Health

When you've got to go...

It’s part of growing old – or is it? David Hughes examines the latest treatments for overactive bladder

The television series, and the latest feature film, of Dad’s Army featured the elderly Private Godfrey, whose contribution to keeping Britain safe from the Nazi hordes was frequently interrupted by the need to answer the call of nature

A source of humour it may be, but finding ourselves wanting to go to the loo more often is no joke

What is overactive bladder?

Overactive bladder (OAB) means the bladder muscle contracts too often or spontaneously and involuntarily. Symptoms can include an urgent need to use the toilet; going to the toilet more than eight times a day (sometimes a lot more); nocturia, going to the toilet several times at night; and urinary incontinence, the involuntary passing of urine.

An estimated one in six people in the UK, particularly in older age groups, suffers from OAB. Many people feel embarrassed by the condition, and don’t seek help or advice because they think it’s a natural consequence of getting older. But, say the experts, it doesn’t have to be, and if we find ourselves in that situation, there’s plenty of help and advice available.

Causes

Exactly what causes an overactive bladder is not fully understood; bacterial infection of the kidneys or bladder can be the cause, and, for men, prostatic obstruction. Certain illnesses, such as Parkinson’s or MS, can trigger it, but for the vast majority of people this is not the case. At any rate, lifestyle changes and avoiding irritants to the bladder can help bring things back to normal, with medications also available for those with no improvement.

How the bladder works

The bladder stores urine produced by the kidneys, and will usually hold about one pint when full. Six to seven visits to the toilet over a 24-hour period normal, depending on how much we drink.

The urinary system functions at its best if we consume around three to four pints of liquid per day. More than this will lead to increased frequency of the need to empty the bladder; but less is also detrimental, as it leads to more concentrated urine which can irritate the bladder. The best liquid for the bladder is water, and it’s best to avoid drinks that are too acidic or are diuretics (see panel).

Diagnosis and treatments

Assessing OAB will involve a chat with your GP about your general state of health, and probably a urine test to check for infection. It’s also common to record a four-day chart for frequency and volume of voiding.

Strategies to normalise bladder function include bladder training, to help you regain control over bladder contractions. Bladder training can take up to three months to show any results, and patients are advised not to be discouraged if immediate changes are not seen. Your GP can also give advice about factors that may contribute to OAB. Smoking, for example, is harmful as nicotine can irritate the bladder, and maintaining a healthy weight is also beneficial.

For those who don’t notice an improvement from the different lifestyle strategies, medicines are available, known as antimuscarinics or anticholinergics; these work by blocking nerve impulses to the bladder which stops it from contracting when it shouldn’t contract. These medicines can be combined with bladder training for maximum results.

As a final resort, various types of surgery are also available, most of which are not funded by the NHS and which carry certain risks; your GP can advise about these.

For most of us, though, bladder training, maintaining healthy weight, and a care with fluid intake are likely to go a long way to reduce the symptoms, and the embarrassment, of OAB – whether in the home or the Home Guard.

Private Godfrey would approve.

Find out more

Bladder and Bowel Foundation. Offers advice and assistance over the phone from specially trained nurses. Tel: 0845 345 0165 (Monday to Friday, 9.30am to 1pm), website: (www.bladderandbowelfoundation.org)

National Association for Continence, website: (www.nafc.org)

The Cystitis and Overactive Bladder Foundation, website: (www.cobfoundation.org)

NHS Choices, website: (www.nhs.uk/Livewell/incontinence/ Pages/Breakingthetaboo.aspx).

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