Time to lift the lid on the loo taboo

Imagine having to map out bathroom locations, calculate traffic conditions, avoid lengthy meetings – and all to accommodate frequent sudden urges to urinate. People with overactive bladders need to stop hiding their problem and seek medical help

EVERYONE HAS had the experience of being caught short, feeling desperate for the loo while stuck in a long queue or traffic jam.

For most people, it’s an occasional annoyance, but for those who suffer from an overactive bladder (OAB), that sense of desperate urgency overtakes them many times every day, disrupting their home and working lives.

In many ways, it’s a hidden problem: although it affects 10-20 per cent of the population, there’s little public awareness of the condition.

It’s certainly not a fashionable cause: there are no celebrities willing to raise the profile of OAB, and people who suffer from it themselves – often feeling embarrassed and awkward – tend to keep quiet about it. In fact, a recent nationwide survey found that 70 per cent of people experiencing symptoms of OAB haven’t even discussed the problem with their GP.

But behind that public and private silence, there’s no doubt that OAB has the capacity to turn people’s lives upside down. Imagine having to plan out your day so that you’re never more than dashing distance from a toilet: mapping out bathroom locations, calculating traffic conditions, avoiding lengthy meetings – and all to accommodate those frequent, strong and sudden urges to urinate.

It’s a situation with which Theresa (not her real name), a mother of four, is all too familiar. “I’m 60 now, and I’ve always been the kind of person who ‘needed to go’ quite often – it was inconvenient, but I just put it down to having given birth four times, and worked around it.

“But in the last four years, the problem has got much worse. On bad days, I’m running to the loo 20 times a day, and getting up two or three times in the night.

“It sounds like such a little thing, needing to spend a penny, but it really is taking over my life. When I’m out of the house, I can’t think about anything else except where to find the nearest toilet. I’ve started walking everywhere – I can’t risk using the bus in case I need to go. It’s definitely worse when I’m feeling anxious, but the awful thing is that you can’t help being anxious when you have this condition – so it’s a vicious circle.

“Am I stressed because I need to go to the loo often, or am I going to the loo so often because I’m stressed? There’s no way of telling.”

Dr Declan Keane, consultant urogynaecologist at the National Maternity Hospital in Dublin, says that, with an ageing population, OAB is a problem we cannot afford to ignore.

“If you think back to schooldays, there was always someone in the class who needed to go more frequently. That can continue in adult life, and not be perceived as much of a problem. But symptoms often increase as people get older.

“If you reach the stage where you just can’t hold on, when you’re rushing out of meetings – then it has become a medical problem.”

While OAB is more common in pre-menopausal women than in men, after the age of 60 the two sexes even out; in fact, in residential or nursing homes, it’s estimated that 50 per cent of all patients suffer from the condition.

What causes this excessive frequency? “In some cases, it’s a bad habit,” says Keane.

“If you keep going to the toilet frequently, your bladder is not used to holding on. And then there’s the fact that Irish people drink more tea than anyone else in the world. Your average fluid intake should be one to two litres a day; I see people who drink four or five litres a day. So you can dramatically reduce symptoms by cutting back on fluids – tea especially.”

Some people’s bladder receptors are particularly sensitive. “Medication may be used to inhibit the effects of a neurotransmitter, acetylcholine, released by the nerve endings of the bladder,” says Keane. For those patients whose symptoms prove resistant to medication, there is the option of having botox injected into the wall of the bladder.

As for the embarrassment factor, Keane says there is no need to keep this problem hidden, or to regard it as something you simply have to put up with, part and parcel of getting older. OAB is treatable at any age.

“OAB symptoms affect quality of life to such a degree that it is a big deal. The more we talk about OAB, especially with GPs, the easier it will be to allow us to treat the symptoms and let people regain quality of life. GPs are much more switched on to the issue now, and referrals have increased dramatically. It’s starting to lose its taboo.”

When it comes to OAB, it seems, there’s no need to suffer in silence.