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HealthInfo Waitaha Canterbury

Overactive bladder (irritable bladder)

An overactive bladder is when your bladder suddenly contracts. It happens without you being in control, and when your bladder is not full.

It's a common condition but often no cause can be found for the repeated and uncontrolled bladder contractions.

Both men and women can be affected, and it can lead to leakage of wee (urine).

Causes of overactive bladder

The causes of overactive bladder aren't fully understood. The bladder muscle becomes overactive and contracts when you do not want it to.

Normally, the bladder muscle is relaxed as the bladder gradually fills up. As the bladder is gradually stretched, we get a feeling of wanting to wee (urinate) when the bladder is about half full.

Most people can hold on quite easily for some time after this initial feeling until a convenient time to go to the toilet. But with an overactive bladder, the bladder muscle seems to give wrong messages to the brain. The bladder may feel fuller than it actually is. The bladder contracts too early when it is not very full. This can make you suddenly need the toilet. In effect, you have much less control over when your bladder contracts to wee (urinate).

There are treatments for overactive bladder so it's important to talk to your general practice team about any bladder problems.

Symptoms of overactive bladder

Treating overactive bladder

Bladder retraining

The aim of bladder retraining is to slowly stretch your bladder so it can hold larger and larger volumes of wee. In time, your bladder muscle should become less overactive, and you should become more in control of your bladder. This means that more time can elapse between feeling the desire to wee and having to get to a toilet. Leaks of urine are then less likely.

Pelvic floor exercises

Regular exercises to strengthen your pelvic floor muscles can help you avoid leaking wee when your bladder muscles contract at unpredictable times. You should learn how to do pelvic floor exercises at the same time as bladder retraining, with help from a continence advisor if needed.

See Pelvic floor training for women and men.

Medicines

An anticholinergic medicine such as solifenacin acts on your bladder muscles to help reduce the frequency and severity of contractions. This can provide some immediate benefit and help you control your bladder while you learn the exercises and techniques described above. After a time, when you've regained bladder control, it may be possible to slowly reduce and stop using the medicines. A dry mouth or indigestion are possible side effects with these drugs.

Women can experience estrogen hormone deficiency, which has been associated with urinary urgency and frequency. Vaginal estrogen cream has been shown to reduce these symptoms.

If there has been no improvement with these treatments, your doctor may refer you to a specialist called a urologist, who can investigate the problem further and consider other treatments. These include botulinum toxin injections at sites within the bladder and sometimes surgery.

Self-care with overactive bladder

Getting to the toilet

Make this as easy as possible. If you have mobility issues, consider special adaptations like a handrail or a raised toilet seat.

Manage caffeine and alcohol

Tea, coffee, cola, energy drinks and some pain relief tablets contain caffeine. Some herbal teas and green tea can also contain caffeine. Caffeine is a diuretic and increases the amount of wee your body makes. Caffeine may also directly stimulate your bladder to make your urgency symptoms worse. It may be worth trying without caffeine for a week or so to see if your symptoms improve.

If your symptoms do improve, you may not want to give up caffeine completely. But you may wish to limit the times that you have a caffeine-containing drink. Also, you'll know to be near a toilet whenever you have caffeine.

In some people, alcohol may make symptoms worse. The same advice applies as with caffeine drinks.

Drink normal quantities of fluids

It may seem sensible to cut back on the amount that you drink so your bladder doesn't fill so quickly. But this can make your symptoms worse as your wee becomes more concentrated, which may irritate your bladder muscle. Aim to drink normal quantities of fluids each day. This is usually about two litres (about six to eight cups) of fluid per day – and more in hot climates and hot weather.

Only go to the toilet when you need to

Some people get into the habit of going to the toilet more often than they need. They may go when their bladder only has a small amount of wee so as "not to be caught short". This may sound sensible, as some people think the symptoms of an overactive bladder will not develop if their bladder doesn't fill very much and they empty it regularly. But this can make symptoms worse in the long run.

If you go to the toilet too often, your bladder becomes used to holding less wee. Your bladder may then become even more sensitive and overactive at times when it's stretched a little. So, you may find that when you need to hold on a bit longer (for example, if you go out), your symptoms are worse than ever.

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Content shared between HealthInfo Canterbury, KidsHealth and Health Navigator NZ as part of a National Health Content Hub collaborative. Page created April 2023.

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Review key: HIURS-53047