Do you find yourself needing to go to the bathroom even when your bladder isn’t full? Do you know every toilet in town by heart? If so, then you may be suffering from a condition called overactive bladder.
Healthy bladder
With the right amount of fluid intake (approx. 30ml/kg of your body weight):
- you should go to the bathroom 6 – 8 times over a 24h period
- average amount of single micturition is 350-500 ml
- you should go to the bathroom no more than once at night
- the difference between fluid input and fluid output is +/- 500ml (normal output is between 1,5-2l in 24 hours)
If the urine production is a normal rate but frequency is high, then it must be a LUT (Lower Urinary Tract) storage/sensory issue.
But if there is an excessive urine production issue, it should be investigated to rule out significant medical issues (not just habit of high fluid intake) e.g., diabetes, heart disease.
With a healthy bladder, signals in your brain let you know that your bladder is getting full or is full, but you can wait to go to the bathroom. With OAB, you can’t wait. You feel a sudden need to go. This can happen even if your bladder isn’t full.
What is overactive bladder?
Overactive bladder (OAB) is an umbrella term used to describe specific bladder symptoms. OAB can interfere with work, going out with friends, exercise and sleep. The three main symptoms are:
- Urgency, a feeling that you have to go to the bathroom now
- Incontinence, which means that you leak urine with the “gotta go” feeling
- Frequency, the need to go to the bathroom often, day and night
There are two kinds of overactive bladder. One without urge incontinence (leak), which is called overactive bladder, dry, and affects two thirds of people; and overactive bladder, wet, which includes the symptoms with urge incontinence (leaking or involuntary bladder voiding).
The prevalence of OAB increases significantly with age.
An urgent bladder repeatedly sends signals to empty, increasing toilet visits to avoid accidents. This can change the way you plan your day, knowing the location of every toilet before going out. For many women urgency can be triggered by turning the tap on, getting up from a chair or a bed or or putting a key in the door.
What is the cause of overactive bladder?
The causes of OAB are not completely understood, and symptoms may differ between people and may be confusing. Pelvic floor plays an important part in OAB. Many studies found that pelvic floor function is impaired in women with OAB. Overactivity is due to loss of the balance between lower urinary tract and the nervous system. Other causes may include:
- hyperactive or non-relaxing pelvic floor muscles
- trigger points in the pelvic floor muscles
- bladder pain syndrome
- recurrent infections
- poorly controlled diabetes
- neurological diseases (Parkinson`s Disease, Multiple Sclerosis, stroke)
- lumbar disc disease
- pelvic surgery
- obstetric injury
How does the bladder work?
The ability to hold your urine and pass it is complex and involves the coordination of muscles, nerve signals and hormones, which is regulated by the brain and the spinal cord.
The bladder expands when it fills up, like a balloon. Nerves in the bladder wall detect the expansion and send a signal to the brain, letting it know that the bladder is full. The urinary bladder can store up to 500 ml of urine. We feel the need to pee when our bladder has between 200 and 350 ml of urine in it. When we empty our bladder, the muscle in our bladder wall tightens to squeeze the urine out of our bladder, while at the same time the sphincter muscles at the base of your bladder relax, allowing the urine to flow out through your urethra. With OAB, this mechanism is disrupted. You feel a sudden need to go even if your bladder isn’t full.
Bladder and sphincter
Image © 2003 Fairman Studios, LLC
How can physiotherapy help?
Pelvic floor physiotherapy for overactive bladder is effective in helping to control OAB symptoms without any side effects. Physiotherapy may include:
- Manual therapy to release overactive pelvic floor muscles and trigger points
- Breathing techniques to help relax pelvic floor muscles
- Pelvic floor muscle re-training program, which will involve relaxation, strengthening exercises or combination of both
- Bladder retraining program, which involves gradually extending the time between visits to the toilet
- Urge suppression strategies to help you overcome a sudden urge to pass urine
- Advice on adequate fluid intake
- NMES (electrical stimulation)
- Biofeedback (such as real-time ultrasound) to ensure that the right muscle groups are being exercised
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Resources
Schmidt RF, Lang F. Physiologie des Menschen. Berlin: Springer; 2017.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938554/