Camilla Lawrence assists Lucy Elkins in explaining Overactive bladders MailOnline, 29th September 2014
On the face of it Hilary Shields had it all. The director of her own management training company, she had two beautiful children, a loving husband and a good social life.
Yet in her late 40s Hilary developed a deeply embarrassing problem that overshadowed all of this.
It affected her work as well as home life, and made her fearful of even the briefest of car journeys.
The condition was overactive bladder — an ailment that despite affecting a staggering seven million people in Britain, is still a taboo subject.
The condition means patients have to go to the loo more often than normal, and with greater urgency — they lose the ability to ‘hold on’.
‘I found it excruciatingly embarrassing,’ recalls Hilary, 51, from Peterborough, who is married to Bob, 66, and has children aged 28 and 26.
‘I had to split my life into 90-minute segments because that was the longest I could possibly last without visiting a loo.
‘And if I got the urge to go, I’d have just seconds before losing control of my bladder.’
And because Hilary needed to use the loo about 14 times a day — normally people go five or six times — every trip out of the house had to be meticulously planned.
‘I became an expert in “toilet maps” making a note of where every loo in the area was whenever I went out,’ she says.
‘If I went to the theatre, I’d have to go to the loo before the interval because if there was a queue, that could be disastrous for me.’
Although a keen golfer, she had to give up the sport.
‘I’d never have managed nine holes without needing to run into the bushes and I rarely went on long walks because I had no idea where the next loo would be,’ she says.
‘At work I’d pretend I needed to make a call during meetings, so I could pop to the loo again and again without people realising what I was doing.
‘Once, on my way to a big presentation, I was stuck in a long traffic jam on the M25 and couldn’t get to a loo in time.
‘I had to pull off the motorway and find a hotel to change in.’
Hardly surprisingly, Hilary’s self-esteem plummeted.
‘I thought this was the kind of problem that affected older people, but then I wasn’t even 50 and feared this was what it was going to be like for the rest of my life,’ she says.
The bladder, which is made of muscle, fills up like a balloon with urine which constantly trickles from the kidneys. When the bladder is full, it starts to have mini spasms and the surrounding nerves send signals to the brain.
The brain responds by sending a message to the bladder to contract and empty.
However, in those with an overactive bladder, it empties spontaneously and without warning, before the bladder is full.
As a result, sufferers have a sudden and overwhelming need to go.
‘People with this condition may need to go eight, ten or more times a day,’ explains Zaki Almallah, a consultant urologist at the Birmingham Bladder Clinic.
‘Some, but not all, have the need to go two or more times through the night, too.‘However, as inconvenient as it is to need to go that often, what affects their quality of life most is the urgency.
‘Whereas most of us can hang on for a bit, some people with an overactive bladder cannot and they need to go there and then, which can lead to accidents.’
Sometimes the problem is caused by a malfunction in the nerves that surround the bladder, causing them to tell the brain that the bladder is full when it is not.
However, the cause of many cases is a mystery, says Mr Almallah.
Middle-aged women are most commonly affected, probably because low levels of the hormone oestrogen (which falls in middle-age) can affect the tone of the muscles of the bladder, making them more likely to contract spontaneously. Childbirth is also thought to be a trigger.
Some estimates suggest as many as four in ten women suffer from it, says Mr Almallah, though he thinks this may be ‘a little over exaggerated — but it is a very common problem’.
He adds it can also affect men and children — it can be why some children wet the bed, but they will normally grow out of it.
The problem can also be triggered by neurological conditions such as stroke, Parkinson’s disease, multiple sclerosis and spinal injury, as these affect how the brain and the nerves of the bladder communicate.
Certain medications can also trigger it — including diuretics, commonly taken for high blood pressure, which increase the amount of urine you produce, and opioid painkillers, which can affect the nerves, too.
Hilary developed the problem after surgery to remedy stress incontinence she’d suffered as a result of delivering two 9lb babies.
Stress incontinence is when you leak a little urine when the bladder is put under pressure — for example when coughing or laughing — and is common after childbirth.
Hilary had undergone an operation using tape — known as tension-free vaginal tape — to support the urethra, the tube that carries urine from the bladder, and reduce the pressure on the bladder.
‘I swapped one form of incontinence for another — and this was far harder to live with,’ she says.
Whatever the cause, many people won’t talk to their doctor about incontinence — a recent survey by Always Discreet, which makes incontinence pads, found 60 per cent of women do not ask their GP for help.
‘Unfortunately, many people suffer in silence, as they are too embarrassed to go to the doctor,’ says Mr Almallah.
‘Even those that do see their doctor do not always get the help they need.’
Some are told the problem is normal or just part of getting older ‘when it absolutely isn’t’, adds Camilla Lawrence, a women’s health physiotherapist at Six Physio clinic, London.
The shame is that it takes people a long time to build up the courage to seek help — most of the people I see have suffered for ten or even 20 years by the time they see me.’
Normally the first treatment option is bladder training — done with the help of a physiotherapist or continence nurse — to retrain the bladder to hold on.
‘It helps if people sit on a hard surface when they are trying to hold it for longer, as it gives them a feeling of support, and distraction is good,’ suggests Ms Lawrence.
‘When people get the urge to go, we encourage them to send a text or make a shopping list, or to think about what they’re having for dinner.’
Bladder training can improve symptoms in about half of cases. If that doesn’t help, tablets called anticholinergics may be offered.
These block faulty nerve signals reaching the brain, but do have side-effects such as dry mouth, itchy eyes and constipation.
There are a number of surgical options.
Bladder augmentation increases the size of the bladder using a section of the bowel or stomach, but is a major procedure with the risk of infection.
Botox injections are also sometimes given, which make the bladder less likely to contract; these, too, carry infection risk.
For Hilary, the solution was easy — it was seeking help that was the problem. She lived with the condition for almost two years before deciding enough was enough.
The final straw came when she was caught short and had an ‘accident’ while driving on the M25.
‘I was so humiliated. I just couldn’t go on like this,’ she says.
Hilary saw a private specialist and was prescribed the anticholinergic VESIcare.
‘Within a week of taking a single tablet at night I did not have overactive bladder any more — I felt stupid that I hadn’t tried to do something about it before,’ she says.
