The Overactive Bladder
Overactive bladder (OAB) is a very common condition characterised by a sudden and uncomfortable need to pass water called urgency with frequency of urination at day and night. When it is associated with leak of urine it is called urgency incontinence.
OAB occurs as a result of abnormal contractions of the bladder more often than normal and at inappropriate times. There are many options for treating this condition including bladder re-training and medical (drug) therapy. More recently, OAB has been successfully treated with innovate approaches such as bladder injections.
Botulinum Toxins Bladder Injections
Although Botulinium Toxin A is most commonly associated with the beauty industry, it has many very valuable medical applications.
Botulinum toxins act by binding to the nerve endings of muscles, blocking the release of the chemical which causes bladder muscles to contract involuntarily. When injected into specific muscles, the muscle becomes paralysed or weakened, but leaves surrounding muscles unaffected, allowing for normal muscle function.
The treatment is carried out with a special telescope (cystoscope) with no cuts involved. The injections are given directly into the inside of the bladder . The procedure can be done under local or general anaesthesia (according to the patient’s preference) and only takes 30 minutes.
The results of this treatment have been very good. A decrease in involuntary urine loss was seen within 14-21 days and symptoms were alleviated for an average of 10 months. Some patients may require repeat injections others may simply be more responsive to medical therapy.
However, this treatment is only recommended for patients who have failed or not tolerated conservative and drug therapy. Botulinum toxins bladder injections are currently given in the UK either as part of clinical research or as off-label medications for patients with severe overactive bladder.
If you have a problem where you suffer from ‘urgency’ i.e a need to rush to the toilet in response to the feeling of needing to go, your bladder is getting in control of you rather than you in control of your bladder. Bladder retraining can help you overcome this state.
What does Bladder Retraining involve?
Normally an adult bladder can hold about 500mls (about 20 fluid ounces) and is emptied between three and seven times in 24 hours. It is normal for some people, particularly older people, to have to get up at night once to pass water, but more frequently than this, regularly, is not normal.
When the bladder becomes sensitive it can give very strong sensations at a time when it should remain relaxed causing you to panic and have to run to the toilet.
Bladder retraining involves using a set of strategies to overcome this overwhelming feeling of having to rush so that you can regain control of when and where you empty your bladder. It may involve a set of procedures including emptying your bladder at specific times during the day and sometimes even at night. There may be additional help with medication, relaxation techniques, and pelvic floor exercises or even with special hand held equipments and computers.
What else can I do?
Never go to the toilet ‘just in case’ as this teaches the bladder to hold smaller and smaller quantities. When you get the message to go, do pelvic floor exercise. This will tighten the pelvic floor and help the bladder muscles to relax to reduce the feeling of urgency.
Try to drink between one and two litres of water each day. It may be better to avoid fizzy drinks and too much caffeine or alcohol as these will make bladder control harder. Empty the bladder efficiently. Sit on the toilet seat comfortably and waiting till it is completely empty. Use distraction tactics by thinking of something else while trying to wait a little longer before going to the toilet.
Use relaxation techniques.
If you experience urgency at night it is better to get up and empty your bladder than lying awake uncomfortable. Often day time symptoms may improve before night time symptoms will.
Medication that is prescribed to help with urgency can make a significant difference and you should try and persevere with them. Occasional side effects like a dry mouth will settle with continued use.