Do you feel like you often can’t hold on when you need to go to the bathroom? Does your urge to pass urine come on suddenly? You may be suffering with overactive bladder syndrome (OAB).
OAB is typically described as a sudden urgent desire to pass urine and may also include needing to frequently go to the toilet during the day and/or during the night. People suffering from OAB may leak urine when they feel this urgent desire, or they may just make it to the toilet in time. It has been found that the sensation of urgently needing to go to the toilet has the biggest impact on quality of life of all urinary symptoms.
The bladder has a muscular component called the detrusor. As the bladder expands, the detrusor relaxes and allows the bladder to stretch and fill with urine. Normally as the bladder gradually becomes full there is increased signaling sent to the brain, which increase the sensations of urgency to go to the toilet. Typically you will experience a strong urge, and feel like you can’t hold on more than 5 minutes once there is between 400-550mls in your bladder. Once the detrusor contracts or squeezes (normally when sitting on the toilet to pass urine) it forces urine out of the bladder. For people with OAB this strong urge may come on with much less than this amount in your bladder, and is often caused by the detrusor contracting at times when they’re not sitting on the toilet. These are often referred to as bladder spasms.
People with OAB often have episodes of urgency or bladder spasms as a response to different stimuli or triggers. Common triggers are;
- Thinking about going to the toilet
- Seeing the toilet
- Hearing running water
- Getting in the shower
- Arriving home after being out
- Putting your key in the front door
- Deciding to go to the toilet and having a bladder spasm on the way to the toilet
There are three main types of OAB based on the cause;
1. Idiopathic detrusor overactivity; The bladder walls have become more sensitized and as a result there are spontaneous spasms of the detrusor muscle. The bladder may become more sensitive due to recurrent UTI’s, or from exposure to bladder irritants such as caffeine, carbonated drinks, smoking or artificial sweeteners. We also know that these spasms may become conditioned to occur in response to triggers, for example every time you get in the shower, or every time you arrive home.
2. Neurogenic detrusor overactivity: There is a disruption to the neurological (brain, spinal chord, nerves) mechanisms that allow the bladder to relax and stretch to store urine or to contract and squeeze urine out of the bladder. This type of overactive bladder most commonly occurs secondary to spinal chord damage, stroke, Parkinson’s disease, MS or other neurological conditions.
3. Decreased bladder compliance: The bladder has reduced capacity to relax and expand to store urine. This may be due to pressure from another structure compressing the bladder such as fibroids, pregnancy, constipation, prolapse or as the bladder itself has lost it’s elasticity post radiation therapy. This type of urgency occurs as a storage issue, rather than an issue with detrusor spasms.
Treatment for overactive bladder often depends on the cause. A comprehensive Physiotherapy Assessment will often include an assessment of your bladder function using a bladder diary and an internal vaginal examination to check the strength of your pelvic floor muscle and for prolapse of pelvic organs. Take a look at our blog on Urinary Urgency for some examples of the different interventions that can be used for Urgency and/or Overactive Bladder.
Overactive Bladder is a condition that can get fantastic results with Physiotherapy as there are a range of treatment methods to suit the cause and symptoms you are experiencing. To book with one of our Women's Health Physiotherapists, click on the link below or call us on (02) 4384 3395.