MAKING CHANGES in everyday behavior is the first line of therapy for an overactive bladder (OAB), said Dr. Victor Federico B. Acepcion, a urologist and chair of the department of surgery of Capiz Emmanuel Hospital.
You may need to modify what you drink and eat, lose extra weight, or stop smoking, he said at an Aug. 11 session organized by UP Med Webinars.
OAB is the frequent and urgent need to empty one’s bladder. The symptoms of OAB are urinary urgency (a sudden and overwhelming urge to urinate immediately); urinary frequency (urinating more than eight times a day); urge incontinence (urine leakage or wetting accidents that follow a sudden urge to urinate); and nocturia (waking up two or more times at night to urinate).
People with OAB practice bathroom mapping so they know where to go when they feel the symptoms of voiding. They also tend to feel reluctant to travel by car or use public transport — even for short distances.
Many individuals with OAB limit their fluid intake in the hope of alleviating their symptoms, Dr. Acepcion said. Not drinking enough fluids, however, can make one’s urine concentrated, thereby irritating the bladder and causing urinary urgency, urinary frequency, urinary tract infections, dehydration, and constipation.
Dr. Acepcion advised avoiding drinking large amounts at one time — such as with meals — and drinking the majority of one’s fluid intake during the first half of the day, while cutting back as evening approaches.
“During the evening, I advise patients to drink just one glass, maybe for their maintenance medications,” he said.
Also to be avoided are food and beverages that contain bladder irritants, the most common of which is caffeine.
Dr. Acepcion recommended consuming fiber-rich fare, like whole grain bread and fresh fruits, instead of OAB contributors like carbonated drinks, tomato-based products, and alcohol.
BLADDER RETRAINING
Bladder retraining, or the gradual conditioning of the bladder to hold urine for longer periods, is another prescribed therapy, according to Dr. Acepcion.
Because the bladder is controlled by muscles, it can be trained, the National Association for Continence (NAFC) said.
The NAFC advised using a bladder diary to keep a log of details such as one’s fluid intake, the number of times one urinates, the number of wetting accidents and what happens when they occur (e.g., while laughing or sneezing), and diet information.
Specific bladder retraining techniques include visiting the bathroom later than your scheduled time (e.g., going to the bathroom every hour and fifteen minutes instead of every hour) and performing Kegel exercises (which strengthen the pelvic muscles that support the bladder).
A technique for patients to locate their pelvic muscles is by pretending to avoid passing gas, per Harvard Health Publishing. Patients can start doing Kegel exercises by contracting their pelvic muscles for three to five seconds, and then relaxing them for three to five seconds, before repeating the cycle for a total of 10 times.
Harvard Health recommends gradually increasing the length of contractions and relaxations to 10 seconds.
Do not tighten your abdominal muscles at the same time, Dr. Acepcion added, noting that abdominal muscles push urine out rather than hold it in. “When done correctly, all other muscles should relax,” he said. — Patricia B. Mirasol