Overactive bladder syndrome: Everything you need to know
Have you got sudden urges to pee that happen without any prior warning? Are they so strong you have to race to the loo as soon as you feel one coming, so you don’t risk having an accident? Then you might be suffering from an overactive bladder, also called urge incontinence.
How do I know if I have got an overactive bladder?
Sudden urges to pee and urinary incontinence
If you have overactive bladder syndrome, your bladder will contract suddenly and without warning. This usually leaves you with a sudden urge to go for a pee; very much along the motto of “When you have to go, you have to go!”. These contractions don’t just give you super little time to make your way to the toilet, but the urge can get so intense that you simply can’t hold on to it anymore. If that happens, there’s a chance that you end up having an accident.
Having to pee more often than usual
If you have an overactive bladder, you may have to go to the bathroom more often than usual; this is called urinary frequency. You might also only pass small amounts of urine every time you do go for a pee. If you don’t have urinary frequency, you’ll averagely go to the toilet somewhere between 6 and 8 times per day but anything from 4 to 10 times is perfectly normal as long as you’re happy and healthy. How often you go to the loo will also fully depend on how much and what you drink in a day. For example, if you drink lots and lots of water or have a few beers, there’s a good chance that you have to nip to the loo more often than is normal for you. That’s no cause for concern, though! However, if your frequency isn’t caused by a change in drinking habits or medication and comes with strong and sudden urges to go for a pee, it might point towards an overactive bladder.
An overactive bladder can cause you to have to get up to pee more than twice during the night. Usually, you should have 6 to 8 hours of sleep every night without getting woken up by your bladder. That is if you haven’t just downed a few pints at the local pub, of course! Nocturia isn’t a tell-tale sign of an overactive bladder, however, as other, completely unrelated issues with your urinary tract can also cause you to have to get up multiple times during the night.
What is the cause of an overactive bladder?
Overactive bladder syndrome is fairly common and can affect people of all ages. Even children! It’s estimated that about 12% of all adults live with an overactive bladder. What actually causes it, however, is not known. What is known about it is the following:
- What you eat and drink can have an impact on your symptoms.
- Anxiety can worsen your symptoms.
- If you have a neurological condition, you are at a much higher risk of experiencing an overactive bladder.
How is an overactive bladder diagnosed?
To begin with, your GP will likely ask you some questions about your symptoms, your general health, and your medical history. As a next step, they will likely test your urine for any signs of infection, and your GP might do a physical examination. You might also be asked to keep a bladder diary for a little while to keep track of how often you go to the loo and how much urine you pass every time you go. Your GP may also suggest a flow test and a post-flow ultrasound. This involves you passing urine in a special machine to measure how strong your urine flow is and whether your bladder gets emptied fully when you do go for a pee.
How is an overactive bladder treated?
Change your drinking habits
Certain drinks can irritate your bladder and you should try to limit those as much as possible for your symptoms to improve. These drinks include:
- Blackcurrant juice
- Green tea
- Drinks containing an artificial sweetener called aspartame
- Tea or coffee (decaffeinated included!)
- Carbonated drinks
- Hot chocolate
- Citrus fruit juice
Instead, you might want to opt for water, herbal or fruit tea, milk, and diluted fruit squash. These are believed to not have any impact on your symptoms.
If you have an overactive bladder, it’s especially important that you are careful about your daily fluid intake. Always aim to drink about 1 to 1.5 litres a day; this equals to about 6 to 8 glasses per day. But it’s also important that you adjust the amount you drink to whatever you are doing. For example, if you’re exercising loads or if you are in a particularly hot climate, you’ll likely be sweating and should up your water intake.
If you struggle with having to get up for a pee multiple times a night you could try to reduce the amount you drink in the evening. Try to reduce your fluid intake about 4 hours before going to bed and always try to avoid caffeine and alcohol right before bed. If you’re thirsty or need to take any medication, try small sips of water rather than gulping down a whole pint glass.
Bladder training is often used to treat symptoms of an overactive bladder. Its aim is to help you regain control of your bladder and suppress the sudden contractions. How does bladder training work? Well, it’s quite simple (in theory, at least). Instead of rushing to the toilet as soon as you feel the urge to pee, try to hold on and wait it out for a little bit before making your way to the bathroom. Ideally, you want to only hold on for short periods at the start and then gradually increase those over time. This can be fairly difficult to begin with and it might not work out every time. Try not to be disappointed if you can’t hold on or if you have an accident; training your bladder takes time and commitment in order to work so it’s super important that you don’t try to rush it and keep at it for a few weeks or even months. Then you’ll be able to see the full benefit! It can also be super helpful to do some pelvic floor exercises to help you control any sudden urges to pee. If you’re unsure where to start with your bladder training, try downloading our super helpful guide with step-by-step instructions on how to retain your bladder. And if you’re still struggling, our Customer Care team is always here to help. Just give them a ring on 0344 225 1519 or drop them an email on firstname.lastname@example.org.
