Overactive Bladder Treatment

Overactive bladder treatment: Overactive bladder is term used for a group of urinary symptoms. Overactive bladder can have a significant effect on the quality of your life provoking an intense “gotta’ go” feeling when you least want or need it.

Overactive bladder has the following symptoms:

Urgency: The most common symptom of overactive bladder is the urge to urinate. This urge is often unexpected and uncontrollable.

Frequency: Depending on the amount you drink and other lifestyle factors, some people’s frequency to urinate is considered manageable and healthy. Most people pass urine 6-8 times per day without any concern. With overactive bladder however, the frequency to urinate is another symptom of the condition that can be excessive and accompanied by this intense urge. You may also pass or feel the need to pass urine several times during a short interval.

Urge incontinence: Your urge to urinate in that moment can be so strong that it causes you to leak urine (also known as urge incontinence). This adds to one’s feelings of embarrassment and humiliation. Others may get to the toilet on time and remain continent, but the fear of having an accident can make the urge feel increasingly more desperate.

Nocturia: Overactive bladder can affect you during the daytime and through the night. Also known as nocturia, the need to pass urine through the night can be exhausting, disrupting your normal restful sleep patterns.

Overactive bladder affects about 12 % of the adult population. It can affect people of all ages, including young children and the elderly.

If you are seeking overactive bladder treatment, first consult with your GP to identify any if there are any underlying health problems that are connected to your overactive bladder symptoms. Your GP may refer you to a consultant for further tests.

If no underlying health problems have been identified or if you have not benefitted from any prescribed overactive bladder treatment from your medical practitioner, hypnotherapy can help treat your (neurogenic) overactive bladder symptoms. It can also help you cope with the stress and anxiety associated with your symptoms alongside other medically prescribed treatments.

Overactive bladder treatment: bladder functioning

The kidneys produce urine that drains into your bladder. With normal bladder functioning, the bladder muscle (detrusor) is relaxed as urine progressively fills the bladder. The gradual stretching of the bladder triggers the urge to want to pass urine when the bladder is about half full. This moderate sensation can be controlled for most people for a reasonable period of time until it is convenient to use a toilet. When you want to urinate, nerve signals instruct the bladder muscle to contract and push urine out of the bladder and into the urethra. These nerve signals are coordinated with the relaxation of the pelvic floor muscles and urethral sphincter muscles as urine passes out of the body.

With overactive bladder, the nerve signals between the bladder and the brain become “faulty”. Sensations of bladder fullness may be triggered prematurely. The bladder muscle becomes overactive and involuntarily squeezes on the bladder too early. This creates the sudden, persistent and uncontrollable urge to urinate even when the bladder isn’t full.

The volume of urine passed each time by a normal adult can vary between 250-400 ml. Most people can hold on between 3-4 hours between visits to the toilet. With overactive bladder the volume of urine passed each time may be between 100-200 ml. Your urination frequency may be hourly.

Overactive bladder treatment: what causes overactive bladder?

There are many medical conditions that may contribute to an overactive bladder which should be discussed with your GP. These include:

• Diabetes.
• Urinary tract infections.
• Menopausal hormonal changes in women.
• Neurological conditions like multiple sclerosis, stroke, Parkinson’s disease and following spinal cord injuries.
• Specific bladder abnormalities like bladder stones and tumours.
• Other factors that can affect bladder flow and incomplete bladder emptying (voiding) including enlarged prostate, constipation, weakened pelvic floor muscles from childbirth and previous incontinence surgery.
• Reduced cognitive function affecting bladder control e.g. related to aging.
• Taking medication that has a diuretic effect.

An overactive bladder treatment will be relevant to your underlying medical condition. Treatments can include medication, incontinence products and surgical procedures.

In many cases of overactive bladder, the exact cause of the symptoms is not fully understood. There are lifestyle factors that can contribute to your overactive bladder symptoms. Changing your lifestyle could form part of your overactive bladder treatment.

