Some people find the incontinence sketch in Little Britain amusing. But in this country more than five million people of all ages are affected by overactive bladder (OAB) — and they may not be laughing. The condition is characterised by a frequent, strong and sudden urge to urinate and, sometimes, loss of control.

Research has shown that, not surprisingly, OAB has a dramatic impact on the sufferer’s quality of life, including their sex life.

The condition, also known as unstable bladder, should not be confused with incontinence, as two thirds of OAB sufferers always make it to the loo in time. But most report a constant fear of incontinence.

In a recent study, single men reported a reluctance to enter into sexual relationships because they were terrified of losing control of their bladders. “Married men declared that their sex lives were almost non-existent; many women were scared that they might ‘leak’ during intercourse,” says Professor Paula Nicholson, a psychologist who led the recent research for Royal Holloway, University of London.

Furthermore, OAB sufferers may have trouble sleeping, as they need to get up frequently in the night to urinate. The urge comes with very little warning, and with such frequency that patients may find themselves using the loo more than eight times a day.

Travelling also becomes a big issue, explains Leslie Jewell, from the Cystitis and Overactive Bladder Foundation. “Because it is often necessary to use the loo as much as every half an hour, people worry that there may not be enough time to make it on to a train or plane — we know of people who have not taken a holiday for years.

“Work is often a nightmare, too, because the loo may be on a different floor or not easily accessible. People with overactive bladder feel distress, embarrassment, inconvenience and loss of selfesteem. Yet there are a variety of treatments out there that could help.”

A normal bladder needs to be emptied between four and eight times a day. The urge to go to the loo increases as it becomes fuller, and at a certain point the brain sends out two signals — to the detrusor muscle (the main muscle in the bladder wall) to contract, and to the outlet valve to open, so the bladder squeezes out the urine. A normal bladder then relaxes again for the process of refilling. In an overactive bladder, the muscle contracts at the wrong time.

Until recently it was thought that inefficient muscles in the bladder wall were to blame. However, new research suggests that the bladder is a far more complex organ than was thought: a paper presented to the American Urological Association by Professor Vivek Kumar, consultant urologist at Hallamshire Hospital, Sheffield, showed that when the bladder is stretched it releases neurotransmitters, causing overactivity of the detrusor muscle. “In other words, the messages to the brain about when to empty the bladder are going awry,” explains Professor Kumar.

Certain ailments can lead to this condition: a urinary tract infection is the most obvious, but men with benign prostatic obstruction, stroke victims and those with Parkinson’s disease or multiple sclerosis may also develop it. Some drugs, such as diuretics, and alcohol, are also linked to OAB.

In mild cases lifestyle changes such as reducing caffeine and alcohol intake may help because both are mild diuretics. Smoking is also known to irritate the bladder. A balanced fluid intake is critical — many people with an overactive bladder believe that drinking less will help, but this concentrates the urine and may irritate the bladder into greater activity — six to eight large glasses of water a day are recommended.

Bladder retraining, which involves keeping a diary of intake and urination, and setting targets to reduce the number of visits to the loo, helps in about half of all cases.

If it fails, drugs known as anticholinergics, such as oxybutonin, propiverine, tolterodine and trospium, may help to calm the bladder muscle.

Oxybutonin may be prescribed if a child wets the bed, although like all these drugs it may have side-effects.

Recent studies have shown that Botox injections may help, too, in those patients for whom drug treatments don’t work or are not well tolerated. In one trial 15 women had Botox injected into the detrusor muscle — 14 reported an immediate improvement in symptoms.

Who can help?

Cystitis and Overactive Bladder Foundation Helpline 01908 569169 www.cobfoundation.org

The Continence Foundation Helpline 0845 3450165 www.continence-foundation.org.uk