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Are you Over your Overactive Bladder?

Urinary urgency, or overactive bladder, is a common condition in both women and men. It can often co-occur with urinary frequency (going to the toilet too often) and nocturia (waking up in the night more than once to empty the bladder). It can also be associated with leaking, or “urinary incontinence”, on the way to the bathroom. It’s a very pesky condition that, when really severe, can stop people from wanting to leave the house or socialise for fear of leaking or lack of toilet access. Fortunately, there are many treatments available through working with a pelvic health physiotherapist.


What’s normal behaviour for the bladder?


A healthy, well-behaved bladder should never be urgent. We should get a gentle reminder from our bladder when it’s getting full, that should give plenty of time to plan our trip to the toilet. We should get these messages around 4-6 times per day – around every 3 hours – and MAYBE once at night (this depends on our age and how much fluid we’ve had before bedtime, but most of us should be aiming for zero). Our biggest wee should be first thing in the morning if we haven’t woken at night, and through the day we should be able to hold at least 300mL of liquid in our bladder comfortably.


What if my bladder’s not “normal”, and feels small or weak?


It’s a common misconception that a “weak bladder” causes urinary frequency or urge incontinence. In fact, the problem is usually that the bladder is contracting inappropriately, or is too squeezing too strongly in proportion to the volume inside. Similarly, there are few instances where someone truly has a “small bladder”; more often, it’s the bladder’s inability to stretch adequately to accommodate a normal volume, or an inappropriate “triggering” from something in the internal bladder environment (known as “bladder irritants”) or in the external environment (like running water, arriving at the front door, or approaching the toilet cubicle).


How do I train my bladder out of making me go to the toilet so often/urgently?


Whilst pelvic floor exercises are usually our first-line treatment for stress incontinence – a type of leakage that happens with activity or exercise like sneezing, jumping or running – overactive bladder or urinary urgency typically requires more behavioural changes. We want to train the bladder to be less over-reactive to either (a) the stretch sensation on the bladder as it fills, (b) environmental triggers, or (c) both! This can be done through things like learning bladder training strategies, reducing bladder “irritants” whilst optimising hydration, and neuromodulation via non-invasive, transcutaneous electrical nerve stimulation (or TENS for short!).


What should I be drinking (and not drinking!) to help my overactive bladder?


The bladder likes for mostly water to be coming in. If we drink things like caffeine, sugary/fizzy drinks, or alcohol, a sensitive bladder sometimes has difficulty holding on. This is because these things can be quite irritating to the bladder lining (in the same way that a urinary tract infection might cause us to feel like we need to wee more – our bladder is trying to expel the offending irritant before the bladder is actually full). Unfortunately, many people with bladder control issues intentionally reduce their water intake as a way to try and manage their bladder problems – if I drink less, I’ll need to pee less, right?


Actually, no: really concentrated or dehydrated urine can also act as a bladder irritant. A good rule of thumb is to drink enough water that your urine runs a pale yellow colour to indicate good hydration (but not overhydration!), and that less than twenty-five percent of your fluids each day are “irritants”. It’s also important to note that caffeine and alcohol make us wee more, and that caffeine late in the day can sometimes cause us to wake more in the night (it stays in our system for hours!).


What can I expect from my physio appointments to address my overactive bladder problem?

To figure out the contributing factors to your overactive bladder, we will ask lots of questions about your symptoms, health and lifestyle. We will often request a bladder diary to better understand what’s going on, which is a record of everything you drink (what, when and how much) and every time you urinate, including the urgency level and volume. It’s a bit of a hassle to do – we know, because we’ve done one too! – but it gives us valuable information and insight into what might be contributing to your problem. From there we give you advice around how to better manage your fluids, how to retrain your bladder out of behaving inappropriately urgently, addressing any lifestyle factors, and pelvic floor training.


What should I do next?


If you would like to worry less about:


- Where the next toilet is

- Whether you’ll make it in time

- Having to pack a spare liner or clothes “just in case”

- If your friends, family or co-workers notice that you visit the toilet a LOT

- If you can get away with having that coffee when you’re out socialising

- Not getting a full night’s sleep because your bladder wakes you SO often…


We recommend you book an appointment with Sophie, Monique or Mischa today to get started on feeling empowered to better manage, if not cure, your overactive bladder. If you don’t live close to a suitably-trained physio clinic, or will have trouble getting into the clinic due to logistical issues, we find telehealth appointments work well for managing overactive bladder (during the peak of COVID, we found that a few people managed to become symptom-free with telehealth support without EVER coming into the clinic!).


We can’t wait to work with you :)


Mischa, Monique & Sophie x


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