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DR. VIJAYASHREE SARAVANAN (MBBS, DGO, FRCOG, CCT (UK) CONSULTANT UROGYNAECOLOGIST ) Managing Director and Cons ultantUrogynaecologist for CURE - Centre for Urogynaecology Research and Education. She has completed her advanced training in Urogynaecology and pelvic floor surgery - University of Manchester, UK.

What is overactive bladder?

The overactive bladder is a very common problem that can cause distressing and inconvenient symptoms in women. It can cause you to rush to the toilet many times during the day and night, and can sometimes also cause you to leak some urine before you reach the toilet.

How common is this problem in women?

Overactive bladder is a very common problem in women. It is thought that upto one in three women will suffer from this problem in their lifetime.

Why does this happen?

These symptoms are usually caused by the bladder muscle squeezing to empty out urine inappropriately which often halve without warning and when you do not want it,

What can cause overactive bladder?

This problem can affect women of all ages and is not simply a result of getting older. The common causes are:
• Urine infection and hence it is important to get the urine tested to rule out any infection of the urine.
• Drinks containing caffeine, citric acid juices and alcohol
• Medication like diuretics
• Constipation
• Bladder emptying problems
• Pelvic floor disorders like uterine prolapse
• Medical problems affecting the bladder nerves like long standing diabetes
• Stones or growth in the bladder

How can I prevent this condition?

It is important to maintain good bladder habits:
• Drink atleast 2 litres of water in a day
• Empty the bladder every 3 or 4 hourly
• Try to avoid trips to the toilet less than 2 hours
• Avoid caffeine, fizzy drinks, fruit juices and alcohol
• Keep conditions like diabetes under control
• Avoid constipation

What treatment options are available for this problem?

Many treatment options are available for this problem and hence seeing aurounaecologist is strongly recommended.
• Bladder training is a very useful technique which can be successful in 1 out of 2 or 3 women with overactive bladder. Bladder training involves gradually increasing the time between visits to the toilet and trying to hold on for a little longer if you experience the urge to empty your bladder.
• Medication is available to help relax the bladder muscle in women who do not have improvement with the conservative measures.

What if I do not benefit from medication?

• Further invasive test called urodynamics will be performed to confirm the diagnosis for your condition
• Minimal access surgical treatment options like injecting Botox in the bladder muscle are also options which can be considered after urodynamic studies.


What is menopause?

Menopause is a natural change marking the cessation of a woman's reproductive ability and considered a normal part of aging when it happens after the age of 40. It is important to understand the effects and possible complications of menopause as women currently spend nearly one third of their lifetime in the menopause.

How do you know you are around the time of menopause?

A woman is menopausal when she has no menstrual periods for 12 months. The process of menopause does not occur overnight, but is a gradual change which could last between 2 to 5 years. This transition period is a different experience for each woman.

Can menopause happen early?

Menopause can sometimes occur early in certain situations like surgical removal of the ovaries, cancer chemotherapy and radiation therapy and premature ovarian failure when menopause happens before the age of 40.

What are the symptoms of menopause?

Symptoms of menopause include abnormal or irregular vaginal bleeding, hot flashes, vaginal and urinary symptoms, and mood changes.Most of these troublesome symptoms are treatable, or at least temporary.

What other changes can happen during this time?

Other physical changes like weight gain, changes in skin texture (wrinkles), worsening of acne are also common. These are due to the hormonal changes that happen during this time.

How to keep healthy and avoid the complications that can happen after menopause?

Although menopause cannot be prevented, certain actions canreduce risk ofcomplications, such as osteoporosis and heart disease –
• Exercise can reduce hot flashes and improve mood, and weight-bearing exercise, such as walking, helps keep bones strong.
• Eat a healthy, balanced diet to avoid weight gain and keep cholesterol levels in check. Your daily diet must include calcium, fiber, water, good fats, soy, fresh fruits and vegetables.
• Ask a doctor regardingcalcium and vitamin D supplements to protect against bone loss.
• Talk to a doctor about hormone replacement therapy (HRT). For some women with severe menopausal symptoms, the benefits of HRT may outweigh the increased risk of breast cancer and stroke.

Are there any serious symptoms of menopause that need to be recognized early?

Some symptoms of menopause are urgent and require medical attention. It is important to recognizethe serious menopause symptoms like heavy bleeding, depression and hypertension and see a specialist to be investigated and treated appropriately.


What is the pelvic floor?

The pelvic floor is a broad sling of muscles, ligaments and sheet-like tissues that stretch from thepubic bone at the front of the body, to the base of the spine at the back in women.The pelvic floor supports the bladder, bowel, and uterus (womb), and helps control the bladder and bowel and maintains continence.

How does pregnancy affect the pelvic floor?

Pregnancy and childbirth can have a lasting effect on pelvic floor muscles in women. Being pregnant can place a lot of stress on these pelvic floor muscles, which can lead to weakness even before the baby is born. The pelvic floor can become weak and stretched from as early as 12 weeks into pregnancy. Constipation is also common in pregnancy and can put even more strain on the pelvic floor. It is therefore important to look after these muscles during this important time.

What problems can happen if my pelvic floor is weak?

Leakingof urine on cough, sneeze or exercise (stress incontinence)can happen ifyou have a weak pelvic floor. A weak pelvic floor can also cause a heavy, dragging sensation due to the bowel, bladder and womb not being well supported.Also, having a weak pelvic floor makes it harder to squeeze the muscles and sphincters of the bladder and bowel to prevent leaking of urine or feces.

How can I prevent problems from weakness of the pelvic floor?

Regular pelvic floor exercises can help to protect from leaking urine during pregnancy and after childbirth. It may also help to prevent a prolapse. It is important to keep the pelvic floor muscles strong for rest of the life, as hormonal changes after the menopause can make pelvic floor problems more likely. Weak muscles can cause the uterus, bowel or bladder to sag down and push against the walls of the vagina (prolapse). Doing just a few pelvic floor exercises every day can help to treat bladder weakness or prolapse symptoms, and will also help to prevent problems later on.

Who do I consult if I have bladder or bowel control problems?

Consult a urogynaecologist for problems relating to the pelvic floor and bladder or bowel control following delivery.