Overactive bladder syndrome is not a disease itself but is the name for a group of different urinary symptoms.
If you're noticing that it's harder to control your bladder after giving birth, you are having leaks or rushing to use the loo all the time, you're not alone. It is common postnatally for women to experience changes in their bladder function, with pregnancy and childbirth increasing your risk of both incontinence and developing an overactive bladder.
The most commonly experienced is an ‘urgency’ where there is a sudden urge or need to have a wee. This can happen at any time during the day or night, often without warning and can lead to a loss of bladder control and accidental leaks. Another common symptom is increased ‘frequency’, where you are needing to wee many times during the day or night.
What are the symptoms of OAB syndrome?
Symptoms associated with OAB syndrome include:
- Urinary Urgency: ‘If you’ve got to go, you’ve got to go!’. Urinary urgency is when your bladder squeezes (contracts) suddenly giving you an urgent need to pass urine.
- Urinary frequency: This means that you need to pass urine more frequently than usual and in smaller volumes.
- What is ‘normal’?
- The number of times a person needs to pass urine during the day can vary depending on fluid intake/type of fluid, and activity levels, and can be affected by certain medications.
- Generally speaking, 6- 8 x per day is considered average.
- A range of 4-10 x per day may also be considered ‘normal’ if you are happy, healthy and accident-free.
- Nocturia – a particularly frustrating issue which means waking up to wee more than twice during the night.
- Urge urinary incontinence – with very little time to get to a loo, if the need to wee is uncontrollable, it can lead to accidental leakage of urine.
Why is this happening to me?
During your pregnancy, you may have noticed you needed to use the loo more frequently, particularly as your bump got larger but, for some women, this common problem doesn’t necessarily end after the baby arrives. Following pregnancy and childbirth there are several factors that may be influencing your bladder function:
- Changes to your pelvic floor muscles (perineal tearing, weakness, tension)
- Possible changes in the nerves that control your bladder
- Movement of your bladder and urethra during pregnancy
In many women, the actual cause of OAB syndrome remains unknown however certain risk factors such as neurological disease, urinary tract infections, hormonal changes, side effects from certain medications, anxiety and the type of fluid you drink have been shown to influence symptoms.
What treatment is available?
If you think you may be struggling with an overactive bladder it is important to make your GP or care provider aware. They will examine you to determine the underlying cause of your symptoms. This assessment may include:
Medical assessment/treatment
Medical physical exam: to feel your abdomen and pelvic organs.
Completion of a bladder diary– you may be asked to track your fluid intake, note when you are having a wee and measure the amount.
Other tests: Urine tests, ultrasound bladder scan.
Treatment: will vary depending on the underlying cause of your symptoms but in any case, it is important to have a clear discussion with your care provider to ensure they are aware of your personal goals.
- Lifestyle Changes- Avoid bladder irritants, bladder diaries, and bladder training.
- Medical and Surgical Treatments
- Prescription Drugs
- Bladder Botox® (botulinum toxin)
- Nerve Stimulation (peripheral and central)
- Surgery
Physiotherapist Assessment/Management
Pelvic health physios are well placed to assess OAB syndrome.
As physiotherapists, we know the bladder does not work alone and its function is affected by various other parts of the body.
- Surrounding muscles
- Organs sitting nearby
- Constipation
- Psychological influences
- Diet and fluid intake
- Bladder and bowel habits.
Physiotherapy will help you to understand what factors might be influencing your symptoms and support you with various treatment techniques that may include:
- Teaching healthy bladder and bowel habits
- Bladder training support.
- Bladder diary review and advice on bladder irritants.
- Pelvic floor internal assessment and treatment
- Lower abdominal and core exercise
- Teaching effective pelvic floor exercises (they are so often done incorrectly!)
- Anxiety-reducing exercises
- Postural correction
