Normally the bladder expands gently as it fills, sending the brain a message in good time to look for an appropriate time and place for the process of emptying. Then the brain sends two signals: one to the muscles in the bladder wall (the "detrusor muscles") to contract and the other to the outlet valve ("sphincter") to open, and the bladder squeezes the urine out. The bladder relaxes again for the process of refilling.

Some people find that their bladders do not work like this. Instead, the muscles may contract uncontrollably at the wrong time. This is called having an "overactive bladder". If you have one, you may feel very little warning of the need to pass urine (this is called urgency) and you may need to urinate very frequently - in exceptional cases as often as every half hour (this is called frequency).

Some people have difficulty in making it to the toilet on time because their bladder gives them so little warning, which may result in urine leaking (urge incontinence).

You may also find that you wake during the night to pass urine (this is called nocturia).

(It is normal to pass water up to eight times a day and once or twice a night: if you are consistently emptying your bladder more frequently than this or being woken more than twice at night you may want to seek information and advice. Of course, if you are drinking abnormally large amounts - whether it is ten pints of lager or 20 cups of tea - you will naturally need to empty your bladder more frequently.)

An overactive bladder (sometimes referred to as an unstable bladder or as detrusor instability) can occur at any age and is the second most common type of bladder problem - and the commonest in men and in elderly people. (The most common in women and overall is stress incontinence in which you leak urine when you cough, laugh or take exercise.)

Very often it has no known cause, although it can occur following a stroke or as a result of Parkinson’s Disease.

TREATMENTS

An overactive bladder can usually be cured and at worst can be managed so that it does not to interfere with your ordinary life.

These are the main types of treatment:-

(1)  Bladder retraining

(2)  Drug Treatments

(3)  Pelvic Floor Exercises - for Men or for Women, which may be supplemented by electrical stimulation. (The effectiveness of pelvic floor exercises to cure an overactive bladder has not yet been fully researched or proven.)

OTHER POINTS

1.   In severe cases of overactive bladder you may be referred to a specialist for investigation and possibly for surgery, although surgery is not the preferred option, since it leaves many people needing to use a catheter to empty their bladders. (A catheter is a small flexible tube that you routinely pass through your urethra into your bladder to drain it.)

2.  If at any time you experience a burning pain when passing water or your urine is cloudy and smells unpleasant, it is possible that you have an infection. You should see your doctor as soon as possible.

3.  Avoid drinks which contain caffeine (such as coffee, strong tea and cola drinks) as these may irritate your bladder.

4.  Never cut down on your fluids to avoid the symptoms of any bladder problem. This will only increase the risk of developing an infection or, by making your urine more concentrated, risk irritating your bladder into greater overactivity. You should aim to drink about 3-4 pints of fluid a day (about 2 litres).

Remember your Healthy Bladder Habits.

The purpose of bladder retraining is to learn to suppress or ignore the desire to pass water, so that you can get back to a more normal pattern of going to the toilet. What you are doing is making the bladder tolerate being stretched as it fills. This should mean you do not need to go to the toilet so often or with such urgency and should mean an end to any incontinent episodes.

Your aim, assuming an average intake of 3-4 pints (2 litres) of liquid a day, is to get back to a normal pattern of emptying your bladder no more than six to eight times a day. (The bladder should be able to hold between three-quarters of a pint and a whole pint (400-600 ml) before it needs to be emptied, and the first sensation of a need to empty it usually comes when it is only half full.)

Bladder retraining is best done with the help of a physiotherapist or a continence nurse specialist (your GP will put you in touch with your local one or else you can phone the Continence Foundation Helpline for details of local services) - but it is possible to go it alone.

To start bladder retraining, you need to keep a record of how often you pass water during the day. This record should be kept initially for one week.  Click here for an example of a suitable blank bladder chart, which you can print out. It also allows you to record any accidental episodes of incontinence. You may also measure the amount you drink and the amount of urine you pass, using a measuring jug, and record this on a more detailed chart.

Once the record is completed you can work out how often, on average, you pass water (and, if you have recorded it, the average amount passed). You can then set your first target. Suppose you have been passing urine about every hour: your first target might be to go to the toilet only every hour and a half. You can aim also to increase the average amount you pass each time.

You may wonder how you are going to manage to hang on for that extra half hour. There are various techniques which may help. When you get the urge to pass urine:-

•  Sit on a hard seat or across a tightly rolled towel. This puts pressure on the pelvic floor muscles.

•  Do five quick squeezes of your pelvic floor muscles. Squeezing the muscles in the pelvic floor sends a message to your bladder which helps calm it down.

It may help if you count backwards from 50 or do something similar to distract you from the urge to go. Once you get to 1 you should find that the urge has gone.

You should continue to keep a record of your pattern of passing urine on a chart. This will enable you to judge how well you are doing with your bladder retraining. Once you have achieved your goal, then set a new one. Keep on like this until all your symptoms have disappeared and you are visiting the toilet every 3 - 4 hours and the amounts you are passing have increased to an average of about half a pint (250 - 350 mls). You will probably find that improving your daytime problems leads to an improvement in frequency and urgency at night.

Bladder retraining requires considerable willpower and determination, but giving in to your bladder will only make things worse. "Mind over matter" can really help your problem - but only you can make it work. The less often you pass urine, the less often you will need to go and eventually you will be able to forget about your bladder for hours at a time. It may take several weeks or months to get to this stage, so don’t give up.

Remember, when you have regained control, do not go longer than 4 -5 hours without passing urine (except, of course, overnight), as the bladder works less well if it is over-filled.

Your doctor may prescribe tablets which help to reduce the overactive contractions of your bladder. There are several drugs which can help, including oxybutinin (sold as Ditropan and under other names), propiverine (sold as Detrunorm), tolterodine (sold as Detrusitol) and trospium chloride (sold as Regurin). These tablets may give you a dry mouth, heartburn, headaches or constipation but these effects may be mild or lessen over time. If the drug you are prescribed does not agree with you, ask your doctor if it would be sensible to try an alternative.

It is important once you start taking drugs for your bladder that you take them for several weeks, as it can take this long before you really notice a difference in your bladder symptoms.

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In very rare cases your doctor may suggest surgery to help with urge incontinence. Before consenting to an operation, you should discuss it fully with your surgeon. Make a list of questions you want to ask, such as the following:

•  what exactly is he or she going to do?

•  what cut will he or she make, what stitches will there be, and what sort of scar will be left?

•  how long will you be in hospital, how long will you be off work or convalescing?

•  what permanent changes in your lifestyle will result - maybe improvements, maybe limitations?

•  how often has your surgeon performed the operation? with what results?

•  what are the chances of a complete cure for your incontinence? of a substantial improvement?

•  will the change be permanent? if not, how long will it last?

•  what adverse effects may there be? how likely are they? are they treatable? how?