Putting an overactive bladder to bed

After a long day, you’ve settled down for a comfortable night’s sleep. You’re just drifting off when suddenly you feel a warm wetness between your legs - something you haven’t felt since you were about five years old. You’ve wet the bed.

For approximately 16% of people over the age of 18 who have an overactive bladder (OAB), this kind of upsetting incident can become a regular occurrence. Even if they make it to the toilet in time, they wake up so often to urinate that they aren’t getting a good night’s sleep.

Generally, the amount of urine in our bodies decreases and becomes more concentrated at night, so we can sleep six or eight hours without having to get up to use the toilet more than once. However, many people with OAB have nocturia, the need to urinate several times a night, which interrupts their sleep cycles.

“It can disrupt sleep completely, and people can be extremely overtired,” says Dr Luis Sanz, director of urogynaecology (an area that specialises in female urology and gynaecology) and pelvic surgery at Virginia Hospital Center in Arlington in the US.

Even worse, those who are particularly sound sleepers or can’t get out of bed fast enough can wind up with wet sheets.

Getting a good night’s sleep with OAB

“Preparation is everything,” says Dr Melody Denson, a urologist in Austin, Texas in the US. You might consider sleeping on a towel and keeping a box of baby wipes near the bed in case of accidents, but you can also take these steps to prevent accidents from happening:

• Limit your fluid intake before bedtime. Consider not drinking any liquids in the 2-3 hours before bedtime.
• Avoid foods and beverages that can irritate your bladder. If you can’t cut them out entirely, skip them in the hours before bedtime to help prevent nocturia. That includes:
  • Caffeine, which is a diuretic, which increases urine output
  • Alcohol
  • Citrus juices
  • Cranberry juice - though it helps prevent recurrent urine infections it can actually be an irritant if you have OAB
  • Spicy foods, such as curries
  • Acidic foods, such as tomatoes and tomato-based sauces
  • Chocolate
  • Artificial sweeteners such as Aspartame (also a bladder irritant)
• Double-void before bed. Denson advises that you double-void, or urinate twice, right before bed. Go to the toilet, she recommends, “then brush your teeth and go through the rest of your bedtime routine. Then, just before you’re about to lie down - even if you don’t feel like you have to go - try to urinate and see if you can squeeze out another tablespoon or so.” 
• Do pelvic floor exercises. Done regularly, they help control an overactive bladder. “They will trigger a reflex mechanism to relax the bladder,” says Denson. “If you feel a tremendous urge to urinate,” she says, do a pelvic floor before you run to the toilet. She explains, “[it] will help settle down the bladder spasm and help you hold it until you get there.”

Pelvic floor exercises simply involve contracting and releasing the muscles around the opening of your urethra, just as you do when you urinate. You can learn what a pelvic floor exercise feels like by starting, then stopping, your urine stream. Start with sets of 8-12 contractions. Hold them for a few seconds each to begin with, and perform these at least three times a day.