Contributing factors can include:

• Drinking too many fluids, particularly those that may have a diuretic effect e.g. caffeinated or alcohol drinks.
• Not drinking enough fluids. This might seem sensible to lower your frequency, but a lack of fluids can cause your urine to become too concentrated and irritate the bladder.
• Having an excessive amount of acidic food and drinks. These can be considered bladder irritants e.g. fruit juice, tomato-based products, spicy food etc.
• Suffering with constipation. The pelvic floor can be damaged when straining during bowel movements. Eating a high-fibre diet, drinking enough fluid and being active and help reduce constipation.
• Having limited mobility. Restricted mobility can make it difficult to get to a toilet and increase your bladder urgency. Being physically active can increase bladder control.
• Smoking. Smokers are more likely to have bladder control problems with a chronic cough. Quitting smoking can reduce these symptoms.
• Urinating more times than is necessary. It can seem logical to go to the toilet “just in case”, particularly if you already fear being able to use a toilet for a while, but it can build a habit of urinating more than times than is necessary. Frequent urination does not prevent overactive bladder; it can make the symptoms worse in the long term as you get used to holding less urine and more sensitive to milder stretches of the bladder. Bladder retraining can help you prolong your urination urge intervals.
• Being overweight. Obesity can be a contributing factor for overactive bladder in females. Excess body weight can increase abdominal and bladder pressure. Losing weight can help this possible cause.
• You have weak pelvic floor muscles. This can be one of many causes of stress urinary incontinence and urge incontinence. Kegel exercises can strengthen your pelvic floor muscles (tensing the muscle that would stop urination midstream). General exercises (performed under supervision) that develop your core muscles, hips and leg muscles can also help strengthen your pelvic floor e.g. pelvic tilts, knee-ball squeezes, squats, bridges, bird-dogs, split table tops etc.

Overactive bladder treatment: emotional factors

Digestion can be affected by your moods and contribute to some symptoms of anxiety-related irritable bowel syndrome. Similarly, there is a strong connection between overactive bladder and those suffering with mental health issues like anxiety and depression. In a study, nearly 50% of patients with overactive bladder symptoms were also found to have anxiety.

Does overactive bladder cause anxiety or vice versa? One study argues that there is an association between conditions like incontinence and anxiety. The physical and emotional link has been further substantiated in another study of lower urinary tract symptoms (LUTS). Your physiology and psychology can exacerbate each other, perpetuating a cycle of increased physical symptoms and heightened negative moods. The relationship doesn’t have to exist, but emotional states like anxiety and depression remain as risk factors for overactive bladder.

When a medical condition is not treated and becomes long term, other anxiety-related conditions can accumulate and make the symptoms worse. As well as anxiety, those who suffer with overactive bladder can also have nocturia-induced insomnia, social isolation, agoraphobia, claustrophobia, fear of embarrassment (social anxiety), shame, low self confidence and low self esteem.

Stress can also be a risk factor for overactive bladder. When you are faced with a highly stressful situation like being chased by a wild animal, your evolutionary stress response or “fight or flight” system is activated by your emotions. Stress hormones are released to help you “fight” the danger or “flee” from it. Priorities are given to certain bodily functions over others.

Most people can relate to the physical responses triggered by these stress hormones when you feel under pressure or feel overwhelmed. Physical responses include your heart beating rapidly, your muscles feeling a bit shaky, your breathing becomes rapid and shallow, you sweat profusely etc. Even with moderate stress, these mild physical responses can be are activated and experienced.

Your bladder is also affected by these stress hormones. Acute stress can cause your pelvic floor muscles to involuntarily relax and your bladder to suddenly empty. Relating this function to an evolutionary response, some people would argue that it’s easier to fight or run away from danger with an empty bladder. When you are under moderate pressure or stress, hormones can trigger a milder response in your body a moderate urge to urinate.

