Why you constantly need to pee

Why you constantly need to pee

Wouldn't it be great if all problems could be solved with a one-off course of treatment? Life, unfortunately, isn't like that. Some conditions last for years, or even for life, and there is no 'one size fits all' solution. AkaMisery posted such a problem on one of our discussion forum boards - the constant urge to pee.

Mind your pees and queues

AkaMisery explained that she felt a constant pressure like she had to pee. As soon as she emptied her bladder, the feeling built up again. There was no burning, her urine was a normal colour and there was no smell. This sort of symptom can have lots of causes. Urine infections and sexually transmitted infections head the list, followed by bladder conditions such as stones and - rarely - tumours. AkaMisery had lots of tests to rule out these conditions and did the rounds of various doctors who she really didn't find very helpful. 

Constant urge to pee

I pretty much constantly feel pressure and like I have to pee. If I hold it in a long time the urge is stronger but as soon as I go, the urge starts creeping up again.

— AkaMisery, Constant urge to pee

Middlechild79 posted on the board that she had had similar symptoms and wondered if the problem was overactive bladder (OAB). I agree that - having ruled out other causes - it's very likely that this is the diagnosis.

OAB occurs when the bladder squeezes (contracts) suddenly without you having control and when the bladder is not full. It's sometimes called an irritable bladder or detrusor instability (detrusor is the medical name for the bladder muscle). OAB can cause major disruption to a person's life. Simple activities, such as going out, shopping or queuing, can become a nightmare.

OAB can occur after a stroke, with Parkinson's disease, in multiple sclerosis or after a spinal injury. However, in most cases no cause can be found. It's then called overactive bladder syndrome.

Don't stop me now

OAB is not an easy condition to treat. A person who has developed the habit of emptying their bladder frequently may become locked into the idea that unless they keep doing so, they will 'have an accident'.  However, there are many different options, and it's often a question of trial and error. Looking at things you can change in your life (often given the grandiose title 'Lifestyle measures' in patient leaflets) is the first port of call.

OAB sometimes starts with an episode where access to a toilet is difficult. Clivealive posted that his started when he was in hospital for a lung biopsy, 'anchored to the bed with drainage tubes', and urine bottles weren't readily available. So make sure that access to the toilet is as easy as possible. If you have mobility problems, this might involve handrails, raising the seat or using a commode at night.

Cutting down on caffeine is another self-help option. Remember that it can be found in cola and some painkillers, as well as in tea and coffee. Trying cutting it out completely for a week and see if it makes any difference. If it does you might want to consider giving it up completely, cutting down, or just reserving it for 'special occasions' like a meal in a restaurant where you know a toilet is nearby. The same approach can be taken for alcohol, which some people find aggravates their OAB.

Opinions varied on the forum as to how much was the 'right' amount of water to drink. NMK said they drank a 'good amount' of water. AkaMisery was worried about getting dehydrated but felt that increasing her water intake made her symptoms worse. Middlechild79 concluded that it was a balancing game. This is closest to the received wisdom from the experts. You need to drink enough water to stop concentrated urine from irritating the bladder, whilst not going overboard on the amount the bladder has to cope with. Aim to drink what you would normally drink, but increase it in hot weather. It's what feels right for you that counts.

Don't go 'just in case'

AkaMisery got into the habit of going to the toilet 'just in case'. Clearly, other posters had got into the habit of emptying their bladders more often than they needed to. Jstinst14 was going 10-15 times a day and NMK could easily go 30-50 times a day. Some people believe that keeping the bladder empty will stop OAB symptoms from getting worse. The reverse is true. As with any muscle, if you don't exercise it, it will get weaker. If you don't allow the bladder to stretch from time to time it will become over-sensitive, so if you go out and need to hang on, symptoms will be worse than ever.

Just hang on to what you've got

This brings me to the subject of bladder retraining.This basically involves keeping a diary for 2-3 days of when you pee and how much urine you pass. You then try to hang on for as long as possible between trips to the toilet. Keep going with the diary which should show that you are going less frequently but passing larger quantities of urine each time. The aim is to go every 3-4 hours. You need to keep up the training for several weeks  The expectation is that after a few months your bladder emptying frequency will be no different from anybody else's.

Bladder retraining requires persistence and commitment. AkaMisery didn't find it helpful to start with, but after encouragement from Middlechild79 she took it up again. It's best done with the encouragement and support of a continence advisor, doctor or nurse. More details of this method can be found in our overactive bladder leaflet.

A pill for every ill

Inevitably, our forum posters have tried a variety of medication for their condition. Middlechild79 was started on oxybutynin, which belongs to a group of medicines called antimuscarinics. These work by blocking some of the nerves to the bladder, relaxing the bladder muscle and increasing capacity. OABgal has tried solifenacin and mentioned tolterodine, which also belong to this group. Anne88137 found the antidepressant amitriptyline helped her get through the night, but this is more likely to be due to its sedative effect than anything else. Mirabegron is a more recent medicine that has become available. It works in a different way to antimuscarinics but also relaxes the bladder muscle.

Accentuate the positive

Forum posters have pursued a bewildering array of other treatments in order to control their symptoms. The good news is that quite a few of them have been successful, although it has taken a long time - sometimes years - to achieve their objective. Middlechild79 has tried botulinum toxin A injections and stimulation of the nerves to the bladder, using electrodes. Surgery to increase the size of the bladder or divert the urine flow are other options.

My advice to you is to do your own research into the pros (of which there are many) and cons (of which there may also be many, although most are temporary) and then have an informed chat with your GP. Middlechild79 points out that If you need a referral to a specialist, try to be referred to a consultant who specialises in the management of OAB. Not all urologist or gynaecologists do.

Finally, it's important to remain positive. As with many other long-term conditions, you can get stressed out from time to time about your symptoms which can make the problem worse. Objective input from a cognitive behavioural therapist or other psychological support, can help to break this deadlock.

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