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Don't hesitate, seek help

Eight times or more during the day and more than two times in the night indicate an overactive bladder

Valli hates going out. Even going to a movie is an ordeal because she knows that she will have to use the bathroom at least twice and she hates using the bathrooms at movie theatres. She even restricts her shopping to one hour so that she does not have to go looking for a toilet.

Chitra never feels rested because she has to get up at least two or three times at night. She catches herself yawning at meetings in the office. She is always terrified that a meeting will go past two hours and that she would have to excuse herself to go to the bathroom. Working in a mainly male dominated office, this embarrasses her no end.

It is a well-known fact that about half of all women have dealt with embarrassing bladder problems at least once in their life. Not being able to “hold it” and experiencing sudden urine leaks is something that women face commonly. But when this problem seems to dominate and control one's life as it does for Valli and Chitra, help has to be sought. They have an ‘overactive bladder' and will respond to treatment.

Do you have an overactive bladder?

If you have to go to the bathroom eight or more times in the day or have to get up more than two times at night, then you have an overactive bladder. Of course, since diabetes is common in Indians and may cause the same symptoms, it is also better to rule out high sugars before starting on treatment for an overactive bladder.

A urinary infection may also cause an overactive bladder but this is usually a short-term problem and will ease off once the infection is treated.

Women sometimes compensate for an overactive bladder without realising that they have a problem. If you cannot go anywhere for more than two hours because you are afraid you may not find a bathroom, if travelling for more than two hours worries you because you are afraid you cannot hold it for longer, if you wear clothes which may not show wetness or wear a pad in case of sudden leaks, then you need to seek medical attention. Many women are so embarrassed and ashamed about the problem that they are reluctant to seek help. Remember, you are only one among millions of women across the world that need medical attention for this problem.

Normal bladder control

The ability to control urination depends on several factors. As the bladder fills up, it stretches to hold the increasing amount of urine. The bladder of an average person can hold 350 ml to 550 ml of urine. Generally, you will feel like you have to urinate when there is approximately 200 ml of urine in the bladder.

To initiate the act of urination, the brain recognises the surroundings, knows you are in a bathroom and then sets in motion the mechanisms involved in urinating. The sphincter, which is the regulatory muscle at the opening of the bladder relaxes and at the same time the detrusor muscles contract. The detrusor muscles are bladder wall muscles that push the urine out of the bladder. If you are in a situation where you cannot relieve yourself, normally the sphincter will tighten up and the detrusor muscles will not contract.

Unfortunately, in women with an overactive bladder, this cascade of events is not well regulated. The detrusor muscles contract as soon as the bladder starts filling up, without recognising the social situation the woman is in.

Retraining your bladder

Instead of your bladder telling you what to do, you have to retrain your bladder to listen to you. As a child you ran to the bathroom whenever your bladder was full. As you grew older, you learnt to control the urge to urinate. You have to relearn skills necessary for bladder storage and proper emptying.

For a week, go to the bathroom every 30 minutes to empty your bladder. This way, the connection from the brain to the bladder is re-established. The bladder contracts when you say it is the right time and place. Increase the interval every week, till you have reached a two-and-a-half to three-hour hour interval.

Your doctor will rule out other problems causing an overactive bladder and may even prescribe some medications. Bladder exercises like Kegel's exercises and pelvic muscle toning will help too.


The author is an obstetrician and gynaecologist practising in Chennai and has written the book 'Passport to a Healthy Pregnancy'.

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