Bladder problems

Introduction

Are you frightened in case you don’t make it to the toilet in time or do you need to know where the nearest toilet is, before you leave the house? Are you getting up in the middle of the night to go to the loo or you are embarrassed about suffering from bed wetting? Maybe you simply hoped your bladder problem would just go away on its own, but things aren’t getting any better.

There is no need to suffer in silence. You are not alone, bladder problems are common in the young and old and you shouldn’t hesitate to seek help from your GP.

There are plenty of options available. As well as traditional medical treatments, there are a number of ways that you can adjust your eating habits to improve your bladder control. Contrary to what you might think, it’s not just what you drink that matters, slight changes to what you eat can make a big difference too.

This website explains bladder problems and their treatment. You’ll find practical advice on your medicines and on lifestyle changes you can make to help manage your bladder problems, including exercise and diet tips.

The website is designed so that you can pick out topics that are of interest to you. So you’ve come to the right place if:

• Your bladder problem has only recently begun and you’re finding out about it for the first time.
• You’d like to delve deeper into the subject after having the condition for some time.
• You care for someone who has bladder problems – there’s a section dedicated to providing information specifically for you.

About bladder problems

If you have a bladder problem, you don’t need to be told how upsetting it can be. Loss of bladder control can make you feel self-conscious and disrupt your lifestyle, so that even everyday activities such as a trip to the shops can become frustrating and stressful.

The good news is that there are plenty of things you can do to manage this common problem and so ease the symptoms. Your doctor can help, too. So there’s no need to restrict your lifestyle – bladder problems can be treated successfully in many cases.

Finding out more about bladder problems and why you’re experiencing them is your first step towards controlling them and enjoying a better quality of life.

Types of bladder problems

Overactive bladder

Overactive bladder means that the bladder muscles become more active and this leads to the feeling of needing to pass urine, even if the bladder is not full. Sometimes the urge to urinate is unexpected and you may feel desperate to go as soon as possible. The sudden, unstoppable urge to go to the loo is called urgency.

When you can’t make it to the bathroom following the urge, this is called urge incontinence You may have only a few seconds between feeling the need to go and actually passing urine. Some people need to go very often (called frequency) or have to get up frequently during the night (nocturia).

Stress incontinence

Stress incontinence is leakage from your bladder that occurs when you suddenly sneeze, laugh, cough or exert yourself, for example, when exercising, or getting up from a chair. It’s particularly common among women who’ve had children and after the menopause. Usually – but not always – the amount of urine passed is small.

Mixed urinary incontinence

Overactive bladder and stress urinary incontinence are separate conditions; however, some people suffer from the symptoms of both at the same time. If you do have mixed urinary incontinence, it’s important to try to work out which is the biggest problem for you so your doctor or nurse can give you the best advice on how to cope.

Why do I have bladder problems?

Bladder problems arise when something happens to disrupt the normal working of your ‘water-works’ or urinary system.

How the bladder works

Each time we eat and drink, our body absorbs liquids which pass into our bloodstream. The kidneys filter out waste and extra water from the blood to make urine, which is stored in our bladder.

The bladder is a stretchy muscular bag that expands like a balloon to hold a cup or two of urine. As it fills, it sends stronger and stronger signals to the brain that it’s time to empty it. At the same time, the muscles at the base of the bladder – known as the sphincter muscles – contract to keep the urine in.

Eventually the signals from the bladder become strong enough for you to need to go to the lavatory. This usually happens up to eight times a day.

Overactive bladder

An overactive bladder doesn’t wait until it’s full to send an urgent signal. Instead it sends ‘false alarms’ which can cause strong sudden urges to urinate and may even lead to an accident. A strong sudden urge to urinate is also known as ‘urgency’.

The reason why someone’s bladder becomes overactive is often not known. It can sometimes be caused by an infection in the bladder or it may occur in people who have other medical conditions such as diabetes, or following a stroke.

Stress incontinence

Stress incontinence (which is leakage from the bladder when you suddenly sneeze, laugh, cough or exert yourself) usually happens because the muscles in the pelvic floor or sphincter are weak or damaged.

This may be worsened if you’re pregnant or overweight, as this puts additional pressure on your bladder, making it harder for you to hold in your urine. If you suffer from constipation or have had a bad cough, you may also be prone to stress incontinence.

Who has bladder problems?

Bladder control isn’t something we tend to talk about. In fact, most of us don’t like to discuss the workings of our bladders even with best friends or partners. As a result, there can be misconceptions over bladder problems.

Bladder problems are much more common than most of us think. In the UK, between three and six million adults are estimated to have been affected by loss of bladder control.

Many people think bladder problems go hand-in-hand with getting older, but in fact anyone at any age can suffer from them. Bladder problems are not an inevitable part of ageing.

