Picture it. You’re going away for the day and it’s a two hour drive. Mentally, you have mapped all the places en route where there’s a toilet you can stop at – service station, hotel and so on. You feel more secure knowing that you won’t be caught short. Now you go to the toilet once more before leaving the house, just in case.

If this pattern describes you, then you may be in need of bladder retraining.

It’s normal to pass urine every three and a half to four hours, and to pass 300ml or so each time. It’s not normal to leak before you go to the toilet or after you’ve just been, or when you cough, laugh, lift, exert yourself or have sex.

It’s not normal to get up several times a night to go to the toilet or to run to the loo countless times a day. It’s also not normal to pass a small amount when you go to the toilet, unless you are drinking very little.

If you are doing any of the above, you may be suffering from an overactive bladder which includes urge incontinence, or stress incontinence (i.e. leaking on exertion or coughing).

ONE-IN-THREE WOMEN HAVE BLADDER PROBLEMS

“Bladder problems are very common,” urodynamicist and Wicklow-born farmer’s daughter Colette Blake says.

“One-in-three women suffer from them and one-in-four men. In the 15 years I’ve been doing this job, patient numbers have risen from 34 to 350 last year.

“That’s because there is more awareness of the problem now and women are being more open about it. Often there are tears of relief when they realise that their bladder can be retrained and that life can get better for them as a result.”

70% of the women Colette sees at the clinic are in their 30s and 40s. 20% are older and a good 10% are only in their 20s.

Generally, leaking when exercising, etc., is associated with women in their 50s who haven’t done enough pelvic floor exercises after childbirth, but why is it also happening to young women?

BAD BLADDER HABITS

“50% of the people coming through here have bladder problems due to bad bladder habits,” she says.

“It’s usually urge incontinence in this case. The bladder is the most trainable organ in the body because it’s a muscle, but too many women have developed bad habits over the years, like not emptying their bladder fully because they are rushing too much, by going to the toilet too often just in case, or by holding on too long. Eventually, the bladder won’t be able to hold on and you will leak urine.”

MAPPING

Anxiety can be a factor in relation to bladder problems, says Colette.

“If you go into a shopping centre and, straight away, map where the toilet is, you are setting yourself up to need to go to that toilet sooner rather than later. You are sending that message to your brain. There’s also a type of incontinence called latch-key incontinence. You get used to rushing to the loo the minute you return home. After years of doing this, your brain associates going to the loo with turning the key in the door and eventually you don’t make it to the toilet in time.”

EMPTYING YOUR BLADDER PROPERLY IS VITAL

Proper bladder emptying is hugely important, she believes.

“Men will generally take their time on the toilet but women – especially mothers – rush in and out and don’t empty their bladders properly. That means they have a residual amount left in their bladder, meaning that they need to go to the loo quicker the next time.

“This means that they have trained their bladder not to empty properly and this then turns into a cycle of frequency, going to the toilet too many times in the day.”

NIGHT-TIME PROBLEMS

Going to the toilet when you wake in the night, if you don’t need to, trains your bladder to need to go at that time every night and this sets up a cycle of waking.

GOOD NEWS

The good news is that for most people their bladder can be retrained.

“I’ve seen women in tears because they can’t drive four miles into town without needing the toilet again or who can’t peel a spud because the running tap makes them want to go.

“I’ve also seen women who are getting up five times a night to go to the toilet. Six weeks of the retraining and most are sorted,” Colette says.

TIPS THAT WILL HELP

While it is advisable to see your GP if you are experiencing continence problems, here are some helpful bladder-retraining tips:

• If your bladder has become accustomed to emptying at certain times (e.g. key in the door), try to break this habit gently by waiting 10 minutes before you go to the toilet.

• Sit correctly on the toilet. Don’t hover over it. Rest your feet on a small box (child step or upturned basin) to assist your bladder to empty fully. This position allows the pelvic floor to relax properly and your bladder to tilt. Take time to empty.

• Keep your fluid intake at a reasonable level, e.g. six to eight glasses or 1.5 litres a day.

• Tea, coffee alcohol, green tea and dark berry juice drinks irritate the bladder. Try water, milk, herbal tea or decaffeinated drinks.

• Losing weight, stopping smoking and healthier drinking will also help.

Note: Toilets are designed by men for men, Colette says. “Women are designed to squat when urinating. This also prevents urinary tract infections. Use a step or upturned basin to raise your knees above your hips when you use the toilet – or a toilet roll under each foot will do if there is nothing else.”

BLADDER CLINIC

Women attending a urodynamics clinic, like that at Wexford General, are referred by a GP or consultant.

They are asked to fill out a 24-hour bladder diary for three to four days prior to attending.

“This provides the information about volume and frequency and is a window to bladder function.”They are also asked to attend with a full bladder.

An ultrasound scan of the bladder is done first, followed by the patient sitting on a computerised chair to urinate. The amount is measured.

A bladder retraining programme for the individual is then designed, this can include a programme of pelvic floor exercises.

Stress incontinence, where the pelvic floor is extremely weak or where the bladder neck is weak, may need surgery. However, further tests – urodynamics – are needed in this case.

Medication is also available, in some cases, where bladder retraining isn’t sufficient to solve the problem.

SYMPTOMS

Having an overactive bladder means that your bladder contracts (squeezes) when you don’t want it to do so. Symptoms of an overactive bladder include:

• Urgency: Sudden urge to pass urine.

• Urgency incontinence: Not getting to the toilet in time.

• Frequency: Passing urine more than eight times a day with or without urgency incontinence.

• Nocturia: Waking at night to pass urine.

This combination of symptoms is known as Overactive Bladder Syndrome (OAB)

BLADDER RETRAINING

Bladder retraining helps regain control of your overactive bladder by suppressing contractions.

You must gradually increase the capacity of your bladder and the time interval between passing urine. Determination is needed.

• Pelvic floor exercises are important in order to strengthen the pelvic floor.

• Example: Imagine your pelvic floor is like a lift. Try to take the lift up and down to different floors.

• Important: Do not stop and start during urination.

“This exercise was taught in the past,” Collette says, “but is not advisable because you are training your bladder muscles to stop and hold half way through. Empty completely is the key message.”