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THERE’S nothing that ruins the enjoyment of a day out more than panicking over where the nearest loo is!
But as we get older, as many as one in three women find they need to pee more than they use to – and many experience embarrassing leaks.
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The good news is that having an impatient bladder isn’t something you have to learn to live with.
There are plenty of ways to take back control and give you back your freedom to get out and about.
How did your bladder get so stressy?
Your bladder is like a balloon.
Read more on women’s health
It fills up with urine, which is the liquid left after your kidneys have filtered waste out of the blood in your body.
When it fills up to about 100-150mls of wee – about the same as three quarters of a fizzy drink can – your bladder sends signals via your nervous system to tell your brain to tell you it’s soon time to empty it.
When it fills up to around 200-300 mls, that feeling will get more urgent.
When you do go to the toilet, the smooth muscle fibres in the walls of your bladder contract to squeeze out the liquid.
At the same time, the muscle around the urethra – the tube that carries urine out of the body – also relaxes to let it flow out.
It’s normal to want to go for a week between six and eight times over 24 hours.
But as we get older that number often starts to rise – with some women finding they need to go twice that amount.
Why do you start needing to go the loo more?
One reason is the drop off in the female sex hormone oestrogen as we approach menopause.
Expert Katie Mann, clinical specialist physiotherapist in the NHS says: “This hormone helps keep the tissues of the organs, including the bladder and the pelvic floor muscles that help control it, strong and flexible.
“So, storage of urine and emptying of your bladder may not be as efficient as it used to be.”
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Oestrogen has another job too: helping to keep the acidity level in your bladder steady.
When this starts to change, you are more at risk of urinary tract infections from bacteria.
This can irritate it and make it feel full, even when it isn’t.
This also sends confusing messages to your brain about when you need to wee, making it ‘overactive.’
If you’ve had bouts of cystitis over the years – and the hot, stinging urine that comes with it – your muscles may have gotten in the habit of tensing up when you empty your bladder.
“If you’ve had lots of infections, then you can get into the habit of going more, and this can become your new ‘norm’,” says Katie.
“More than three episodes of confirmed infection in a twelve-month period should be investigated – so speak with your GP.”
Do you sometimes spring a leak too?
Alongside wanting to go more often, some women may also leak when they sneeze, laugh or jump – or find it harder to hold it in.
Why? If you’ve had kids, the weight of carrying the baby, the hormonal changes and the wear and tear of giving birth, may have weakened your pelvic floor – the hammock shaped layer of muscle at the base of the pelvis which supports the uterus, bowel and bladder.
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If this starts to weaken, the weight of the other organs can press down on the bladder, putting pressure on it, squashing it so it can’t hold as much urine.
Plus, the muscles that pull the urethra open and shut also may not work as well.
This helps to explain why twice as many women have urinary incontinence compared to men, according to research.
The signs of bladder cancer you should know
There are around 10,500 new bladder cancer cases in the UK every year, according to Cancer Research.
That’s 29 every day, making it the 11th most common form of cancer in the UK.
Smoking is the single biggest risk factor for bladder cancer, causing 45 per cent of cases in the UK.
But exposure to other chemicals, including industrial, is also known to be a cause. Sometimes the cause of bladder cancer is not known.
Around six in 10 cases are in people aged 75 or over, with a steep rise in risk from age 50.
The signs of bladder cancer
- Blood in urine: This is the most common sign. It might not be obvious and may come and go. It might look like streaks of blood, or brown urine.
- A need to urinate more
- A burning sensation when passing urine
- Pelvic pain
- Bone pain
- Unintentional weight loss
- Swelling of the legs
Another reason your bladder may get squeezed is due to prolapse – when the pelvic organs, like the womb, bladder or bowel are no longer fully supported by the muscles and ligaments in the pelvis and start to drop lower.
Katie says: “If those organs are not well supported, they don’t work as well and that may mean you feel the need to urinate more.
“Forty per cent of women in the UK have some level of prolapse, so it’s really common.
‘You may also notice that if you cough, sneeze, jump or laugh, some urine may also escape.
“If you can’t get to the loo quickly enough, some urine may escape and this is called urinary urge incontinence.”
