Overactive Bladder and Urgency

WHAT IS OVERACTIVE BLADDER?

The bladder is an organ that stores urine. It’s wall is made of muscle which contracts to empty the bladder when it is full and you are ready to go to the toilet. An overactive bladder means the bladder contracts before it is full. It can sometimes contract when you are not ready. You might go to the toilet often and find it hard to hold on until you get there. At times you may leak urine on the way to the toilet.

WHAT CAUSES OVERACTIVE BLADDER? 

An overactive bladder may be related to health problems, such as:

• stroke
• having an enlarged prostate gland
• Parkinson's disease
• Multiple Sclerosis

For some people the cause is unknown.

WHAT ARE NORMAL BLADDER HABITS?

It is normal to: 

• empty your bladder about four to six times through the day 
• empty your bladder before you go to bed at night 
• empty your bladder once overnight 
• empty your bladder when you get out of bed in the morning 

A healthy bladder holds about 400-600mls. The first sensation or urge to go to the toilet usually starts when there is 200-300mls in the bladder.    

This pattern may change a little in older people. Older people may need to go to the toilet more often including up to twice at night.    
 

WHAT IS IN A BLADDER TRAINING PROGRAM?

The aim of bladder training is to improve symptoms of overactive bladder. Bladder training teaches you how to hold more urine in your bladder without the feelings of urgency. Visit your doctor, a nurse continence specialist or pelvic health physiotherapist if you think you have an overactive bladder, especially if you are experiencing any incontinence or leakage. They could start you on a bladder training program.

You may be asked to keep a bladder diary. You need to keep the diary for at least 3 days. It keeps track of how your bladder works. 

The bladder diary keeps track of:

• the time you go to the toilet
• how much urine you pass each time
• how strong you felt the urge to empty each time   
   

The bladder diary may look like this:

How do I measure the amount of urine passed?

Put a container (like an ice cream container) in the toilet. Now sit on the toilet and relax with your feet on the floor. Pass urine into the container. Then tip the urine into a jug to measure it. Men may want to stand and pass urine directly into a measuring jug. 

How do I measure urgency?

How do I measure leaking using a Pad Weight Test?

This test helps to work out how much urine you leak over a few days. To do this test you will need some accurate scales for weighing. You do this test by:

1. Weighing a dry pad in a plastic bag before you wear the pad

2. Then weighing the wet pad in a plastic bag after you wear it

3. Taking the weight of the dry pad away from the weight of the wet pad. 

This will show how much you have leaked because each gram equals one ml.

This will show much you have leaked because each gram equals one ml. 

Like this:

Amount leaked = 250mls

WHO CAN HELP WITH YOUR BLADDER TRAINING PROGRAM?

A doctor, nurse continence specialist or pelvic health physiotherapist can get the best results for you. They will work out a program to suit you.

The National Continence Helpline 1800 33 00 66 can provide advice on an overactive bladder and help you find your local continence service.

HOW LONG WILL IT TAKE?

Most bladder training programs take about three months. You may have regular appointments with your nurse continence specialist or pelvic health physiotherapist. They will teach you ways to hold on for longer between trips to the toilet and reduce the feeling of urgency when needing to go. This will mean you can hold more urine in your bladder.

SOME HELPFUL THINGS YOU WILL LEARN DURING BLADDER TRAINING

Pelvic floor muscle training

The pelvic health physiotherapist or nurse continence specialist will teach you how to use your pelvic floor muscles. These muscles support your bladder and urethra. The urethra is the tube that carries urine from the bladder to the outside. Strong pelvic floor muscles and squeezing or contracting your muscles when you feel the sudden urge to pass urine, can help you settle down the urge to pass urine. This will help you hold on until you reach the toilet.    

Deferment techniques and relaxation   

These are techniques to help suppress or settle down the feeling of urgency to pass urine.  They can include:

• slow breathing
• distraction, e.g., singing a song
• positive affirmations, e.g., saying you are in control of your bladder
• sitting on the edge of a hard chair or bed
• doing toe curls
• pressing on your heels.

Good bladder habits

Have plenty of fluids every day. Fluid is everything you drink, but it can also include foods like yoghurt and soup. The best fluid to drink is water.    

You need to keep track of how much you drink each day. To do this, you will need to know how much your cup or mug holds. Cups can hold from 120 to 180mls while mugs can hold 280 to 300mls or more.   

Avoid drinking fizzy drinks or drinks with caffeine. These can upset the bladder and make it harder for you to hold on. There is some caffeine in chocolate, tea, coffee, cola and some energy drinks. It is best to limit how much you drink of these.

Good bowel habits

Constipation and straining to pass a bowel motion can stretch your pelvic floor muscles. Constipation may also affect the bladder and have an impact on an overactive bladder. Try to avoid constipation. Try to eat at least two pieces of fruit and five serves of vegetables daily.    
 

Will there be setbacks?

There will be small day to day changes in your bladder control. Anyone on a bladder training program may have days when your symptoms seem worse. This may happen when: 

• you have a urinary tract or bladder infection (see your doctor right away)
• you are tired or run down
• you are worried or stressed
• the weather is wet, windy or cold
• you are ill (such as a cold, or a flu)
• if you are menstruating (commonly referred to as having a period).

During these times, try and stay positive and keep trying.   
 

Seek Help

An overactive bladder can be treated, better managed with the right treatment or even cured. Phone the nurse continence specialists on the National Continence Helpline for free confidential:

• advice
• information
• resources
• information about local continence services.

1800 33 00 66* (8am–8pm Monday to Friday AEST)    

To arrange for an interpreter through the Translating and Interpreting Service (TIS National), phone 13 14 50 Monday to Friday and ask for the National Continence Helpline. Information in other languages is also available from continence.org.au/other-languages    
For more information: pelvicfloorfirst.org.au, health.gov.au/bladder-bowel