When your bladder causes you grief

NAIROBI: The bladder is a forgiving organ, but patients with an overactive bladder know otherwise. This is a debilitating condition, which used to be known as an irritable or unstable bladder.

An overactive bladder is characterised by a sudden urge to use the toilet that cannot be delayed and often patients leak urine, known as urge incontinence, and tend to use the toilet frequently - sometimes several times an hour and are often up numerous times at night to empty their bladder.

Others have to contend with incomplete emptying or double voiding which means they still feel like urinating, even after using the toilet, and they keep going back.

This ailment affects one in six people at some point in their lives in varying degrees of severity. The distribution between male and female is the same, ranging between 8-43 per cent.

What is often overlooked is the impact on the quality of life for sufferers.

In the Western world, many patients see their general practitioners for a sleeping pill just to go through a night. Some patients, even in our society, are confined to their homes, unable to go to work or engage in any outdoor activities.

They often ‘toilet map’ when they go out. This means they find out where the nearest toilets are and determine how quickly they can reach them if need be.

Some use the toilet even if there is no urge, carry spare underwear, wear dark clothes and use perfume to cover the smell of urine.

Unfortunately, some afflicted by this disease do not know that there is help available.

While bladder problems do get worse with age, an overactive bladder is not part of the normal aging process so talking to a doctor about your concerns should be done sooner rather than later. Some doctors may not ask about your bladder and it’s a good idea to volunteer these symptoms so that they can be addressed.

Your doctor may suggest some measures that you can do at home to help improve how your bladder works.

Some of these suggestions include not cutting back on how much water you drink since this makes your urine too concentrated, in turn irritating your bladder lining and water pipe (urethra). On the other hand, excessive intake may make you want to use the toilet very frequently so stick to about 1.5 – 2 litres of fluid, which comes to about 6 - 8 small cups.

Patients are also advised to avoid caffeine, found in tea, coffee, cola and some medications as much as possible. Caffeine makes you form more urine (it’s a diuretic) and also directly irritates the bladder wall.

The doctor may also advise that you use the toilet when you need to, rather than all the time in an effort to avoid leaking (timed voiding). If you go too frequently before you fill up, the bladder learns to hold less and less urine making the condition a lot worse.

Bladder training or ‘bladder drill’ is another technique that patients are taught. The aim is to pass urine about 5-6 times in 24 hours or every 3-4 hours.

While doing this, your doctor may ask you to complete a bladder diary stating the fluids you take, when you use the toilet and if there are any episodes when you leak urine or use pads.

Your doctor will also recommend that you perform pelvic floor exercises to strengthen the muscles that wrap underneath the bladder and rectum. These are often referred to as ‘Kegel’ exercises. In addition to bladder and pelvic floor muscle training, there are tablets called anti-muscarinics, which your doctor may prescribe to help your bladder not contract and expel urine when not full.

Where all measures fail and patients are still leaking urine, pads can be used to avoid embarrassing leaks as well as to protect the skin from the burning caused by urine.

In a few patients, the symptoms may not improve and referral to a sub-specialised clinic is recommended where a specific bladder test called urodynamics is done.