Needing to pass urine frequently can be a nuisance at any age.
As a senior consultant gynaecologist, I see many young women who find themselves in this uncomfortable situation. They feel the need to pass urine several times a day, sometimes every hour and not uncommonly, a couple of times at night. Along with the frequency, there may be a sensation of urgency and on occasions, leaking of urine. There are usually no other symptoms to suggest an infection. Stress seems to make matters worse.
It is normal for most women to pass urine every three to four hours when awake and not need to get up more than once at night. Needing the bathroom more than seven times a day may indicate a problem.
Urine is continually produced by our kidneys; it then collects in the bladder that slowly distends like a balloon. When the bladder is about half full, it sends a signal to the brain to empty itself. (First Sensation). One is usually able to ignore this sensation, which passes until the bladder is properly full; then one feels the need again to pass urine.
For many women who repeatedly respond to this first sensation, the bladder detrusor muscles can get overactive with time and forget how to relax properly.
The good news is that more than half of women with urgency due to an overactive bladder (OAB) respond very well to lifestyle modifications and bladder training. The exact cause for an overactive bladder is unknown but it affects as many as 1 in 6 women.
Bladder Retraining - Start by keeping a written record (or it can be on your smart phone) for a couple of days of your fluid intake and the number of times you need to urinate. This will give you a baseline to see the extent of your problem.
You should then start to increase the time interval between passing urine, initially by 5-15 minutes. You may need to use distraction techniques (for example, deep breathing, counting backwards in your head, listening to music, pelvic floor contraction exercises) until you are able to reach an acceptable time gap (usually three hours) in between your trips to the bathroom. This allows the bladder muscles to relearn to relax and respond correctly to the signals sent by the brain.
Be patient as it can take up to six months for symptoms to improve. Some women need the help and support of a specialist nurse or doctor. Keeping a diary every day for a week or so and then a weekly diary can help keep you motivated to reach your goal.
Here is some of the other advice that my patients have found helpful.
> Avoid caffeine containing drinks such as fizzy drinks, coffee, tea, green tea or pain medications with caffeine and artificial sweeteners as all of these are known bladder irritants and can make urinary symptoms worse. Replace these drinks with herbal teas or water for a couple of weeks and see if there is a difference. If so, make it a part of your lifestyle.
> Drink about two litres of fluid (6-8 glasses, it doesn't have to just be water) to avoid getting dehydrated unless it is very hot or you are exercising a lot, when you will need more. Passing concentrated urine can make matters worse but also avoid drinking too much fluid as this will lead to several trips to the bathroom. Your urine should be clear to indicate that you are drinking enough fluid.
> Constipation can make symptoms worse so don't forget your five- a-day and include fibre in your diet with plenty of vegetables, fruits, beans and whole grains.
> Remember to empty your bladder before going to bed and limit drinking fluids a couple of hours before bedtime if getting up at night is an issue.
> Smoking and alcohol are known to overstimulate the bladder, so stopping these may be helpful in many women. Again, it can take a few weeks to see a difference.
> Several studies have shown overweight women who lose weight find improvement in their bladder symptoms by directly relieving pressure on the bladder.
> Many find relaxation and breathing techniques help reduce the frequency of urination as stress can make matters worse.
It is important to rule out a Urinary Tract Infection (UTI) as this is a very common problem in women. Symptoms of an UTI include frequency, burning or tummy pain which is worse on passing urine. The urine itself may have blood or look cloudy. Simple reliable tests at the doctors' surgery will usually identify these urine infections and can be quite easily treated with the right antibiotics. Blood in the urine, even just once, should be taken very seriously at any age.
It is uncommon for most young women with an overactive bladder (OAB) to need further tests. It is also important to remember that many treatments have side effects, so specialist advice is recommended in a select few women. Lifestyle changes and bladder retraining should be the first line of treatment as with the right advice, women can get control back over their lives.