Don’t wait to fix an impatient bladder
Many women think an impatient bladder is just something they have to live with.
Research shows only half of women seek help for it – and if they do, they wait for five years to seven years to talk to their doctor, according to women’s chartered physiotherapist Christien Bird of the Whitehart Clinic in Surrey (whitehartclinic.co.uk).
Expert Katie also urges women not to wait for it to get worse.
She says: “Research has found that incontinence is a significant reason why women are admitted to care homes in later life.”
7 ways to make your bladder more patient
1. Rule out medical reasons
Needing the loo a lot could be a side-effect of some medicines, like some opioid painkillers or medication for high blood pressure.
It may also be a symptom of a urinary infection, diabetes or some nerve disorders.
So check with your GP first.
2. Cut back on the booze and coffee
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The amount of coffee we drink has risen dramatically over the last ten years, with the average Brit drinking two cups a day on average.
But coffee is also a diuretic – which means it makes your body get rid of liquid more often.
Research has also found the caffeine it contains tends to irritate the walls of the bowel more, making them spasm.
Alcohol has the same effect, so limit booze consumption too.
3. Drink more water
Katie says: “Lots of women who have irritated bladders will cut their fluid intake so they make less visits to the loo,” says Katie.
“That’s actually counterproductive because this can concentrate your urine and make the bladder more irritable.”
If you find it hard to get into the habit, get a water bottle you like using, add flavourings like lemon or cucumber, or eat more water-rich foods like fruit and soups.
4. Lose that tummy fat
Putting on weight especially around the tummy area puts more pressure on your pelvic floor which supports your bladder.
Research has shown even losing 8 per cent of your body weight, usually around 15 to 20 pounds, can help and dial down bladder issues by as much as a quarter.
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5. Get the ‘knack‘
If you know you’re going to jump, sneeze or cough, and there’s a chance some wee may leak out, you can contract your pelvic floor in anticipation and that can prevent loss of urine.
Katie says: “This is called The Knack.”
6. Sit down on the seat
While a lot of us don’t like our bottoms to hit the seat in public loos, it’s important not to hover as this does not allow your pelvic floor to relax completely while you empty your bladder, says Katie.
“Once you’re sure your flow of urine has finished, wait for another five to ten seconds.
“Sitting relaxed for a short while longer can allow this to come out and improve the signals between your bladder and brain.”
6. Train your bladder to be more patient
The muscles around your bladder in your pelvic floor are rather like a drawstring purse which gets pulled tighter.
But over time these can get out of balance; either weaker or tenser after childbirth, or they don’t respond quickly enough.
Finding the right set of exercises – often different sets of squeezes and releases – can give you back better control of your bladder.
An exercise routine should be tailored to your individual need, so it’s best to be referred to a specialist physio who can assess you first, give a tailored programme and monitor you, says Katie.
“Think of it as having a personal trainer for your pelvic floor!,” she says.
7. Get an app or a gadget
One option is Squeezy app, designed by pelvic health specialists, which comes with an exercise plan and diary reminders.
Or you can go one step further, and get a gadget which you can insert into your vagina like a tampon and which will measure the strength of your squeezes, and which you can monitor on your phone, as you get stronger.
For example, you could try an Elvie trainer, which costs £169 at www.elvie.com .
You may also be able to get one free on the NHS if you are receiving treatment.
And, if you’re caught short……
1. Tense your muscles
If you feel a sudden need to go, try some pelvic floor contractions.
This may actually help you relax the bladder.
Katie says: “A strong pelvic floor muscle contraction has an inhibitory effect on a contracting bladder muscle, so calms it down.”
2. Try thinking about something else
Switching your attention away from the bladder by counting backwards or counting your steps as you walk to the loo.
Katie says: “When we feel we want to wee, urgency there is often a desire to clench your legs together or rush to the toilet.
“But it’s often better to relax until after the initial strong sensation of urgency has passed.
“Then walk to the toilet at your normal pace.”
Find out more about bladder issues and what causes them at Pelvic Obstetric and Gynaecological Physiotherapy at thepogp.co.uk/resources/booklets
