Bladder

Introduction

Many bladder problems are caused by weak or overstretched pelvic floor muscles. In addition, lifestyle and other factors in our environment have a role to play. Up to a third of all women experience a problem with their pelvic floor muscles during their lifetime.
The most common types of bladder problem are:

Stress Urinary Incontinence (SUI)
Urgency Urinary Incontinence (UUI)
Overactive Bladder (OAB)

What is Stress Urinary Incontinence (SUI)?

Stress urinary incontinence (SUI) is the leakage of urine on activity and is the most common type of leakage. During coughing, sneezing, laughing, changing position, or exercise, your diaphragm (directly under your lungs) moves downwards. This increases the pressure in your abdomen, which in turn presses down on the bladder. This can force the bladder to leak urine. The pelvic floor muscles help to counteract this pressure. If the pelvic floor muscles are weak then they are unable to do this and leakage happens.

What is Urgency Urinary Incontinence (UUI)?

Urgency is the sudden urgent desire to go to the toilet immediately. If you leak on the way to the toilet, this is called urinary urge incontinence.

Having these symptoms with a very full bladder is normal. You will have experienced your bladder signalling that it was getting fuller and fuller, and have put off going to the toilet. But having these symptoms with just a small amount of urine in your bladder is abnormal and can be treated.

Normally, adult women can comfortably hold 300-400ml in their bladder. The first signal from the bladder is normally sensed at approximately 150-200ml. If you are anxious or stressed, this sensation is heightened and can become an urgent “need to go” feeling. This causes us to pass urine, usually before the bladder is actually full.

Sometimes triggers, such as the sound of running water, cold weather, or putting a key in the front door, can cause the bladder to involuntarily contract, resulting in leakage before reaching the toilet. A vicious cycle may then develop. You go more often because of urgency and the worry about leaking. Over time, the bladder gets used to storing only small amounts of urine and is not stretching to its normal capacity. As your bladder is now used to the smaller capacity, you experience the first signal at smaller and smaller volumes, making you go to the toilet more frequently.

What is Overactive Bladder (OAB)?

OAB is a collection of symptoms:

Urgency – a sudden and intense need to pass urine immediately. Sometimes you may not make it to the toilet in time and may leak (UUI)
Frequency – going to the toilet many times during the day (usually more than 7) and during the night (usually more than once).

OAB symptoms are caused by the bladder muscle squeezing without warning, and when you do not want it to. Sometimes OAB can be caused by your drinking habits, or drinking fluids which can irritate the bladder. For many people, the exact cause of their OAB is never found. Despite this, there are many treatments which can help you manage your symptoms.

‍

How Can I Help Myself?

You may want to try our self-management app getUBetter.

Our new Pelvic Health Module is designed to give you the knowledge and confidence to manage your symptoms and live a healthier life.

This module covers:

Female pelvic pain
Female pelvic prolapse
Female bladder & bowel health (including incontinence)
Cis-female biology & anatomy

General Advice

Look After Your Body During Pregnancy

Extra weight and pregnancy hormones increase the risk of continence problems. Do your pelvic floor exercises during pregnancy and continue when post-natal.

Avoid Chronic Constipation

Straining when constipated puts pressure on the pelvic floor muscles, weakening them and increasing the risk of incontinence. Increasing your fluid intake and ensuring a healthy diet can help.

Avoid Heavy or Repeated Lifting

Heavy lifting increases pressure in your abdomen which pushes down on your pelvic floor. Avoid heavy or repetitive lifting whenever you can. With any lifting, tighten your pelvic floor muscles before and during the lift, and don’t hold your breath.

Physical Exercise

Moderate physical activity decreases the risk of incontinence. However, high-impact exercise, weight-lifting and very vigorous gym activities can overload your pelvic floor muscles, worsening leakage. Changing or modifying your exercise can help. Make strengthening the pelvic floor muscles an essential part of your exercise regime.

Avoid Being Overweight

Extra weight causes a continuous pressure on the pelvic floor muscles. This weakens them and then they are less able to deal with the extra pressure caused by any of the other activities listed above.
Both UUI and SUI increase as body mass index (BMI) increases.

Check Your Medications

Some medications can make it more difficult to control the bladder. Check your medication to see if bladder problems are listed as a side-effect.

Stop Smoking

Coughing, associated with smoking, puts pressure on the pelvic floor muscles, weakening them over time. In addition, nicotine is a bladder irritant and is strongly associated with OAB symptoms.

Menopause

Loss of oestrogen at the menopause may weaken the pelvic floor muscles, tissues, and ligaments. This decreases the support around the urethra, contributing to urinary leakage. Many women find that HRT is useful. HRT can also be taken as a tablet (or cream) that is inserted in the vagina. Taken like this, it can directly help the tissues that need it.

Diet

Eat a balanced diet to ensure you are getting enough vitamins and minerals. A healthy diet helps to maintain the tissue strength in your pelvic floor and supports the normal workings of your urinary system and your gut.