Although they do more commonly affect older people, bladder problems can occur in people in their early 30s or 40s, or at an even younger age. Among middle-aged women, for instance, over half have experienced some loss of bladder control.

Not surprisingly, pregnancy can put a strain on your bladder so you are more likely to have bladder problems if you’re expecting a baby or after giving birth. There are also links between menopause and incontinence. Men and women who are overweight are more likely to develop bladder problems.

For some people, bladder problems can be caused simply by everyday habits that can irritate the bladder, such as too much caffeine. But for many others, no particular reason is found.

What are the signs and symptoms?

Any kind of unexpected bladder weakness or leakage may be a sign of an overactive bladder or stress urinary incontinence.

Take a look at these questions to help you identify your symptoms:

Do you

• Often have a sudden urge to pass urine?
• Sometimes not make it to the toilet in time?
• Have to go to pass urine very often – more than eight times a day?
• Have to get up to go to the toilet in the night?
• Ever wet the bed?

These are all symptoms of an overactive bladder. However, some of these symptoms are also seen with other conditions, so it’s important to check with your doctor.

Or do you:

• Leak urine when you’re exercising or lifting heavy things?
• Leak urine when you sneeze or cough, or laugh loudly?
• Worry about leaking urine while you’re making love?

If yes, you may have stress urinary incontinence.

Overactive bladder and stress incontinence are different from a urinary infection such as cystitis, symptoms of which include a burning pain while you’re passing urine and a cloudy look to your urine. Sometimes you may see blood in the urine if you have an infection.

Once you know what’s causing your problem, you’ll be able to talk about possible treatments with your doctor or continence nurse. They will discuss the condition with you and describe how the various treatments can help.

Are your symptoms affecting your lifestyle?

You may feel you’re coping well with your symptoms, but many people don’t realise how much improvement could be gained through better control of their symptoms. Ask yourself these questions to help identify how much your symptoms are affecting your day-to-day life:

Do you:

• Avoid long car rides?
• Stay at home instead of going out with friends?
• Avoid places and activities where there might not be a toilet?
• Map out all the local toilets?
• Often feel embarrassed because of accidents?
• Avoid being close to loved ones?
• Find yourself worrying about when your next accident will happen?

If your answer to any of these questions is ‘yes,’ then it may be possible for you to gain better control of your bladder condition. Have a chat with your doctor or continence nurse, as they may well have suggestions as to how to improve your symptoms.

Complications

Many people find their bladder control is improved with medication and/or other approaches.

There are a few complications you should keep an eye out for, that can occur as a result of bladder problems, including:

Skin problems – If you have incontinence that causes your skin to be wet much of the time, you may develop sores or a skin infection.

Disrupting day-to-day activities – Bladder problems can disrupt your daily lifestyle. For instance, you may feel less like doing your usual sports, going to the shops, or traveling to see friends. If this is happening to you, it might be time to pay a visit to your doctor.

Changes in your work life – Bladder problems may affect your concentration at work especially if you are anxious about going to the toilet all the time.

Interfering with your love life – Some people avoid having sex because they worry they may leak urine. Talking about your feelings with your partner may not cure the problem – but it can make it seem far less important and more manageable.

How medicines fit in

There is no cure for bladder problems, but treatment may help control your symptoms very effectively. Contrary to popular belief, loss of bladder control isn’t something you have to live with, especially if you get help as soon as you realise that something is wrong.

Some people find that making some changes to their lifestyle can bring their bladder problems under control. But if lifestyle changes don’t help, your doctor may suggest medication to help you manage your symptoms. What he or she recommends will depend on the kind of bladder problems you’re experiencing.

Your doctor or continence advisor will help you decide the right option for you. Whatever you choose, you can maximise the effectiveness of the medication by also making those all-important changes to your lifestyle and eating habits.

For overactive bladder – Overactive bladder (which is when the bladder muscles become more active, leading to the sudden or urgent feeling of needing to pass urine even when the bladder is not full) is commonly treated with medicines known as antimuscarinics. They can help relax the bladder muscle so that you are less likely to experience the strong urge to urinate.

For stress incontinence – Estrogen has been shown to help women who are experiencing stress incontinence (which is leakage from your bladder that occurs when you suddenly sneeze, laugh, cough or exert yourself), and some anti-depressants can be used by some doctors to try and stop the bladder from contracting and make the bladder muscles better at holding in urine.

More than medication

n addition to taking your medicine, there are a number of other steps you can take that may help you manage your symptoms and give you better control over your bladder.

Taking control

You can start to regain control of your symptoms by making small changes in your daily habits. Don’t rely on avoiding difficult situations or cutting back on your fluid intake. In the long term, these solutions don’t work and simply interfere with your quality of life.

