Understanding
Overactive
Bladder
This booklet was developed in collaboration with:
continence promotion unit
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Introduction
Overactive bladder (OAB) is a medical condition
that affects the way your bladder behaves. It is
characterised by symptoms of:
Frequency: going to the toilet more often than
you did before,
Urgency: a sudden strong urge to empty the
bladder quickly,
Nocturia: being woken at night several times to
go to the toilet.
It may be associated with urgency incontinence.
This is when there is an overwhelming need to
urinate and there may be involuntary loss of urine
before you reach the toilet.
This can be a very distressing and embarrassing
problem which can be difficult to talk about. It is not
a normal part of ageing and it commonly affects
millions of men and women worldwide. Within
Ireland, it is estimated that at least 300,000 people
suffer from this condition1*.
This information pack aims to reassure you that
OAB is a medical condition that can be successfully
treated. It also aims to reassure you that your
doctor, nurse, continence advisor or women’s
health physiotherapist can do a lot to help you
regain control of your bladder.
*Estimation based upon prevalence figures taken from reference 1
1
Figure 1: Anatomy of the Urinary Tract
Female
Male
Figure 2: Structure of the Bladder
Female
Male
Figure 3: Diagram of the Bladder
Control System
2
How Does the Normal
Bladder Work?
The bladder is a balloon like muscle (also known
as the detrusor muscle), which stores urine. It can
hold around 500mls or 1 pint. It collects and stores
urine that is produced by the kidneys. The bladder
expands as it fills and then contracts to empty.
As the bladder fills towards capacity, a nerve
signal is sent from the bladder to the brain giving a
sensation that it needs to pass urine. By tightening
your pelvic floor and urethral sphincter muscles
you should be able to delay the urge and postpone
emptying the bladder until it is convenient at the
right time and place.
When it is the right time to empty your bladder, the
muscles around the urethra relax, and the bladder
contracts and urine is passed through the urethra.
It is normal to empty your bladder 8 times in a 24
hour period.
3
Overactive Bladder
OAB occurs when the detrusor (bladder) muscle
is too active and contracts involuntarily. Instead of
staying at rest as urine fills the bladder, the detrusor
muscle contracts and causes a person to feel
a sudden and sometimes overwhelming urge to
urinate even when the bladder is not full.
Although in many cases the reason for this
involuntary contraction is unclear, for some people
it may be due to problem with the nerve signals that
run from the brain to the bladder.
Causes of Over Active Bladder
The possible causes of OAB are not fully
understood, but it is thought that a variety of things
can worsen symptoms. Some of these could be:
Alcohol:
For some people, alcohol may make bladder
problems worse. If you do drink alcohol, try to cut
down the amount you drink or, if possible, avoid
it altogether.
4
Anxiety:
Being anxious or nervous can make the feeling
of urgency worse. Use slow deep breaths, gentle
exercises or doing activities that help you to relax.
Constipation:
Constipation can put pressure on the bladder. To
avoid this, try to eat a balanced diet with lots of fruit,
vegetables and drink enough fluid. When sitting on
the toilet raise your feet up on a stool so that your
knees are higher than your hips.
Drinks:
Try to avoid drinks containing caffeine (tea, coffee,
cola) as this is known to increase the production
of urine and may also irritate the bladder and
make urgency symptoms worse. Also avoid diet
fizzy drinks containing artificial sugars such as
aspartame, acesulfame K and sodium saccharin
(diet cola, diet lemonade).
Medication:
Some medicines such as diuretics or water tablets
may cause OAB.
Medical conditions:
(diabetes, stroke, prostate problems):
It is important that these conditions are under
control as they may cause bladder problems.
For example, diabetes that is not controlled can
increase the risk of urine infections.
Overweight:
Losing weight will help your bladder problem.
Surgery:
Previous pelvic or prostate surgery can cause OAB.
Smoking:
Stopping smoking will help you reduce your
OAB symptoms.
5
OAB is characterised by the
following symptoms:
Frequency:
Having to go to the toilet many more times than 8
visits per 24 hours.
Nocturia:
Being woken at night several times to go to the toilet.
Urgency:
Strong, sudden need to urinate which often
necessitates rushing to the toilet.
