2019 AGM: Bladder Management - Dr Mohammed Belal

The final talk of the day was Dr Mohammed Belal of University Hospital Birmingham who talked on bladder management with HSP.

He began by giving some basic information. The bladder is a low pressure reservoir for fluids, it is a void within the body. The bladder is controlled from the brain with nerves between the bladder and the brain. The average person urinates 7 times in a 24 hour period, with young people urinating fewer times than older people.

An over-active bladder is one which gives the person urgency to go to the toilet before the bladder is full. The bladder is contracting without the permission of the person. In the normal population some 15-20% have an overactive bladder.

Dr Belal described two areas of interest in reducing bladder effects.

Lifestyle Changes

Have your last drink of the day 1-2hours before bed. Even taking a sip of drink during the night will create more urine. As you get older more urine is generated at night.

If you snore then more urine is produced, so getting a better pillow to reduce snoring should reduce the amount of urine generated.

If your wee/urine is clear then you are drinking too much. 1 litre of fluids is enough.

Tea, coffee and alcohol are diuretics whose job is is to generate more urine. Reducing intake of these drinks can reduce the amount of urine.

Bladder training can be effective. Even trying to hold back another 10 minutes can be beneficial. It is wise to keep a bladder diary to identify how often you go. Exercising the pelvic floor muscles can help. Emptying the bladder before going out and before going to bed can help.

Reducing weight and stopping smoking can also help.

The body takes a couple of weeks to adapt to any changes, so perseverance is needed when investigating these factors.

Medication

The aim is to reduce pressure in the bladder. This can be achieved in two ways, self catheterisation or using medication

Antimuscarinic drugs reduce bladder spasms. These come in a lot of different forms with different symptoms and risks. Treatment can be limited by side effects including a dry mouth, constipation and effects on the central nervous system.

Botox injections can increase bladder capacity.

Infections are common when starting to use self-catheterisation, which usually need a course of anti-biotics to treat. It is necessary to practice.

It is possible to combine more than one medication.


Dr Belal also described a study which retrospectively looked at 33 people with HSP and their urological function. (link to abstract: https://www.ncbi.nlm.nih.gov/pubmed/30848841).

The most frequent symptom was urgency, most use medication, one third use self catheterisation and 10% have botox injections.