There are medicines that can be used to treat your overactive bladder. These are called anticholinergics or Beta 3 agonists and taking them will block the nerve impulses to the bladder that cause your sudden contractions. Although medication can improve your symptoms, it’s unfortunately unlikely that it will fully cure your condition. It’s also not guaranteed that taking medication will help with your symptoms at all as this is fully dependent on your individual situation.
You’ll most commonly take medication for about six weeks and if your symptoms improve during this time, you may be able to take it for another six months. After these six months, you’ll probably be asked to stop the medication to check how your symptoms are without it. Be aware that your symptoms can return once you stop taking your anticholinergics.
Side effects are unfortunately also quite common with these types of medications, but they are generally very minor and fairly tolerable. Common side effects are having a dry mouth, dry eyes, blurry vision, or you might get constipated. Even though the side effects are fairly minor, you should still speak to your healthcare professional if you experience any. There are different medications out there and you might be able to try one that suites you better.
If your symptoms fail to improve with any of the previously mentioned treatment options, your next step can be a urodynamics test which measures the pressure inside your bladder. During this test, you’ll have to pass urine into a flow meter which is there to measure how fast your urine flow is. You’ll then get a very fine tube inserted into your rectum and another two fine tubes inserted into your bladder. From the two tubes going into your bladder, one is for filling it up and the other one is for measuring the pressure. The whole process might be slightly uncomfortable, but you shouldn’t feel any pain.
The bladder will be filled slowly with sterile fluid until you feel like it’s full. Once that’s done, the fine tube that was inserted to fill your bladder will be removed and you’ll be asked to do a bit of a stress test including squatting, coughing, and jumping to help diagnose the problem. After this test, you’ll be allowed to release the sterile fluid from your bladder and the other fine tubes are removed. The test report will then be sent off to your consultant who you’ll have an appointment with to discuss the results.
You might find that it’s slightly uncomfortable to pee for the first few times after the test. This is fairly common and nothing to worry about; just drink plenty of fluids and it will soon be gone. You might also see some blood in your urine after the test. But are there any real risks to this urodynamics test? There aren’t any significant risks to doing this kind of test. However, about 3 in 100 people will develop a urinary tract infection which will present with burning and stinging when you go for a pee and cloudy, strong-smelling urine. If you think you have a UTI, speak with your GP who will be able to prescribe a short course of antibiotics for you.
If none of the already mentioned treatments are successful and your overactive bladder symptoms have a great impact on your day-to-day life, surgical treatment might be an option for you. This will only be done if it’s definitely confirmed that you have an overactive bladder and there are different surgical procedures that can be considered.
Botox will be injected into the inside of your bladder via a small telescope which can calm the sudden contractions of your bladder down. However, as a side effect, it can also affect the normal contractions of your bladder and you might not be able to empty it fully anymore. If you’re among the 10% to 20% of people who suffer from this side effect, you’ll likely be taught how to catheterise yourself in order to empty your bladder fully. This is called intermittent self-catheterisation.
Sacral nerve stimulation
Your overactive bladder can be treated with something called sacral nerve stimulation. This means that a small device will be implanted under the skin of your buttock which will then send electrical signals to the nerves that control your bladder. You can imagine it a bit like a pacemaker, but for your bladder!
A small piece of bowel from either your small or large intestine is added to the bladder wall in order to increase the size of your bladder. If you have this type of surgery, you might not be able to pass urine “the normal way” anymore and need to learn how to catheterise yourself to empty your bladder. This is, again, called intermittent self-catheterisation.
A urinary diversion means that the flow of your urine will be diverted so it bypasses your bladder. The bladder can either be removed or kept in the body with this type of surgery. With a urinary diversion, your ureters – these are the tubes that connect your bladder and your kidneys – are routed either directly through a stoma into an externally worn bag or into a pouch made from a part of your small intestine where the urine will be stored. This pouch is connected to the outside via a stoma and has to be emptied about 4 to 5 times a day using a catheter. This is very invasive surgery and will only be done if all other options to treat your overactive bladder have been unsuccessful.