Urge Incontinence:
An overwhelming urgency to urinate but not having
enough time to make it to the toilet. Often results in a
wetting accident.
In addition to OAB, there are other types of bladder
control problems that have a major impact on
peoples’ lives. Some of these include:
Stress Incontinence:
This is leaking from the bladder when you cough,
sneeze or exercise. It is associated with weakness
of the pelvic floor muscles due to pregnancy,
childbirth and menopause. Other causes include
being overweight, chronic cough and constipation.
Men may also experience stress incontinence, most
commonly following prostate surgery.
Urinary Tract Infections:
Bacterial or viral infections in the urinary tract can
cause problems with bladder control. However, unlike
OAB, a urinary tract infection is usually associated
with a burning sensation during urination. If you think
that you could have one, consult your doctor as it
could become serious if not treated quickly.
Prostate Problems:
Some men who experience symptoms of urgency and
frequency may have a condition known as benign
prostatic hyperplasia (BPH) or an enlarged prostate.
A healthcare professional can tell you whether you
have OAB, an enlarged prostate or both.
6
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What Can I Do About It?
Whatever your symptoms, it is very important that you
discuss them with a healthcare professional so that a
proper assessment and diagnosis of your bladder
control problem can be made. Although you may feel
embarrassed, healthcare professionals are there to
help you.
Many people suffer in silence because they are too
embarrassed to discuss their problem or they think
that it is a normal part of ageing. It is never too late
to seek help.
While there is no consensus on the cause
of OAB, one thing is certain:
OAB is not normal in adults of any age and you
should not have to suffer needlessly. Most cases
of OAB can be successfully treated. You must be
positive and know that your healthcare professional
will do all that they can to minimise your problem in
order to give you the freedom to live life as normally
as possible.
7
What are the Treatment Options for OAB?
Although your healthcare professional will recommend
the most appropriate treatment for your OAB, some of
the options include:
Pelvic floor exercises
You can strengthen the muscles supporting the
bladder and urethra by performing pelvic floor muscle
exercises. Toning these pelvic floor muscles can
help support the bladder and reduce urgency and
frequency episodes.
Finding the muscles
Sit comfortably on an upright chair, knees apart,
pelvis in neutral. Keep the buttocks relaxed.
Imagine you are stopping yourself emptying the
bladder or passing wind. Or imagine your pelvic floor
is like a lift moving up and down to different floors.
Continue to breathe normally during this exercise
(don’t take big breathes to lift up your muscles).
Learn how to control the urgency
As soon as the urge starts, try to relax, stay still and
take a few deep breaths. Squeeze the muscle as
hard as you can until the urge begins to fade. Then
once you have the control, hold the muscles gently
while walking to the toilet. Squeeze hard again when
undressing. Practice using the muscles to control the
bladder every time you have the strong urge until you
can reach the toilet in time.
Bladder retraining
Once you have mastered controlling the bladder in
order to reach the toilet in time, you can start to use the
exercises to increase the length of time between your
trips to the toilet. This involves slowly increasing the
time you wait before going to the toilet. Try to distract
yourself while waiting by doing tasks that are mentally
challenging but not physically challenging e.g. Count,
read, think positive thoughts, ‘I can control my bladder’.
Over the weeks and months, gradually change your
daily schedule of trips to the toilet so that you are slowly
building up the time interval between toilet trips.
8
Understanding
Overactive
Bladder
Add 5-10 mins before you feel you have to go to the
bathroom, once you have successfully managed this time
interval, begin to increase by 15 mins.
Dietary changes
Limit your intake of caffeine; avoid food and drinks that
contain alcohol and sugar as they can often irritate the
bladder. You should aim to drink approximately 1.5
litres per day, (particularly water) and eat a sensible
diet in order to minimise constipation.
Medication
Your doctor can prescribe medication to improve or
reduce your symptoms of OAB.
In certain cases your doctor may recommend that
you also visit a specialist.
There are incontinence products available however,
whilst they manage the problem they do not treat the
cause of the problem. With support, guidance and
advice from a healthcare professional the symptoms
of OAB can be improved or even cured.
