Overactive bladder (irritable bladder)

The bladder muscle is normally relaxed as the bladder gradually fills up. As the bladder is gradually stretched, you get a feeling of wanting to wee when the bladder is about half full.

Most people can hold on quite easily for some time after this initial feeling until it is convenient to have a wee. But with an overactive bladder, the bladder muscle seems to send the wrong messages to the brain. The bladder may feel fuller than it actually is. The bladder contracts too early when it is not very full. This can make you suddenly need to wee. You have much less control over when your bladder contracts to wee.

Some conditions can affect your bladder muscle, increasing your risk of an overactive bladder. These include:

• pregnancy and childbirth
• nerve damage, such as Parkinson's disease or stroke
• bladder infection
• hormonal changes after menopause
• alcohol and caffeine use.

Symptoms of an overactive bladder include:

• a sudden urgent desire to wee — you are not able to put off going to the toilet.
• going to the toilet more than 7 times a day (in many cases, it is a lot more than 7 times a day)
• waking to go to the toilet more than once at night
• a feeling of urgency and leaking wee before you can get to the toilet.

To diagnose an overactive bladder, your healthcare provider will ask about your symptoms and may examine you.

They may ask you to complete a bladder diary, writing down:

• what and how much you drink
• when you feel a desire to wee
• when you wee or leak.

You may have tests such as:

• a urine test to look for signs of infection
• a urodynamic test, which involves filling and emptying your bladder with water while taking pressure measurements.

Getting to the toilet

Make this as easy as possible. If you have mobility issues, think about getting special adaptations like a handrail or a raised toilet seat.

Manage caffeine and alcohol

Caffeine is a diuretic — it increases the amount of wee your body makes.

Caffeine may also directly stimulate your bladder, making your need to wee worse. It may be worth trying to go without caffeine for a week or so to see if your symptoms improve.

Items that contain caffeine include:

• coffee
• tea, including some herbal and green tea
• cola drinks
• energy drinks
• some pain relief tablets.

If your symptoms improve, you may not want to give up caffeine completely. Instead, you could:

• limit the times that you have a caffeine-containing drink
• make sure you are near a toilet whenever you have caffeine.

In some people, alcohol may make symptoms worse. The same advice applies as with caffeine drinks.

Drink normal quantities of fluids

It may seem sensible to cut back on the amount you drink so your bladder does not fill so quickly. But this can make your symptoms worse as your wee becomes more concentrated, which may irritate your bladder muscle.

Aim to drink normal quantities of fluids each day. This is usually about 2 litres (8 cups) of fluid per day. You may need to drink extra fluid if:

• the weather is hot and humid
• you are doing a lot of physical activity
• you have hard poos or runny poos
• you are breastfeeding.

Only go to the toilet when you need to

Some people get into the habit of going to the toilet more often than they need to. They may go when their bladder only has a small amount of wee, just in case. This may sound sensible, as some people think the symptoms of an overactive bladder will not develop if their bladder does not fill very much and they empty it regularly. But this can make symptoms worse in the long run.

If you go to the toilet too often, your bladder becomes used to holding less wee. Your bladder may then become even more sensitive and overactive at times when it is stretched a little. So, you may find that when you need to hold on a bit longer, for example, if you go out, your symptoms are worse.

It is important to talk to your healthcare provider about any bladder problems.

Bladder retraining

Bladder retraining aims to slowly stretch your bladder so it can hold larger and larger volumes of wee. In time, your bladder muscle should become less overactive, and you should become more in control of your bladder. This means that more time can elapse between feeling the need to wee and having to get to a toilet. Leaks are then less likely.

Treating urinary incontinence without surgery — bladder retraining

Pelvic floor exercises

Doing pelvic floor exercises regularly helps to strengthen your pelvic floor muscles. This can help you to avoid leaking wee when your bladder muscles contract at unpredictable times.

You should learn how to do pelvic floor exercises at the same time as bladder retraining. A continence advisor can help if needed.

Continence service providers — Continence NZexternal link

Medicines

An anticholinergic medicine (such as oxybutynin or solifenacin) acts on your bladder muscles. It helps reduce the frequency and severity of contractions. This can:

• provide some immediate benefit
• help you to control your bladder while you learn the exercises and techniques described above.

It may be possible to slowly reduce and stop using the medicines once you regain bladder control. Possible side effects with these medicines include:

• stomach ache
• headache
• dry mouth.

Some women can experience estrogen hormone deficiency. It is most common after menopause or during breastfeeding. It has been associated with an urgent and frequent need to wee. Vaginal estrogen cream has been shown to reduce these symptoms.

If there has been no improvement with these treatments, your healthcare provider may refer you to a specialist (urologist). They can investigate the problem further and consider other treatments. These include botulinum toxin injections at sites within the bladder and sometimes surgery.