Bladder matters

The official definition of overactive bladder (OAB) is: urgency to urinate, associated with frequency and nocturia. Translate that into layman’s language and it is: the sudden urge to pee, needing to pee more than eight times a day and being woken from sleep with the urge to pee.

Twenty per cent of over-40s affected

OAB is a common condition, with an estimated 350,000 Irish people experiencing it and 20% of those over 40 – female and male – affected. In the under 40s, OAB is more common in females but once you get over 40, men are equally as likely to be afflicted.

“It also becomes more common with increasing age,” says consultant urologist at Beaumont and Mater Private Liza McLornan. “Forty per cent of those over the age of 80 might have it.”

Spectrum of symptoms

“There can be a spectrum of symptoms related to OAB,” Ms McLornan says. “OAB is what we call a storage symptom. That’s the inability of the bladder to store urine; instead it starts to involuntarily contract at low levels of filling.”

There are two types of OAB – wet and dry, she states.

“Some people constantly need to pee but they never wet themselves (dry). Others do wet themselves known as urge incontinence (wet). The diagnostic question, for me, to patients is: ‘Would you have to leave the top of the queue in the Post Office if you were posting your Christmas parcels because of the urge/fear of wetting?’ There can be a cystitis element as well with OAB symptoms being similar to the symptoms of a urinary tract infection.”

What causes OAB?

Several conditions can contribute to the symptoms of OAB including, neurological conditions (such as stroke, MS and Parkinson’s Disease), endocrine causes (such as diabetes), hormonal changes during menopause and urological causes (such as infection, stone, inflammation and tumour). General causes can include excessive intake of caffeine and alcohol, constipation and declining function due to ageing mentally (dementia) and physically.

It’s important to take a detailed history and perform an examination, Dr McLornan says, and lifestyle questions are important.

“Patients say to me, ‘I don’t drink caffeine, doctor, only tea’ – not realising that there is as much caffeine in a teabag as in a teaspoon of coffee.”

Affects quality of life

Ms McLornan believes many people leave it too long to seek help for this problem and this shouldn’t be the case.

“Symptoms can be easily managed at GP level and onward specialist referral is available as necessary, so nobody should suffer in silence,” she says.

OAB or any type of incontinence does, of course, affect a person’s quality of life. “You’re toilet mapping – worrying about whether or not a toilet is close,” she says.

“It affects employment too. You can’t leave a till in Tesco every five minutes. Apart from that, you’ve got the self-image problems – wetting yourself, having to wear pads – and social isolation. Women tell me about all they’ve given up. They say, ‘I used to go to yoga or keep fit class’ or ‘I don’t go to Dublin on the bus anymore for a day out like I used to’. Then there can be interpersonal relationship issues, intimacy and so on. The frequent getting up at night to go to the toilet can lead to sleep disturbance and to falls and fracture in the elderly, too.”

Treatment

Lifestyle modification is the first approach, often with the help of your GP, after infection is ruled out as a cause.

But first, what’s normal when it comes to urination?

“Six to eight times a day is normal,” Dr McLornan says. “If you are woken from sleep more than twice, that’s a problem. You should be able to get four hours’ sleep without going to the toilet. Your bladder should be able to hold enough for you to do that. The recommended fluid intake is 1.5-2l of liquid [per day], in total. That includes cups of tea or coffee and, don’t forget, there is fluid in food [like soups and vegetables] as well. Some women coming to me are drinking 4l a day and think they are doing well, flushing everything through – but no wonder they have to urinate frequently!”

Bladder diary

In order to assess the situation, patients are asked to fill in a frequency volume chart or bladder diary – usually when they consult a GP.

“That involves buying a plastic jug, peeing into it and measuring the amount,” Dr McLornan says. “Likewise, measure all that you drink for a couple of days. Your GP will know after that how big a problem you have. The advice then might be to reduce or stop caffeine (high-energy drinks are also full of caffeine) and steer clear of the plethora of foods that irritate the bladder like citrus fruits, tomatoes and chillies.”