The stress response can affect the urinary system in other ways too. When some people are experiencing stress, the urinary sphincter can clamp or tighten, making it difficult to urinate (also known as shy bladder or paruresis). Why it affects some people in this way is not fully known, but as another evolutionary response when you sense danger, it would be practical to “shutdown” some bodily functions until it’s convenient to urinate.

With stress having the potential to over-stimulate bodily functions, some functions can become faulty. When you are in a state of constant hypervigilance, some researchers argue that the normal communication between the brain and urinary organs can become erratic. One urologist suggests that when you are anxious or stressed there may be an increase in urine production by the kidneys. With more urine being produced, it would have the natural consequence of increasing your normal urinary frequency.

Living with neurogenic overactive bladder

Anxiety can weave its way into the management of any physical condition including overactive bladder. The fear of embarrassment or humiliation of having an accident in public may be central to what makes overactive bladder so problematic for those people who already suffer with a generalised social phobia. Even without having a social phobia, a condition like overactive bladder can become a specific feature of your anxiety when you consider a typical historical development from a young age. You may personally have had an accident, had near-misses or heard others mock those who have had an accident.

Young children can feel embarrassed to ask a teacher to use the toilet in school. Even if you have the courage to ask the teacher to leave the class, your request may be met with an embarrassing public refusal. Unless there is a recognised medical reason, teachers often think that going to the toilet can be a reason for “bunking off” from the lesson. If you are allowed to leave the class, the awkwardness of leaving the classroom and then returning with the whole class looking at you can be unnerving for some children.

Being taunted for something that is different to others is typical of how young children deal with insecurity. Trying to keep overactive bladder a secret from your peers can backfire if you have to keep leaving your peer group and disappearing somewhere. Unfortunately, suppressing a condition can make your anxiety worse increase your urinary urge symptoms.

Being constantly worried and distracted about your overactive bladder and hoping to “ride it out” until break time can have a negative effect on your learning. Your distress may be heightened when you have the pressure of coping in exams. Strategies like limiting fluid intake can seem like a positive way of managing the condition but being excessively thirsty can also affect cognitive functioning.

Cognitive functioning at school can also be impaired by the fatigue of insomnia. There is a strong connection between anxiety and insomnia. Anticipating and worrying about how you will cope with overactive bladder during the next school day can affect the quality of your sleep. Persistent waking can then start early patterns of nocturia-induced insomnia, creating the habit of going to the toilet each time you wake up and urinating when your bladder is only half full.

As an older teenager, the quality of your social life can be disrupted knowing that alcohol will act as a diuretic. Using the toilet at the social venue allows you some respite, but the journey home can be agonising when you are inebriated with a large intake of alcohol and you have less control over your bodily functions.

Rituals to urinate before your bladder is full can seem sensible when attending something important. You will habitually use the toilet before exams, lectures, work meetings, presentations, going to the cinema, theatre or to a concert performance. You may try to sit on an aisle seat or towards the exit to minimise disruption to the performance, developing a type of urinary-induced claustrophobia.

Managing public performance situations can leave you feeling on edge. You don’t want to leave it until there is a scheduled interval/break as the queues might be too long. You then fear that the toilet could be out of order. For women, you may feel disgusted that the public toilet is too filthy to use. You then build up your urge dashing to use another toilet situated in the other side of the building.

Travelling with overactive bladder can be troublesome, particularly on public transport with groups or where you will only stop at scheduled intervals. You may feel too embarrassed or ashamed to communicate your overactive bladder to the driver. Travelling by car on motorways can seem like you are counting the miles to the next service station, even when you are in the driving seat. Flying can also be problematic with periods when you are advised not to use the toilet and need to remain seated. When the seatbelt sign is off, you have built up your urgency and you rush for the toilet to avoid queuing up.

Even though you strategically plan the location of toilets in urban areas when you leave the house, fear of being stuck in traffic during peak times can intensify your urge. Travelling away from your home towards open spaces has the uncertainty of finding a toilet and can develop a type of urinary-induced agoraphobia.

