Millions of Britons have bladder issues, but simple lifestyle changes and, if necessary, a referral to a specialist team can end any problems.
Q. What are the symptoms of bladder problems?
Feeling a sudden hard-to-resist urge to go to the toilet can be a sign of an overactive bladder. Some people leak before they reach the bathroom, or need to go more than seven times a day and frequently through the night.
Others have stress urinary incontinence – leaking when they laugh, sneeze, cough or exercise. “Bladder problems really affect people’s lives, but can often be easily treated,” says Jan Chaseley, clinical nurse specialist, continence care at Benenden Hospital Trust.
“There are around 14 million people in the UK today with some form of bladder problem, more than those with asthma, diabetes and epilepsy put together,” she says.
Q. What causes these issues?
Bladder problems affect one in three women and one in five men. In women, the urethra or tube carrying urine from the bladder is shorter and more prone to leaks. Stress incontinence can affect women after childbirth, because of extra strain on the pelvis or childbirth problems. Either can weaken the pelvic floor muscles which hold the bladder and bowel in place and help to stop leaks.
Men can also develop stress incontinence after surgery for prostate cancer. As they age, and the prostate which surrounds the urethra grows, they may also have difficulty emptying their bladder fully.
Some women also develop stress incontinence after menopause, as hormone changes weaken the pelvic floor. “But bladder problems should never be seen as a normal part of ageing,” says Jan, who along with her team, treats stress incontinence, overactive bladder syndrome, prolapse and many other bladder issues.
Q. How can symptoms be managed?
Simple lifestyle changes can make a difference: avoiding drinks containing caffeine, which can irritate the bladder, and fizzy drinks which can contain caffeine and artificial sweeteners. Alcoholic drinks and acid in fruit juices can make problems worse.
But drinking too little can make the bladder more prone to infection. “When you are not drinking enough, the bladder gets used to holding smaller amounts of urine and can become overly sensitive,” says Jan.
Being overweight can also put excessive pressure on the bladder and pelvic floor muscles, so weight loss can be beneficial. Smoking, too, can irritate the bladder, so cutting down and quitting helps. So can a healthy diet, so the bowel empties properly – constipation can put pressure on the bladder.
“Practising pelvic floor exercises to strengthen the muscles of the pelvic floor is effective, and we teach patients to do their exercises properly,” says Jan. “We also teach bladder re-training exercises, so people wait longer and control their pelvic floor muscles, so the bladder gets used to holding more again.”
Q. When should you ask for support?
“When bladder problems affect people’s lives and it becomes difficult for them to enjoy the theatre, undertake long journeys or go on holiday, it’s time to ask for help,” says Jan.
“Urinary incontinence causes huge embarrassment and inconvenience, but there are often simple lifestyle measures which can help. So see your GP and if necessary ask for a referral to a specialist nurse.”
Q. What kinds of treatment are on offer?
Practising pelvic floor exercises regularly can help to strengthen the muscles and make the bladder less prone to leaking: specialist nurses can teach these exercises. Lifestyle measures such as weight loss can also be effective.
We also now offer percutaneous tibial nerve stimulation (PTNS), where an acupuncture needle linked to a TENS machine can stimulate the tibial nerve in the ankle. This acts on the nerve controlling the bladder. “This is effective, though it takes up to 12 weekly sessions to work – it feels like a pleasant tingle,” says Jan.
The specialist team supports patients undergoing regular Botox injections to reduce over-activity. Patients who find that they need to frequently get up to use the loo at night can also be taught to use a small catheter, to re-train the bladder to empty itself properly.
As a last resort, the team can also refer to gynaecology or urology teams who can offer further treatments.
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Published on 20 June 2018