and see if your symptoms improve.
  • Alcohol may aggravate some people’s bladder symptoms. Experiment with cutting out or reducing your alcohol intake to see if you notice a change.
  • Drink normal quantities of liquids. This means drinking 1-2 litres a day or 6-8 cups of fluid. The reason for this is that if you don’t drink much the urine becomes concentrated and may irritate the bladder more.
  • Go to the toilet only when you need to, not “just in case”. If you continually empty your bladder when you are only holding small volumes of urine your bladder gets used to it and can become even more sensitive.
  • Bladder training: this hopes to re-educate your bladder so that it can hold larger amounts of urine. Gradually, you will be able to hold on for longer as the bladder becomes less irritable. Your specialist or a continence advisor can explain how this is done in more detail and will give you support as bladder training can be difficult and requires perseverance. It may take several weeks.
What can the specialist do to help my overactive bladder?

Once the correct diagnosis has been made and underlying problems have been ruled out, your specialist will go through some of the lifestyle changes listed above. Learning techniques such as bladder retraining and pelvic floor exercises is often helpful and an appointment with a continence advisor or physiotherapist can be arranged if appropriate.

Treatments

Oestrogen treatment
The bladder is sensitive to hormone levels. Low-dose oestrogen cream, or pessaries, inserted into the vagina can improve overactive bladder symptoms in patients who have gone through the menopause.

Tablets
Antimuscarinics (also called anticholinergics) are a group of medicines that work by relaxing the bladder muscles and making the bladder less sensitive. This can help to increase the amount the bladder can hold and therefore improve symptoms. These tablets can also be used to help people who are working through bladder training exercises. Antimuscarinics do have side-effects. Dry mouth and dry eyes are common but most people find these tolerable. If the side effects are bothersome it is worth switching to a different brand to find one that suits you better.
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Botox bladder injections 
Botox injections are commonly used in cosmetic surgery to relax facial muscles to help reduce the appearance of wrinkles. Botox injections into the bladder help relax the bladder muscle to treat patients with an overactive bladder. This procedure can be performed under a local anaesthetic using a small telescopic camera which is introduced into the urethra. Seventy-five per cent of patients notice an improvement in their symptoms after their first treatment. Repeat injections may be needed as the effects of Botox can wear off after approximately nine months.
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Sacral neuromodulation
This treatment improves symptoms in 70% of patients. It involves inserting a thin wire (an electrode) near the nerves in your lower back that control the bladder. This wire is connected to a stimulator implanted under the skin in the upper buttock area. The stimulator is about the size of a £2 coin. The stimulator sends signals through the electrode wires to the bladder nerves, helping to restore normal function to the bladder. This procedure can be done under local anaesthetic and takes about 1 hour to perform.

Augmentation cystoplasty
This operation is performed under general anaesthetic. A small section of bowel is added to the wall of the bladder to increase its capacity. A side effect of this operation is that some patients have difficulty emptying their bladder properly afterwards and may need to learn to pass a catheter tube into the bladder 3 or 4 times a day to drain the urine out. Another common side effect is mucus in the urine.

Urinary diversion
This operation is only used as a last resort. The urether tubes, which drain urine from the kidneys down to the bladder, are disconnected from the bladder and a section of bowel is used to connect them to the skin on the tummy. A bag is worn on the tummy to collect the urine


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