Doctors in medical school are taught that the bladder is a forgiving organ but patients with overactive bladder know otherwise. This is a debilitating condition whose older names are irritable bladder or unstable bladder. An overactive bladder is characterized by a sudden urge to use the toilet which cannot be delayed and often patients leak urine before getting there (urge incontinence).
Patients tend to use the toilet frequently and several times an hour and are often up several times in the night to empty their bladder. Some patients use the toilet and soon after, still feel the presence of more urine in the bladder and realize they need to go back (incomplete emptying or double voiding).
Patients with these symptoms are said to be suffering from an overactive bladder. It affects 1 in 6 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 of these patients. 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, social places, school, shopping and exercise.
They often ‘toilet map’ when they go out, that is, find out where the toilets are and a quick way to the nearest just in case they are caught short. Some patients use the toilet even if there is no urge, carry spare underwear, wear dark clothes and use perfumes to cover the smell of urine.
When you see your doctor, s/he may ask you several questions regarding your bladder. Some doctors may not ask, and it a good idea to volunteer these symptoms so that they can be addressed. A lot of patients are embarrassed about bladder problems and choose to suffer in silence rather than seek help. Some patients may not realize there is help available. It is important to note that although bladder problems get worse with age, they are not part of normal aging.
Your doctor may suggest some measures which you can do at home to help improve how your bladder works. You should avoid cutting back on how much you drink as your urine will become too concentrated and irritate your bladder lining and water pipe (urethra). Excessive intake may make you want to use the toilet frequently too. On a normal cool day, it is advisable to take about 1.5 – 2litres of fluids which comes to about 6 - 8 small cups of fluid.
If you have problems reaching the toilet, adaptations like hand rail or raised toilet seat may make it easy to use the toilet. A special commode can be used in the bedroom for those with restricted mobility.
Patients are usually asked to try and avoid caffeine as much as possible. Caffeine is found in tea, coffee and cola. It may also be found in medications such as some painkillers and cough syrups (please read label). Caffeine makes you form more urine (diuretic) and also directly irritates the bladder wall. You can try avoiding caffeine for a week to see if your symptoms improve. If they do, try decaffeinated products or other alternatives. Your doctor may also recommend you limit or avoid alcoholic drinks altogether.
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 so that they can hold more and more urine in their bladder and for longer duration. 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 giving 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 commonly taught after delivery but should be encouraged for all women throughout their lives. They 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 to contract and expel urine when not full. These medications commonly cause some side effects which include dryness of the mouth and drowsiness. Most treatments last between three and six months.
Where all measures fail and patients are still leaking of urine, pads can be used to avoid embarrassing leaks as well protect the skin from the burning caused by urine with a resultant increase in confidence levels among these patients.
In a few patients, the symptoms may not improve and referral to a sub-specialized clinic is recommended. Here, a specific bladder test called urodynamics and possibly an operation can be done. This is available at Aga Khan University Hospital, and we run a weekly clinic. Appointments can be made through calls to the Gynaecology clinic from Monday to Friday between 9.00 am and 5.00 pm.
Overall symptoms of an overactive bladder are not a laughing matter. A lot of women suffer in silence not knowing there is plenty of help. Progress can be realized to a large extent by simple measures thus improving the patient’s quality of life.
By Dr Johnstone Miheso, Programme Director and Consultant Urogynaecologist at Aga Khan University Hospital. Email: [email protected]