"I’ve no problem talking about OAB – a lot of men definitely would have, they’d find it very embarrassing and they wouldn’t talk to their friends or anyone about it"
Joe's StoryAlthough Joe Curley describes his Overactive Bladder (OAB) symptoms as mild, it’s an “inconvenience” that he has had to cope with for the best part of forty years.
“As far as managing my OAB is concerned, I do okay. Some days are better than others, and some nights I may only be up two or three times to relieve myself; other nights it could be four or five times,” says the Galway man (aged 81). “It’s not too bad but it’s an inconvenience I live with. It’s like having a tooth ache, when it’s gone you don’t worry about it, but when it’s there you do your best to cope with it.”
“When I’m at home and in my own environment, it’s easy enough. But long meetings, church services such as funerals, going to the theatre or cinema can be very difficult. It is very important for me to know beforehand where the toilets are located for obvious reasons. But at a meeting of say four or five people it is embarrassing to have to leave more than once.
“Over the years I’ve noticed a few triggers for my OAB; it can depend on what I eat or drink, or if it’s a stressful day, that seems to trigger the frequency a bit. Some times a drop in temperature has an immediate effect putting pressure on the bladder, even stepping out from a warm car. The difference in temperature can be as little as a few degrees,” he adds.
Now almost 82, Joe recalls having bladder problem from a very early age. He first attended an urologist for treatment in the early 1970s without much success. “It was possible to live with the condition once I was within reach of a place to relieve myself, I could write a book about that.”
“Years ago before the big roadway programme, not just the motorways, it was not a problem to stop along the road to relieve yourself. I remember one early morning on the way to Dublin in the dark I was relieving myself at the end of a lane on to the main road when I was illuminated, in full flow, by a farmer’s tractor not ten feet away just starting out for the day. We Irish are very sensitive about seeing someone who literally has to pee,” Joe laughs. “Thankfully an increasing number of service stations on the motorways now that should solve the problem there.”
In the 1990s Joe recalls that his OAB symptoms worsened. He was referred by his doctor to another urologist and was prescribed medication for his condition, which seemed to work for a while. However, Joe has found that simple self-management techniques provide him with the greatest relief from his OAB symptoms.
“I try to avoid fizzy drinks and fruit juices or drinking too late at night. Some foods can also be a trigger. My daughter told me about pelvic floor exercises a while back and I do them every day. I think in fact the exercises are getting it more under control. I think self-management is the best way to go for me and hopefully that will improve the situation.”
John's Story“I worked as a company executive and was often on the road; frequent pit stops were the order of the day. I had a mental map of where all the rest rooms were”
John Whelan does not subscribe to the theory that overactive bladder (OAB) syndrome is an inevitable consequence of old age, a condition that develops as the Golden Years set in. And he is correct. Although it's more common among older adults, overactive bladder is not a normal part of aging. Now in his early 70s, Dublin-based John was just 46 when he first developed the OAB symptoms of urgency, frequency and nocturia (waking often during the night to urinate).
“I worked as a company executive and was often on the road; frequent pit stops were the order of the day. I had a mental map of where all the rest rooms were,” he says.
“At the time my GP referred me to a consultant who performed a two-step surgical procedure in which my urethra was dilated and my bladder stretched. It was thought that I might have a small bladder and the sum result of the surgery should have been less frequency afterwards, but it really didn’t help. With OAB, the bladder doesn’t have to be full for the urge to urinate to be there.
“I’m fortunate enough; my symptoms are mild during the day. I’m up and about so it’s just a case of finding a bathroom when I feel the urge. But at night it can be a bit disruptive, waking up two or three times to go to the toilet. It doesn’t matter whether I don’t drink after 6 o’clock in the evening or whether I do, I’m still rising at night. It’s an inconvenience more than anything else,” says John, who hails from Rathfarnham, Co. Dublin.
After more than two decades living with OAB, he is keenly aware of certain triggers and carbonated drinks are top of the list. “I’m not an alcohol drinker, I love a Coke or a Fanta, but these drinks are just lethal to me. Water is probably the best,” he adds.