Instead, try the tips in this section to help find what works best for you. And remember – managing the symptoms of bladder problems doesn’t happen overnight. Small steps mean progress. It may help if you set some simple goals that you know you can realistically achieve.

Re-train your bladder

If you have overactive bladder (which is when the bladder muscles become more active, leading to the sudden or urgent feeling of needing to pass urine even when the bladder is not full), your doctor or continence nurse may suggest bladder re-training.

The first step is to keep a diary to record the number of times you go to the toilet and the amount of urine you pass each time. Once you know how often you go and how much urine you pass, you can aim to ‘hold on’ for as long as possible before each time you go to the toilet. It may take several weeks but your ultimate goal is to pass urine up to eight times in 24 hours.

Tips to train your bladder:

• Try to wait longer between toilet trips. If you go every hour, then try to wait for 1 hour and 15 minutes.
• When you can wait that long without fear of an accident for one or two weeks, try to increase the time further. Try 15 minutes more at first. Then, little by little, wait longer.
• Stick to your timing as much as you can, whether or not you have to go.

When you have a strong urge to urinate:

• Stop what you’re doing and sit down when you can. When you’re still, it’s easier to control your urge.
• Squeeze your pelvic floor muscles quickly several times. These are the muscles that help you hold urine in.
• Relax the rest of your body. Take a few deep breaths to help you let go of your tension.
• Wait until the urge subsides.
• Walk to the toilet. Don’t rush.

Five steps to a firmer pelvic floor

There are many different exercise routines available to help firm up your pelvic floor. Follow these five steps and you should strengthen the muscles that help you hold urine and should make it easier to avoid accidents.

1. Get ready – ideally lie on your back with your knees slightly raised.
2. Locate your pelvic floor muscles (they’re the ones around your urethra, vagina and rectum that you use to hold back gas or stop a urine stream). Tighten these muscles and lift up inside as if trying to stop passing urine and wind at the same time.
3. Squeeze your muscles tightly for up to 10 seconds. Women should get a lifting feeling in the area around the vagina. Or you might feel a ‘pulling in’ of the rectum.
4. Relax completely for 10 seconds. It’s important to control both the tightening and relaxing of the muscle.
5. Repeat in sets of up to 8, three times a day.

Exercise in sets of eight at first. As you get stronger, you can do more sets, fewer times a day. Exercising each day is best, but three or four times a week will still help. Find ways to help you remember to do the exercises – some people do them every time they see the colour red, for example – a red bus, red traffic lights, a red coat, and so on.

The more you perform these exercises, the stronger your pelvic floor muscles will get. And the faster you’ll improve. Alternate between lying down, sitting, or standing when doing the exercises. This will help you to have more control.

More treatment options

Beyond medication and exercises, there a few different options to try:

Pads provide peace of mind

The chances are that pelvic floor exercises and medications will put you back in charge of your bladder. But you may need extra help while you’re waiting for treatment to take effect, or just to give you peace of mind. Y

ou can buy pads and pants that have been specially designed to absorb leaks from the bladder. Some are disposable, while others can be washed and re-used.

There are many varieties available for sale in shops or by mail order. Often women use sanitary pads to mop up leakage as they’re cheaper, but they don’t work as well as the incontinence pads, which draw urine away from the surface of the pad, leaving the skin dry.

When the usual methods don’t work

For a few people with bladder problems, the symptoms are not easily managed. If you find you’re having difficulties with your symptoms, don’t give up. Go back and see your doctor as there may be more options to try.

In extreme cases of stress urinary incontinence, for instance, your doctor may suggest surgery. There are several different types, including procedures to raise or support the neck of your bladder. Discuss this with your GP or specialist.

Lifestyle dos and don’ts

Do:

• Drink water or herbal teas instead of caffeinated drinks such as tea or coffee.
• Commit to bladder re-training. The aim is to increase the amount of urine the bladder can hold and for you to gain confidence that your bladder can be controlled.
• Make pelvic floor exercises a part of your everyday routine.  No one can see that you’re doing them so feel free to exercise at work, in the bus queue or outside the school gates.
• Eat lots of fresh fruit, vegetables and high fibre foods to avoid constipation, which may be putting extra pressure on your bladder.
• Exercise to achieve and maintain a healthy weight and prevent constipation.

Don’t:

• Cut down the amount of liquid you drink as this can make bladder problems worse. Aim to drink six to eight glasses of fluid throughout the day.
• Go to the toilet too often, ‘just in case’, as this can make the symptoms of overactive bladder worse because the bladder gets in the habit of holding less urine.
• Smoke – Smoking can irritate the bladder. Ask your doctor or practice nurse about local stop smoking services.
• Suffer in silence – get help from your healthcare professionals. Don’t forget that your friends and family can be a source of support. The more they know about what you’re going through, the more they can help provide the support you need.