Most people associate issues around rushing to find a toilet in a busy shopping centre or at family gathering with women of a certain age and, while bladder incontinence affects one in two of all women during their lifetime, it’s also a problem for many men.
"About 350,000 people over 40 have symptoms of overactive bladder and that is split evenly between women and men," explains Dr James Forde, urologist at Beaumont Hospital in Dublin.
Dr Forde, who deals with the most severe forms of incontinence, says that problems with the bladder can have a big impact on people’s quality of life. “They disrupt their daily routines, social life and impact sleep. Some people are anxious about meeting friends because they need to go to the loo so often or if they are in the middle of a row of cinema seats or they don’t know where the nearest public toilet is. During the pandemic, it was even more difficult when restaurants and bars were closed.”
Dr Forde defines overactive bladder as a collection of symptoms which include the need to go to the loo urgently without being able to wait, the need to go very often or needing to get up to go several times during the night.
The average person should go to the toilet every three to four hours but this varies if there is higher intake of liquids.
Helen Keeble, pelvis health physiotherapist, defines urge incontinence as "being unable to hold urine when your body tells you that you need to wee so that you end up leaking on the way to the toilet". This, she says, is very common when you are just coming in the door. "Our bladder can get into annoying habits really easily, especially when the pelvis floor muscles have become weakened or stiff," says Keeble. Overactive bladder occurs when the muscle that makes up the wall of the bladder is overly sensitive or "overactive" thus telling you that you need to wee a lot more frequently than usual and often urgently.
“If the pelvis floor muscles are weakened or stiff for any reason then urge incontinence can coexist with overactive bladder,” explains Keeble.
Reasons
Reasons for overactive bladder range from prostate enlargement in men to complications following childbirth or the onset of the menopause in women. Certain surgeries and neurological conditions (stroke, Parkinson's disease and multiple sclerosis) can also result in bladder problems (see oab.ie).
Initial treatments include pelvis floor physiotherapy to restore normal movement and strength to the pelvis floor muscles. Cutting down on alcohol and caffeine while ensuring you are drinking an adequate amount of water each day is also crucial. “People often cut down on the amount of water they drink to avoid bladder problems but concentrated urine can actually make the problem worse,” says Keeble.
Dr Forde says that as caffeine is a bladder irritant – and caffeine intake is quite high in Ireland – reducing it can be as effective as medication for some people with bladder problems.
“I would definitely advise people to reduce their caffeine intake and have a glass of water instead of a caffeine drink later in the day and avoid caffeine drinks after 6pm. Carbonated and energy drinks with sweeteners and sugars also irritate the bladder,” says Dr Forde who encourages his patients to keep a bladder diary to record which drinks they have during the day.
Bladder training is also essential. This includes learning how to do pelvis floor exercises and teaching the bladder new habits such as waiting for 15 minutes longer to go to the toilet rather than rushing when you get the first signal to go.
As bladder health becomes less of a taboo subject, apps are being developed to help people learn pelvis floor exercises and other bladder training techniques. However, there is a small group of people with bladder problems who will require more interventions such as medication to slow down the action of the bladder thus preventing the urge sensation. “Medications are reserved for those where other approaches have failed,” explains Dr Forde.
Similarly, surgical interventions are used in a small number of cases where other treatment approaches haven’t succeeded. These include Botox injections into the bladder which encourage the relaxation of bladder muscles. Repeat injections are required every nine or 10 months or so as the effect wears off.
Nerve stimulation to modulate the nerve activity of the bladder is another approach that is used in severe cases of overactive bladder. “Both these treatments show between 70-80 per cent improvement in bladder symptoms,” says Dr Forde.
Surgery
John (61) had nerve stimulation surgery when other approaches to solving his bladder problems didn’t work. “I needed to go to the loo any number of times during the day without warning. I went to my doctor, who referred me to a specialist. I was put on two different types of medications which didn’t work. I had the Botox in my bladder but it didn’t last so I had the nerve stimulation surgery which has changed my life dramatically,” he says.
The device to stimulate the nerves of the bladder is operated by a Bluetooth-enabled control which John can adjust as required. “It has given me great peace of mind. I have the odd urge to go but it’s nothing like before. I think it’s important that men speak about these issues because all the advertisements on the television and radio focus on women but men suffer from bladder problems too.”
– To help improve public understanding of overactive bladder (OAB) and encourage more women and men aged 40 or older to identify and control OAB symptoms, Astellas has launched a new educational podcast series Control OAB – visit oab.ie for more information