John says that occasionally being in a situation that puts him on edge can trigger the urgency to urinate. “There is some element of nervousness about it, if I was waiting to see a doctor for example I’d probably start feeling the urge. Having said that, sometimes when something else takes over mentally it can actually distract you and the urge lessens.
“I can’t remember more than once in the last 25 years not having to get up at night. The only way it disrupts me in the daytime is if I’m going somewhere I need to know there’s a bathroom on the way, and I’d be very reluctant to take a long bus journey.
“I’m not obsessive about it,” he stresses. “I could empty my bladder before I leave the house but before long the urge will be there again. It’s not severe but it’s there. I can still make it to the bathroom on time.”
John adds that his OAB hasn’t adversely impacted on family life or relationships. “My wife is a nurse and she’s the one I talk to about this. Although I never really felt the need to discuss it with other people, perhaps if it were more severe I would have. When you compare it to things like cancer or other serious conditions, it’s very minor really but it’s annoying, that’s the best word to describe it. It is what it is, and it hasn’t gone away.”
Exercises for men
The floor of the pelvis consists of layers of muscle and other tissues. These layers stretch like a hammock or sling from the tailbone to the back to the pubic bone in front. The pelvic floor muscles support the bladder and bowel (and uterus in a woman).
Pelvic floor exercises strengthen the pelvic floor muscles. As with any muscle, regular exercise can make these muscles stronger and thereby help you prevent or control urinary incontinence and other pelvic floor problems.
You can do pelvic exercises discreetly just about anytime, whether you’re driving in the car, sitting at your desk or relaxing on the couch. However, they do take practise. The first step in performing pelvic floor muscle exercises is to identify the correct muscles.
Finding the muscles
- Sit comfortably on an upright chair, knees apart and pelvis in neutral. (Keeping the natural curve in your lower spine). The buttocks should stay relaxed
- Squeeze the ring of muscle around the back passage as if you are trying to stop passing wind.
- For men, stand sideways in front of a mirror (with no clothes on). As you pull in your pelvic floor muscles strongly and hold them, you should see your penis draw in and your scrotum lift up.5
- A common mistake is to use your in breath to try to lift up your muscles. So, start by breathing in normally, then as you breathe out, lift up the pelvic floor muscles and hold them while you continue to breathe. Let them relax totally between squeezes.
- You can try the stop test. You can feel your pelvic floor muscles if you try to stop the flow of urine, however, it is not recommended that you regularly stop your flow of urine midstream as this can be harmful to the bladder.
Once you have mastered finding the muscles, you can start to control and strengthen them. If you are holding your breath or tightening your buttocks, then you are trying too hard. Repeat lifting the muscle more gently.
Strengthening the muscles
- Lift up the pelvic floor muscle, add a squeeze and squeeze again. This will provide strength by working the muscle hard.
- Release completely between lifts.
Aim for 10 squeezes lasting 6-8 seconds. Then aim for 3 sets of 10.
You can also add fast squeezes to your exercise programme. Squeeze the muscles as hard and fast as you can and let go immediately. Repeat 10 times
Progressing the programme
- Do these 1-3 times per day. Work the muscles until they are tired. It is more effective than doing them little and often.
- Start in a sitting position and once you have mastered this, progress to doing them in a standing position.
- To control bladder urgency, you may need to hold the squeeze for up to 20 seconds.
Learn how to control the urgency
As soon as the urge starts, stay still and take a few deep breaths. Squeeze the muscle as hard as you can and keep squeezing until the urge begins to fade.
Remember to: Freeze Breathe Squeeze
Then once you have the control, hold the muscles gently while walking to the toilet. Squeeze hard again when undressing. You should practise using the muscles to control the bladder every time you go to the toilet so that the muscles get used to controlling the bladder again.
This information should be used as a guide only. If you are having difficulty finding your pelvic floor muscles, a specialist physiotherapist can help teach you which muscles to use, measure your muscle strength and offer biofeedback therapy.
You can find a physiotherapist in your area by contacting the:
Irish Society of Chartered Physiotherapists
Royal College of Surgeons
St Stephen’s Green
01 402 2148