Over Active Bladder in women
Date issued: May 2024
For review: May 2026
Ref: A-237/Gynae/HF/Over active bladder in women v4
PDF: Over active bladder in women v4.pdf[pdf] 195KB
What is Over Active Bladder (OAB)?
OAB is a common condition affecting around one in four women. OAB happens when the bladder contracts suddenly without you having control, when the bladder may not be full or ready to empty.
Symptoms include:
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Urgency. The sudden urgent need to pass urine. Feeling unable to put off going to the toilet and feeling you might leak urine if you don’t get there in time.
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Frequency. Passing urine more frequently during the day.
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Urge incontinence. When you leak urine while experiencing the sudden urge to pass urine.
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Nocturia. Waking to pass urine more than once or twice at night.
Why does my bladder behave like this?
Normally the bladder muscle is like a balloon which is relaxed as it fills up. When the bladder senses it is becoming full it signals to the brain that it needs to empty (pass urine). The signal then returns to the bladder to contract (squeeze) releasing the urine. Most adults can hold on for some time after the initial feeling until it is convenient to go to the toilet. It is usual to pass urine 5 – 8 times a day and maybe once at night.
What causes OAB?
There is no one main cause of OAB but we know certain things make symptoms worse
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Anxiety
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Constipation
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Infection: you have pain passing urine please see your doctor.
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Drinks: Those containing caffeine (tea, coffee, cola, green tea, alcohol, fizzy drinks.)
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Sweeteners: These can irritate your bladder: saccharin, aspartame.
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Some medicines
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Some medical conditions Parkinson’s, M.S. and Stroke along with poorly controlled diabetes.
How can I keep my bladder healthy?
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Lifestyle changes, these actions alone work for some women.
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Bladder retraining: Up to 60% of people who follow the programme may notice an improvement.
Avoid
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Drinks with caffeine such as, tea, coffee, cola, green tea, fizzy or diet types.
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Sweeteners: saccharin, aspartame®, acesulfame K®
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Black currant cordial (e.g. Ribena®, Vimto®).
Constipation
Try Including more fruit, vegetables and wholemeal (fibre) in your diet. If your bowel is full, it can worsen your bladder problems.
Make sure you drink enough, your body needs about 2 litres (2,000mls) of fluid per day. This is about 6 or 7 mugs or glasses of drinks spaced out throughout the day. Many people believe drinking less will stop them producing urine, but your bladder needs enough fluid to stretch and fill regularly.
Over time too little fluid can make your bladder feel full even when it isn’t, making it contract (or overreact) too often. This is the same reason to avoid going to the toilet “just in case”; remember the “frequency/urgency”?
Try decaffeinated tea and coffee. Redbush (Rooibosh®) tea has no caffeine and is naturally low in tannin. Instead of diet drinks dilute a third of a glass of pure fruit juice topped up with water.
Bladder Training
Bladder control can be improved by having a strict routine for going to the toilet. On your Frequency/Volume chart, record every time you pass urine and each drink for 3 days and nights. This will help your doctor, nurse or physiotherapist assess your symptoms. They can plan your treatment with you and review its progress.
To keep the chart you will need a jug which measures up to 500ml (millilitres) for measuring your urine.
Write down
Drinks:
What e.g. water, tea, juice
How much:
- 1 mug = 300mls
- 1 glass tumbler = 250mls
- 1 cup = 150mls
Urine:
Measure how much urine every time day or night.
Leakage:
Pad:
- Damp = +
- Wet = ++
- Soaking = +++
Look at your chart. What is the longest time between your visits to the toilet? What is the largest amount of urine you have passed? This will show you how much you can actually hold at present.
If you can hold your urine for example 2 hours, try to hold on for an extra ¼ an hour (2 ¼ hours).
When you can manage that length of time without rushing to the toilet, stretch the time out by another 15 minutes e.g. from 2 ¼ hours to 2 ½ hours.
You should gradually increase the time between toileting until you are going only 6 or 7 times a day and no more than once or twice at night.
This may take weeks to achieve and some days may be difficult or there are setbacks but please don’t give up.
You can compare a Frequency/volume chart from the beginning of treatment with a chart completed after treatment to see how much change there has been. Remember, when you have successfully trained your bladder into good habits, you need to practice these habits for the rest of your life.
Medication:
Sometimes these approaches are not quite enough. Ask your doctor or specialist continence nurse whether medicines to relax the bladder could help. The medications work best in conjunction with changes in lifestyle and bladder retraining. It is therefore still important to control what you drink and train your bladder .
Most medicines which calm the overactive bladder can have unwanted side effects. The most common being dry mouth, dry eyes and constipation. Sucking low sugar sweets or ice can make saliva. Talk to your healthcare professional for ways to help with this.
If medication and bladder training does not improve your symptoms than your doctor will discuss the following options with you
Percutaneous Tibial Nerve Stimulation (PTNS)
It involves stimulating a nerve near the ankle (posterior tibial nerve) to treat overactive bladder. The posterior tibial nerve contains fibres that originate from the same spinal segments as the nerves to the bladder and pelvic floor. It involves inserting a needle electrode near the ankle and stimulating it for 30 minutes using a special stimulator.
The procedure is performed by nurses in the gynaecology clinic and requires weekly sessions for 12 weeks. It works in 60% of patients with OAB but the effect may reduce over time which will necessitate repeat top-up sessions.
Botox injections
Botox can be injected into the bladder muscles via a telescope either under localanaesthetic or general anaesthetic. It relaxes the bladder muscle and allows thebladder to store more urine and reduces urgency, frequency and leakage episodes.It works in up to 75% patients with OAB and the effect lasts for up to 9 months, afterwhich repeat injections may be needed.
This licensed for use in the bladder. One in10 women have problems emptying their bladder after this treatment which is why it isnecessary to learn self catheterization before the procedure.
Useful contacts for support and advice
Tel. 0845 345 0165
