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Overactive bladder

Written by physiotherapist Ashleigh Crawford.

Do you often need to race to the bathroom to empty your bladder out of fear of leaking urine? Are you going to the bathroom to empty your bladder frequently throughout the day? Do you get an intense, sudden need to empty your bladder and/or loose control of your bladder when you get home from being out or when you hear running water? If you are experiencing any of these symptoms, you may be suffering from what’s called Overactive Bladder. 40% of women and 30% of men have overactive bladder symptoms. The good news is that there is something that can be done about it. Keep reading to find out more!

What is overactive bladder?

Overactive bladder refers to symptomatic urgency, with or without urine leakage, usually with an increased frequency of bladder emptying during the day and night.

“Urgency” can mean different things to different people but refers to a difficult-to-defer desire to pass urine for fear of leakage.

  • Unofficially regarded as the perception of inability to defer 5 minutes or more

  • A desperate sensation of not being able to hold

  • The inability to wait to empty the bladder

What causes overactive bladder?

Overactive bladder is commonly caused by detrusor overactivity. The detrusor is the muscle of the bladder wall. Detrusor overactivity refers to contractions of the bladder wall muscle (the detrusor) during the filling phase which may be spontaneous or provoked.

Things that can irritate the bladder wall and cause these symptoms include: not consuming enough water or fluid throughout the day, drinking too much of bladder irritants (caffeine, alcohol, artificial sweeteners, carbonated drinks) or consuming fluid too quickly. Overactive bladder can also be caused by the development of associations between a certain activity and bladder emptying. For example; emptying your bladder in the shower. If you regularly empty your bladder in the shower, the brain may create an association with that activity and emptying your bladder. Therefore, even if your bladder is not full, when you get into the shower, your brain tells your bladder that it is time to empty. This can lead to overactive bladder symptoms being triggered by showering or hearing/feeling running water.

Overactive bladder can also be caused by a bladder wall that has decreased compliance or is ‘tight’. As a result, as the bladder fills, it has difficulty stretching and expanding. This results in a stronger than usual sensation of needling to pass urine at lower than normal bladder volumes.

In some cases, overactive bladder can be caused by increased signalling of the nerves that carry messages from the bladder to the brain. These nerves tell the brain how full the bladder is and if these nerves become overactive, this can increase the sensation of how full the bladder is even when there is only small volumes of urine in the bladder.

How do we treat overactive bladder?

Overactive bladder symptoms can present differently from person to person and the cause of the overactivity can also be different person to person. This is why during a pelvic health assessment with one of our pelvic health physiotherapists, we will get you to complete a bladder diary (24-48 hour record of bladder emptying and fluid intake to be done at home) which is a very useful tool and allows us to understand what might be triggering your bladder overactivity. From here, we can use a number of research based treatment methods to treat your symptoms. A common treatment method that we use is behaviour retraining. Step 1 of behaviour retraining involves lifestyle and diet modification. Step 2 involves learning how to suppress or calm down the intense urges you get when your bladder is going into spasm and therefore stop any urine leakage occurring while rushing to the bathroom. If behaviour retraining doesn’t help you or does but not enough, then we may recommend trying Trans-tibial nerve stimulation (TTNS).

What is TTNS?

TTNS is a form of electrical stimulation that involves the activation of the tibial nerve (a nerve that runs on the inside of your lower leg). It is non-invasive (no penetration of the skin) and uses 2 surface electrodes (sticky patches) that are placed just above the ankle on the inner side of the lower leg. The reason that the electrodes are placed here, is because the tibial nerve converges on the same neural pathway as the nerve that supplies the muscular wall of the bladder. By increasing the stimulation to this nerve, it dampens down the signal going to the bladder wall and hence calms down the bladder wall. TTNS needs to be used for at least a few weeks to be effective, but good news, we can show you how to set it up and use it in the comfort of your own home. We have all the equipment you need available to hire/purchase.

There are a few more treatment options we can use but these are the most common. If you or anyone you know has symptoms of overactive bladder, come see one of our pelvic health physiotherapists to have an assessment and get the treatment you need. You don’t have to live with this or suffer in silence anymore!

Picture: Application of TTNS.

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