Healthy bladder guideInformation for patients

WelcomeIt is normal to go to the toilet between four to eight times per day and no more than once a night. Poor bladder habits can lead to poor bladder control and sometimes incontinence.

This leaflet tells you about some simple lifestyle measures that you should follow to keep your bladder healthy.

Step 1: Fluid intakeTry to drink at least 1.5 litres (six to eight cups) of fluid per day, unless advised otherwise by your doctor. Limit the amount of caffeine and alcohol you drink as these can irritate the bladder. Don’t drink too much coffee, tea or cola.

Tips: Instant coffee contains less caffeine than percolated coffee. Tea contains less caffeine than coffee.

Step 2: Practice good toilet habits Don’t get into the habit of going to the toilet ‘just in case’ as this tends to result in the bladder developing a smaller capacity. Try to only go to the toilet when your bladder is full and you need to go. However, emptying your bladder before going to bed is fine.

Take your time when urinating so that your bladder has an opportunity to empty completely. If you rush, this may result in your bladder not being completely empty and may lead to possible urinary infections.

Step 3: Maintain good bowel habitsKeep your bowels regular and avoid constipation. Persistent straining when using your bowels can weaken your pelvic floor muscles.

What is an overactive bladder? An overactive bladder is when the bladder contracts suddenly without you having control, and when the bladder is not full. Overactive bladder syndrome is a common condition where no cause can be found for repeated and uncontrolled bladder contractions.

Overactive bladder syndrome is sometimes called an irritable bladder and may give symptoms such as:

• Urgency: A sudden urgent desire to pass urine. You are not able to put off going to the toilet.

• Frequency: Going to the toilet often - more than seven times a day. In many cases it is a lot more than seven times a day.

• Nocturia: This means waking to go to the toilet more than twice at night.

• Urge incontinence: This can occur in some cases and is a leaking of urine before you can get to the toilet when you have a feeling of urgency.

What treatment is there for overactive bladder syndrome?• Some general lifestyle measures

which were outlined earlier in this leaflet may help.

• Bladder re-training is the main treatment and can work well in up to half of cases. There is more information on bladder re-training later in this leaflet.

• Medication may be advised instead of, or in addition to, bladder re-training.

• Pelvic floor exercises should be practiced at the same time as any treatment.

What are pelvic floor exercises?Pelvic floor exercises can help you to strengthen your pelvic floor muscles. The floor of the pelvis is made up of layers of muscle and other tissues. These layers stretch like a hammock from the tail bone at the back to the pubic bone at the front. It supports the urethra (front passage), the vagina (birth canal) and the rectum (back passage) in females. In men it supports the bladder and the rectum.

The pelvic floor muscles can be weakened by:

• Pregnancy and childbirth • Prostate / bladder surgery in men• Continual straining to empty

your bowels (constipation) • Persistent heavy lifting • A chronic cough (such as

smoker's cough or chronic bronchitis and asthma)

• Being overweight • Changes in hormone levels at

menopause (female change of life)

Anyone with stress incontinence (losing urine when coughing, sneezing or exercising) should especially benefit from these exercises.

Pelvic floor muscles

Bladder

Uterus

Spine

Rectum

Anus

Pelvic bone Pelvic floor muscles

BladderProstate

Spine

Rectum

Pelvic bone

Urethra

Anus

How to do pelvic floor exercisesYou should practice the following exercise routine three times every day.

• Sit or lay down comfortably with the muscles of your thighs, buttocks and abdomen relaxed.

• Tighten the ring of muscle around the back passage as if you are trying to control diarrhoea or wind. Relax it. Practise this movement several times until you are sure you are exercising the correct muscle. Try not to squeeze your buttocks.

• Holding that squeeze, pull up the vagina / penis and the urethra all at once lifting them up inside. Try and hold this contraction strongly as you count to five and then release and relax. You should have a definite feeling of 'letting go'.

• Repeat 'squeeze and lift' and relax. It is important to rest for about ten seconds in between each contraction. If you find it easy to hold for a count of five, try to hold for longer - up to ten seconds.

• Repeat this as many times as you are able up to a maximum of eight to ten squeezes.

• Now do five to ten short, fast, but strong contractions.

While doing the exercises:

• Do not hold your breath • Do not push down instead of

squeezing and lifting up• Do not tighten your tummy,

buttocks or thighs.

Bladder re-trainingBladder re-training helps to decrease the time between each visit to the toilet by holding on for as long as possible before you go. This will seem difficult at first. For example, it you normally go to the toilet every hour, it may seem quite a struggle to last one hour and five minutes between toilet trips.

When trying to hold-on, try distracting yourself. For example:

• Sitting straight on a hard seat may help

• Try counting backwards from 100

• Try doing some pelvic floor exercises.

With time, it should become easier as the bladder becomes used to holding larger amounts of urine.

The idea is to gradually extend the time between toilet trips and to train your bladder to stretch more easily. It may take several weeks to reach the target of passing urine only five to six times in 24 hours (about every three-four hours). Make sure you drink a normal amount of fluids when you do bladder re-training (at least 1.5 litres a day).

Tell us we’re listening!Our staff want to know how they are doing. Tell us what you think at: www.cnwl.nhs.uk/feedback and then we’ll know what we have to do.

Contact usHillingdon and Harrow Adult Bladder and Bowel Service

Tel: 01895 485100

Central and North West London NHS Foundation Trust, Stephenson House, 75 Hampstead Road, London NW1 2PL.

Tel: 020 3214 5700 www.cnwl.nhs.uk

© Central and North West London NHS Foundation Trust

Ref: 0171_MAR2015 | March 2015

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