Bladder can be trained

Behaviour modification is also advised to break the “habit” of frequent urination.

“If someone comes to you and they are going to the loo 15 times a day, you’re talking about bladder training which is teaching your bladder to hold more,” she says.

“The approach is that you don’t hang on until you’re in pain, but you do put off going for a while, say five minutes in the first week, then the next week concentrate on waiting an extra 10 minutes (before giving in to the urge). Over time, you can get yourself to two or three hours between each toilet trip.

“Use distraction techniques to put off going like make a phone call, turn on the telly, tidy a press,” she continues. “Patients should also stop smoking, lose weight if necessary, keep active and perform pelvic floor exercises. If all this doesn’t work the next step is to try medication.”

Drug remedy route

There are two main groups of drugs that can help alleviate OAB; both can be prescribed by GPs or specialists. These block the nerve signals to the bladder muscle to relax the muscle or help increase bladder filling and storage.

They do have side effects, however, like dry mouth, constipation and dry eyes. One group of these drugs can’t be taken if you have uncontrolled high blood pressure.

Referral to a consultant urologist

All the above can be prescribed by a GP, but a consultant urologist’s job is to rule out pathological causes like bladder tumours, stones or anatomical problems – or to work out which medical condition is contributing to OAB.

Bladder function tests

An easy test is to perform a scan to see how well the bladder empties (post void residual), or the rate of flow of the urine by asking the patient to urinate into a special flowmeter.

“People who come to me may need a cystoscopy (a bladder inspection procedure),” Dr McLornan says.

Testing bladder pressure (urodynamics) helps with the diagnosis of OAB. This involves the insertion of a thin tube, filling of the bladder with warm fluid and the measuring of how well the person’s bladder, sphincter muscles and urethra hold and release urine. The test can identify whether you have involuntary muscle contractions or maybe a smaller, stiff or sensitive bladder.

Botox injections

If OAB is proven by the urodynamic testing and medication doesn’t work, Botox injections can be tried.

“The Botox relaxes the bladder muscle, decreasing its over-contraction and it has good success rates,” Dr McLornan says. “However, 10-15% of patients who use this may need to self-catetherise four times a day afterwards. Botox also wears off so it would have to be repeated after nine to 12 months.”

Other options

Down the line, there is also a treatment called sacral nerve stimulation to stimulate the nerve root that supplies the bladder or a surgical option like a clamstcystoscopy (ie using some of bowel to replace the bladder). This is seldom done, however.

“Taking control of OAB can be life-changing and everyone should be encouraged to seek advice from a medical professional,” Dr McLornan says.

It’s now possible to get a set of hearing aids for free, following changes to the PRSI scheme run by the Department of Social Protection.

Up to the end of March 2021, there was a requirement for buyers of hearing aids to pay a minimum of 50% towards the cost of hearing aids.

The Department paid half the cost of a hearing aid subject to a fixed maximum of €500 for each hearing aid every four years, and paid half the cost of repairs to aids. This requirement has now been removed following industry recommendations to encourage more people to get hearing aids, given that one in six Irish adults has some hearing loss.

Thanks to these changes, if you only require basic level hearing aids (which cost around €500 each) you could get them for free.

A number of hearing aid providers will be offering hearing aids for around €1,000 from 1 April. Those eligible for the benefit can now get a pair of hearing aids up to the value of €1,000 (and not pay anything at all) or they can put their PRSI contribution (€500 for each hearing aid – total €1,000) towards the cost of a more expensive pair of hearing aids.

What the Department of Social Protection says:

Suppliers may provide hearing aids if they have a contract with the department. In this case, the department pays:

Note: Do check guarantee periods for the hearing aids you buy, however. The grant is only payable every four years. Guarantee periods for basic level hearing aids may/may not extend that long.