With a progressive overactive bladder, home becomes the safe place. You can live in the moment and feel relaxed. You have a toilet that you feel comfortable using and can (usually) use it at your convenience. Ironically, you may use a toilet less frequently when you know that one is available. The thought of leaving the house changes your feeling of security. This is how anxiety can affect the management of conditions like overactive bladder

Overactive bladder treatment using hypnotherapy

There is some evidence that hypnotherapy can benefit your overactive bladder treatment. One study compared behavioural therapy alone with behavioural therapy using hypnotherapy. Both groups benefitted from the treatment, but the latter produced slightly better outcomes.

In another study, patients with interstitial cystitis (a condition that also has symptoms of urinary urgency and frequency) were offered hypnotherapeutic imagery for their symptoms, others were offered rest. The hypnotherapeutic imagery used suggestions to heal the bladder, relax the pelvic floor muscles and calm the nerves that caused the condition. Three times as many people who used the hypnotherapeutic imagery reported moderate or marked improvements compared to the group that were offered rest only.

Reporting these studies and other case studies, researchers argue that hypnotherapy can be used as an adjunctive procedure for overactive bladder treatment, helping to reduce the severity of symptoms and self efficacy.

How can you benefit from hypnotherapy?

Hypnotherapy can help you lower your general anxiety

High levels of anxiety can keep you locked in a negative emotion-behaviour cycle. Your treatment will treat your general anxiety and explore if your condition has stemmed from other emotional issues.

Hypnotherapy can integrate relaxation suggestions as part of the general hypnotic process. Your treatment will also teach you relaxation exercises and self hypnosis to empower you to control your anxiety outside of the treatment sessions.

Hypnotherapy can target your specific overactive bladder anxiety

In hypnosis, you are more receptive to accepting suggestions and affirmations without the interference of your conscious mind. Your overactive bladder condition will be discussed exploring your urgency, frequency, incontinence and nocturia symptoms. Hypnotic urinary-directed suggestions will also be personalised to treat your individual condition and treat your symptom-coping abilities.

Hypnotherapy can lower your stress-related tension

By overreacting to the subtle sensations of lower abdominal tension, you have formed habits that are exacerbating your condition. This may be causing the neural pathways to your urinary system to become faulty. Your treatment will examine how you are generally managing stress and develop new techniques to deal with lower abdominal muscle tension.

Your treatment can also integrate recommended procedures like controlled voiding and pelvic floor exercises.

Hypnotherapy will help you visualise your positive changes

Visualisation (also known as mental rehearsal and guided imagery) is a powerful mind tool that can prime your desired behaviour. For example, when you visualise controlling your urge response in a positive way, you are stimulating the neural networks to sense and feel changes in those parts of your body. With repetition, those positive changes become expected and it feels natural to behave as you want to imagine yourself. As your treatment progresses, visualisation can be used integrate other essential issues like trusting your body again, building your self confidence and your self esteem.

Hypnotherapy can improve your nocturia-induced insomnia

Waking up to go to the toilet several times through the night can be exhausting. You lay there wasting time, wondering whether you can drift off back to sleep or whether the urge will get stronger as your frustration builds up. Waking up drained of your energy can confirm that it’s easier to give in to your urinary urge. Hypnotherapy can improve your sleep quality and how you are controlling your nocturnal urinary urge.

Hypnotherapy can reframe your past traumas

The effect of previous accidents or near-misses can traumatise you, creating a surge of anxiety each time you feel anxious or deal with similar situations. Like a phobia, you feel threatened by those situations overwhelming you again. A regressive approach can be combined with solution-focused approach. Regression can help you to release the emotion from your past traumas and help you embrace the positive changes of your treatment goals.

For more information on overactive bladder treatment using hypnotherapy contact Richard J D’Souza Hypnotherapy Cardiff