The overactive bladder explained

Fiona Clark

Running to the toilet more than 7 times a day? Feel the need that you have to go right now? Find out why and what you can do about it.


Most of the time we don’t pay much attention to our bladder – it just does what it does – emptying a few times a day to rid the body of waste products it doesn’t need – but – when it goes wrong, we notice!

One common problem many women face, especially as oestrogen levels drop, is a feeling that they have to keep racing to the loo far more often than they used it. It’s called an overactive bladder (OAB).

It’s said to affect around 30% of men and 40% of women but the Urology Care Foundation says number of people who are affected could actually be much higher as many women don’t seek help because they find it embarrassing to talk about. We’re also told that it’s a natural part of ageing that we should accept, and that’s reinforced by advertising that normalises leakage to sell absorbent underpants.

But nothing could be further from the truth, according to Jo Gipson, a pelvic floor physiotherapist from Leto Woman. She says this condition can affect quality of life.

Getting up repeatedly at night to go to the loo disrupts sleep, and the urgency that some people experience can be an issue at work or socially. And if there’s leakage – that can be embarrassing.

The good new is, there are a variety of treatments that can help.


What is an Overactive Bladder?

What are we talking about when we say overactive bladder?  Basically, urgency and frequency.

“Sometimes there’s a sense of urgency, that feeling that you really have to go now. Sometimes that’s associated with leakage and if so it’s called urge urinary incontinence or Overactive Bladder Wet, which means your leaking as well as the urgency. But it can also be dry – so you feel the urgency but you don’t leak. That’s Overactive Bladder Dry”, Jo says.

Then there’s the number of times we go. Jo says it’s normal to go up to 7 times a day, but when it’s 8 or more it’s getting into the problem area.

Age plays a role in what’s considered to be normal frequency.

“If you’re under 65 you shouldn’t need to go at night at all, if your over 65 you may wake up once at night and then add in another one more wee a night for every ten years afterwards. So if you’re 75 it would be normal to go twice at night, and 85 it would be three times”, she says.

It’s not the same as stress urinary incontinence, Jo says, which is when you have leakage when you cough, laugh or sneeze. Often there are triggers involved too, like alcohol or coming home and putting the key in the door, and they can get to a point where they are so bad that “it can stop people from leaving the house”, Jo says.

But, she says, many people many don’t know that they have it and think this is just the way it is for them or that they come from a family of “small bladders”.

Risk Factors and Causes

Being a woman is a risk factor as is age, and it’s a lot more common after the menopause, and there are certain medications that can cause it as well.

When is comes to causes there may be a few things going on.

1. the bladder muscle gets a bit twitchy and signals urgency to go

2. a neurological cause due to damage or sensitivity of disease like MS

3. changes to the cells lining the bladder, which may be aggravated by frequent UTIs

There may also be issues with bowel movement or the way the pelvic floor muscle are functioning.

For women, declining oestrogen levels may play a role as well, Jo says. “There are parts of the bladder that are really oestrogen sensitive” as is the urethra – the tube that carries the urine from the bladder and out of the body. When we have adequate levels or oestrogen it almost zip locks itself closed but as levels decline that self shutting mechanism is compromised, which means our risk of getting a urinary tract infection (UTI) increases.

“It’s really multifactorial. You can’t always say you’ve got this, so that’s why you’ve got these symptoms. Sometimes there are lots of things at play.”


alcohol overactive bladder trigger

Triggers and Lifestyle

First up, Jo says, if you have a bladder issue, it’s a good idea to make sure there are no infections or other problems that could be causing the issue.

Then, once you know there are no other issues, a physio can help. First up she says a full assessment is needed. Lots of questions are asked about bowel movements, back or hip pain, vaginal health and how the pelvic floor muscles are functioning, so they can devise the best plan.

Sometimes the problem is a weakened pelvic floor a program to strengthen the muscles is advised, but other times the muscles may be too tight and they need to be relaxed, and sometimes, Jo says, it’s a combination of the two.

“Often people have done loads of kegels but they don’t really know how to do them so they end up in trouble, that’s why an assessment is so important”, says Jo. “It’s not that you always fit in one box, and it can be a moving feast.”

Lifestyle is also important.

There may be triggers that can make things worse, she says, including:

  • Fizzy drinks
  • Artificial sweeteners
  • Alcohol and,
  • Caffeine.

Things to consider are whether you’ve emptied your bladder properly when you go and if you’re drinking enough fluids. She says you’re urine should be a light straw colour. If it’s too dark or concentrated it may irritate the bladder and make things worse.

Jo says a common mistake people make when they have an overactive bladder is to limit their fluid intake because they’re nervous about leakage, but that can risk dehydration and may also increase your risk of a UTI.

Bad Bladder Habits

Other bad habits that Jo often sees Jo also advises against stopping your urine flow as a way of strengthening  your pelvic floor. This sends mixed messages, she says. Your bladder is wanting to empty but then you’re telling it to stop and it gets confused. Plus it may lead to retention of urine in your bladder that could in turn lead to a UTI. “That’s a hard no”, says Jo.

Another is peeing on cue – for example every time you leave the house, or too many times before you go to sleep “just in case”.

“The problem is when you go too often your sending signals that the bladder  has to empty when it may only be half full. That’s a habit we have to break.”


overactive bladder

Treatment Options

Desensitising the bladder is one technique that can be useful, Jo Says, and distraction is a good way to do that. “Counting backwards from 107, thinking of a girls name for every letter of the alphabet. It doesn’t matter what, just distract yourself.”

Deep breathing can be helpful too, she says, as well as contracting the pelvic floor for 20 seconds or applying pressure to the perineal area – the area between your vagina and anus. If you’re in an office a good trick for this, she says, is to sit on the edge of your desk or chair and get some pressure on the area – no one will every know!

Bladder retraining is another option – this helps us recalibrate the bladder to it’s fullness. “We ask to keep a bladder diary, and measure the amount of urine they have at each wee” and then when their comfortable the time is extended between each wee.

Getting on tip of the triggers is important too. For example – “if your trigger is putting a key in the door and going for a wee, that association has to be broken.” This can be done by, for example, going for that wee and then going for a walk around the block straight away and then when you come back and put the key in the door and you feel that urgency – don’t go, because you know that your bladder is empty. Then you can distract yourself.

Bowel health is also important, as constipation can put pressure on the bladder and increase the urgency.

And then there is transcutaneous tibial nerve stimulation or TNNS. This can be as effective as medication for overactive bladder, she says, but without the side effects.

It involves attaching little pads near your ankle that send an electrical signal though the tibial nerve and over a period of 12 weeks of treatment it can improve the condition. It is important to have the right settings, so you’d need to see a pelvic floor physio for guidance.

And, there’s even Botox for the bladder as another option.

“There are so many options out there, you don’t have to live with this”, Jo says.


The Truth About OAB from Urology Health 

OAB is not a normal part of getting older.
OAB is not just part of being a woman.
OAB is not just an issue with the prostate.
OAB is not caused by something you did.
Surgery is not the only treatment for OAB.
There are treatments to help people manage OAB symptoms.
There are treatments to help even minor OAB symptoms

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