Do I have an overactive bladder?

If you frequently need to go to the toilet – urgently – during perimenopause and menopause, learn how to get help

The saying ‘when you’ve got to go, you’ve got to go’ never rings truer than for some menopausal women.

Overactive bladder syndrome (OAB) is urinary urgency – a sudden, compelling need to wee that’s difficult to put off. It might or might not be accompanied by urge incontinence or nocturia, the need to regularly get up and wee in the night [1]. Urge incontinence is the urgent need to pass urine and sometimes urine leaks before making it to the toilet.

Overactive bladder is a symptom, not a disease, and is not painful but it does affect the quality of life of millions of women worldwide.

What causes overactive bladder syndrome?

Although overactive bladder can affect anyone, adult women are most commonly affected, and incidence can increase with age. Many women do not seek help as they believe it’s a natural part of ageing or a consequence of childbirth.

While there are numerous potential causes of OAB – including urinary tract infection, medicines, certain conditions, drinking excess fluids, or alcohol or caffeinated drinks – hormonal changes can have an impact.

Is the menopause to blame?

Studies have indicated that the menopause is a risk factor for the development of pelvic floor disorders, and the urinary symptoms of these disorders increase significantly after the menopause [2].

Newson Health GP and Menopause Specialist Dr Clair Crockett says: ‘The loss of the hormones during menopause also affects the epithelium, the cells that form the top covering of the bladder, the urethra and the vulva, making them more sensitive, thinner, less flexible and less robust. This extra sensitivity can increase overactive bladder symptoms and bring on strong feelings of urgently needing to urinate.’

Can I treat an overactive bladder?

A doctor or nurse may take a urine test to check for infection and you may be asked to complete a Bladder Diary to help healthcare professionals better understand your symptoms.

You may also have a test to assess how quickly you pass urine and the amount of urine passed, this is called a flow test or uroflow test. This is performed by passing urine into a machine which will measure the strength of your urine flow. It is usually followed by a post-flow ultrasound test to see if you have emptied your bladder completely.

Bladder training, under the supervision of a specialist nurse or physiotherapist, can teach the bladder to hold more urine and empty less frequently.

Growing evidence suggests using topical vaginal oestrogen in postmenopausal women can be of benefit. Other medications are sometimes considered, and can include oxybutynin and mirabegron, both of which relax the muscles around your bladder so it can hold more liquid, and Botox, which stops the muscle wall from squeezing too much.

Lifestyle factors – such as reducing your caffeine intake, drinking the recommended fluid intake, achieving a healthy weight – can all help so it’s well worth seeking help to find the right treatment plan for you.

References

1. International Continence Society ‘Overactive bladder (OAB, urgency) syndrome’

2. Rahn D.D., Ward R.M., Sanses T.V. (2014), ‘Vaginal estrogen use in postmenopausal women with pelvic floor disorders: systematic review and practice guidelines’, International Urogynecology Journal. doi: 10.1007/s00192-014-2554-z