WOMEN’S BODIES: UNSTABLE BLADDER
Unstable bladder
Many people, especially women, haven’t learnt good bladder control in childhood and have what we call a ‘weak’, overactive or unstable bladder, in which all the mechanisms for holding a reasonable amount of urine are disturbed. Their lives become dominated by frequency, urgency and urge incontinence.
When the bladder is oversensitive to stretch, it contracts inappropriately while it’s filling or in response to other stimuli such as hearing a running tap, feeling cold or changing posture. It tells you that you must urinate long before it is filled to capacity. The unstable bladder contracts, as if to empty, without your permission. The contraction leads to a powerful, knee-crossing, eye-watering, urgent desire to urinate. This sense of urgency can’t be suppressed easily, and might eventually progress to become urge incontinence.
Treatment of unstable bladder
The most successful approach to an unstable bladder and urge incontinence is through bladder-retraining programmes, which teach your bladder to hold more before registering the urge to urinate, and how to control the urge when you feel it. These programmes are taught in bladder-control clinics or you can try teaching yourself from a self-help book or Continence Foundation Fact Sheet. However, it’s generally best to have all incontinence problems assessed by a specialist urologist to ensure that you have no chronic urinary infection or other condition that needs different treatment, and to advise you about suitable exercises.
One important part of bladder retraining is increasing your daily fluid intake to around 2 liters. Most women with urinary control problems are in the habit of limiting fluid intake to fit in with their plans. If you’re going to the theatre in the evening, you make a point of drinking nothing after lunch so that you won’t have to wait in the loo queue at interval (though you do, ‘just in case’) or, worse still, go in the middle of Act One.
The point of increasing fluid intake is to allow you to experience the feeling of true bladder fullness. Once your bladder has had the opportunity to be really full several times a day it will stop sending out bursting messages when it contains (dare I say) piddling amounts. One woman who’d successfully retrained her unstable bladder told me ‘Until now I’ve missed out on the great joy of weeing when my bladder’s really full’.
Bladder retraining needs willingness to persevere and determination to succeed. (It also needs strong pelvic-floor muscles, so get them in good shape with pelvic-floor exercises before you start.) It can take several months to achieve the full benefit, though you’ll be encouraged by the considerable improvement you notice after the first couple of weeks. In some cases the use of drugs to relax the bladder will help with retraining. Some people are helped by biofeedback techniques and acupuncture.
Surgical repair is not often used to treat urge incontinence, unless there is also stress incontinence resulting from damage that is too severe to respond to pelvic-floor exercises. Surgery for any type of incontinence should be on the advice of a specialist urologist, and after a urodynamic test to investigate the problem.
Such fistulas, however, are uncommon.
Incontinence caused by permanent damage to the nervous system such as multiple sclerosis, stroke or spinal injury cannot be cured, but special management plans and newly available drags can do much to improve the lot of sufferers. Recently there have been reports of success with some such cases of incontinence when artificial sphincters have been used,
It is important that in every case of incontinence, proper testing is carried out to diagnose the exact cause(s) and to look for any additional problems such as urinary infection or chronic bladder inflammation. Successful treatment depends on a precise understanding of the cause.
The Continence Foundation of Australia will tell you where to find special clinics for the diagnosis and treatment of incontinence. If you think you would benefit from attending a clinic, ask your doctor for a referral. I’m sure you will find that any travelling that may be necessary is well worthwhile.
Community services
The Continence Foundation of Australia (59 Victoria Parade, Collingwood, Vic. 3006. Tel. (03) 9416 0857) provides information about services available throughout Australia, pamphlets, self-help fact sheets including instructions for pelvic-floor exercises and bladder retraining, educational programmes for health workers and the public, and a quarterly newsletter.
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