9
Bladder Diary
To provide a full picture of your symptoms, it is a
good idea to keep a bladder diary for a few days
before you visit a healthcare professional. In this
diary you could note:
• When you go to the toilet and how much urine
you pass
• If you accidentally leak urine and the activity
you were doing at the time
• When, how much you drink and what type of
fluid you drink
You could do this by simply writing down the times
you go to the toilet in a notebook or you could
complete the Bladder Diary at the back of
this booklet. This information will help your doctor
or nurse to assess your symptoms and allow them to
determine how frequently you go to the toilet, how
much urine your bladder can hold and whether you
are drinking too much or too little fluid. It will also
help determine the type of treatment that will suit best.
Self-Assessment
Bladder Questionnaire
It is also recommended that you complete the SelfAssessment Bladder Questionnaire (V8 screener) that
is contained at the back of this booklet before you
attend your doctor or nurse. This is a simple quiz that
can give you an indication of whether you may suffer
from the symptoms of OAB. Please choose the answer
that best describes how bothered you may be by each
of the bladder symptoms. Add the numbers together
for a total score and record the score in the boxes
provided at the bottom.
References: 1. Milsom et al. How Widespread are the Symptoms of OAB?
BJU Intl. 2001; 87: 760-766.
10
Bladder Diary
Frequency and Volume
Day
Time
Day 1
F
T
U
Day 2
W
F
T
U
W
6am
7am
8am
9am
10am
11am
12pm
1pm
2pm
3pm
4pm
5pm
6pm
7pm
8pm
9pm
10pm
11pm
12-3am
3-6am
Total
F
In this column record how much
fluid you drink, i.e. coffee, tea,
water, beer etc.
T
Record in this box the type of
fluid taken.
U
W
In this column record the amount
or volume of urine passed.
In this column record any wet
episodes by simply ticking the box
against the corresponding hour
of the day.
Example
Day
Time
Day 1
F
T
6am
200ml water
7am
150ml tea
8am
9am
U
Day 2
W
F
T
U
W
300ml
✓
✓
Bladder Diary
Frequency and Volume
Day 3
Day
Time
F
T
Day 4
U
W
F
T
U
W
6am
7am
8am
9am
10am
11am
12pm
1pm
2pm
3pm
4pm
5pm
6pm
7pm
8pm
9pm
10pm
11pm
12-3am
3-6am
Total
F
T
U
W
In this column record how much
fluid you drink, i.e. coffee, tea,
water, beer etc.
Record in this box the type of
fluid taken.
In this column record the amount
or volume of urine passed.
In this column record any wet
episodes by simply ticking the
box against the corresponding
hour of the day.
Example
Day
Time
Day 3
F
7am
9am
U
Day 4
W
F
300ml
6am
8am
T
150ml
T
U
W
✓
OAB — V8 Screener
The questions below ask about how bothered you
may be by some bladder symptoms. Some people are
bothered by bladder symptoms and may not realise
that there are treatments available for their symptoms.
Please circle that number that best describes how
much you have been bothered by each symptom.
Add the numbers together for a total score and record
the score in the boxes provided at the bottom.
How bothered
have you been
by...
Not
at
all
A
little
bit
Some
What
Quite
a bit
A
great
deal
A
very
great
deal
1. F requent urination
during the
daytime hours?
0
1
2
3
4
5
2. A
n uncomfortable
urge to urinate?
0
1
2
3
4
5
3. A
sudden urge to
urinate with little
or no warning?
0
1
2
3
4
5
4. A
ccidental loss of
small amounts of
urine?
0
1
2
3
4
5
5. N
ight time
urination?
0
1
2
3
4
5
6. Waking up at
night because you
had to urinate?
0
1
2
3
4
5
7. A
n uncontrollable
urge to urinate?
0
1
2
3
4
5
8. U
rine loss
associated with a
strong desire to
urinate?
0
1
2
3
4
5
Are you male? If male, add 2 points to your score
Please add up your responses to the questions above
Please hand this page to your doctor when you see
him/her for your visit.
If your score is 8 or greater, you may have overactive bladder.
There are effective treatments for this condition. You may want to talk
with a healthcare professional about your symptoms.
*The OAB-V8 Screener was validated in a multi-centre study comprising 1260 patients.2
References: 2. Coyne K et al. Validation of an OAB screener in a primary care patient
population in the US. Poster presented at ICS Paris, 2004.
TOV/2010/038
Date of preparation: February 2011
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www.befreefromoab.ie