What is overactive bladder?
If you feel an urgent need to pass urine and have to go more often your bladder may be irritable or overactive. This makes it difficult to get to the toilet on time and you could have leakage before you get there. Normally the muscle lining the bladder stays relaxed so the bladder can fill up and store urine until you decide to go to the toilet. When the bladder muscle is overactive it squeezes and tries to empty the bladder even when it isn’t full.
Image used with permission of the American Urogynecologic Society
The muscle that lines the bladder, called the detrusor muscle, squeezes down too often and too powerfully. This causes urine to come out at the wrong times. Common things that bring this on are hearing running water, putting your key in the door at home, or seeing the toilet.
How does bladder training work?
It is normal to pass around 300-400mls of urine, about 7 times a day and once at night. Bladder training works by gradually putting off passing urine for longer so that the bladder gets used to holding more urine and you need to pass urine less often. You will learn to deal with the feelings of urgency and will start to gain confidence in your control over your bladder.
Staying motivated
Bladder training will take time and it is a gradual process. Keeping a fluid chart and discussing it with your nurse at each appointment will help you to see the improvements you are making. Bladder training will only work if you keep trying. If you are struggling contact the nurse.
What could be irritating your bladder?
Before you start it will help to change anything that could be irritating the bladder.
- Constipation
- Smoking
- Drinks with caffeine (coffee and tea), fizzy drinks, blackcurrant, large amounts of citrus fruit
- Not drinking enough
- High blood sugar
- Enlarged prostate
- Vaginal changes after the menopause
Pelvic Floor Exercises
You can use your pelvic floor muscle to help you control the urgency and prevent leaks. Start by making sure you know how to squeeze your pelvic floor muscle and getting it as strong as possible. Sit in a chair and keep your tummy muscles, leg muscles and buttock muscles relaxed.
Step 1) Squeeze around your back passage as if you are trying to stop wind (and around your vagina)
Step 2) Squeeze as if you are trying to stop urine mid-stream.
Slow exercises: Tighten and draw up both around the back passage (and the vagina) and as if you are stopping urine mid-stream. Try to hold the squeeze.
Fast exercises: Tighten and draw up both around the back passage (and the vagina) and as if you are stopping urine mid-stream, then relax.
Images used with permission of HARTMANN
Controlling the urge
When you have a feeling of urgency this means the bladder muscle is squeezing and trying to empty the bladder. If you rush to the toilet while the bladder muscle is squeezing you are more likely to leak.
Instead when you feel the first urge to pass urine practise controlling the urge and putting off going to the toilet.
Tips for controlling the urge:
- Sit down on a chair or on the arm of the chair, relax and breathe slowly.
- Do some fast pelvic floor squeezes.
- Distract yourself with another activity eg count to 100, write a shopping list, watch TV, read, do a crossword.
- When the urgency is reduced (after about a minute) get up and go to the toilet calmly.
Putting off for longer
Once you have learnt to use strategies to control the urge, try to gradually put off going to the toilet for longer. This will help your bladder get used to holding more urine and you won’t have to go as often. Practice during the day initially at home or in a safe place. During the night go to the toilet as normal.
After you have controlled the urge, instead of getting up to go to the toilet, put off for longer by getting up and doing something else. At first go and do another activity then go to the toilet. When you are confident about managing gradually increase the length of time you distract yourself for until you are passing urine about every 3-4 hours.
Your plan
Putting off
When you feel the first urge to pass urine
- Sit down
- Do some fast pelvic floor squeezes
- Then for distract yourself by: ……………………………………………………………………………………………………….
When the urge has reduced go and distract yourself with another activity for…… minutes, then go to the toilet.
When you are managing to hold on comfortably increase the length of time by….. minutes every 2 weeks.
Fill in your fluid chart for one day every 2 weeks to see how you are improving.
Pelvic floor exercises
…………. Slow exercises holding for….. seconds then
…………. Fast exercises
3 times a day
Download the NHS Squeezy App to help you remember your exercises or do them at a regular time each day.
Other advice
- Avoid going to the toilet just in case
- Reduce drinks with caffeine (eg tea, coffee, hot chocolate), alcohol, fizzy drinks, blackcurrant, citrus juices
- Gradually change to decaffeinated tea/coffee, well diluted squash, water, herbal/fruit teas
- Have six to eight drinks evenly spaced out throughout the day (1.5 – 2 litres)
- Have your last drink no later than one and a half hours before sleeping at night
- Avoid constipation
I agree to follow the plan above
Signed………………………………. Date………………………………………..