Overactive Bladder Physiotherapy in Clapham

Overactive bladder (OAB) is when the bladder muscle squeezes before the bladder is full, sending a strong “need to go now” signal. Common symptoms include:

• Urgency: a sudden, strong urge to wee that’s hard to put off
• Frequency: needing to go more than about eight times a day
• Waking at night: getting up more than once a night to wee (nocturia)
• Urge leaking: leaking before you reach the toilet, known as urge incontinence
• Trigger urgency: the “key in the door” feeling when you get home, or urgency at the sound of running water

You can have overactive bladder without any leaking. Many women don’t realise it’s treatable and plan their day around toilets for years.

Often there’s no single cause, and several factors add up.

Bladder habits

Going “just in case” can train the bladder to signal earlier and earlier, so it holds less over time.

Bladder irritants

Caffeine, alcohol, fizzy drinks and artificial sweeteners can irritate the bladder and increase urgency. Not drinking enough can also make things worse, as concentrated urine is more irritating.

Perimenopause and menopause

Falling oestrogen levels affect the tissues of the bladder and urethra, so urgency and frequency often appear or get worse during perimenopause and menopause.

Pelvic floor dysfunction

A weak pelvic floor gives less control over urgency, while a tight or overactive pelvic floor can make the bladder more sensitive. Constipation adds pressure on the bladder too, so treating constipation sometimes helps.

Stress and anxiety

The bladder and nervous system are closely linked, so stress and anxiety can heighten urgency.

Bladder training is a recommended first treatment for overactive bladder, and NICE guidance recommends at least six weeks of it for urgency. Your plan is tailored to you, but may include:

• Bladder retraining: gradually stretching the time between toilet trips so your bladder learns to hold more
• Urge suppression: techniques to calm a sudden urge, such as pelvic floor squeezes, slow breathing and distraction
• Pelvic floor training: strengthening or relaxing the pelvic floor, depending on what your assessment shows
• Bladder diary: tracking what and when you drink and wee, to spot patterns and measure progress
• Fluid and diet advice: what to drink, how much, and which drinks to cut back on

When the urge hits

Stop and stand still or sit down, do a few quick, strong pelvic floor squeezes and breathe slowly until the urge passes. Then walk calmly to the toilet rather than rushing.

Cut back on bladder irritants

Try reducing caffeine (coffee, tea, cola and energy drinks), alcohol, fizzy drinks and artificial sweeteners for a couple of weeks to see if symptoms ease. Swapping to decaf is a good start.

Drink enough, spread through the day

Cutting down on fluids often backfires. Aim for steady drinks through the day, and have less in the two hours before bed if you’re waking at night.

Avoid “just in case” trips

Try to go when your bladder is full rather than out of habit, and build up the gaps gradually.

Your first appointment lasts 60 minutes and takes place in a private, judgement-free room at our Clapham clinic. Olivia will:

• Talk through your bladder habits, symptoms, fluid intake, medical history and goals
• Assess your posture, breathing and core
• With your consent, carry out an internal examination to assess your pelvic floor. It’s always optional and fully explained beforehand
• Explain what she has found and agree a treatment plan with you

You’ll usually be asked to keep a short bladder diary, which is one of the most useful tools for understanding urgency and frequency.

NICE recommends at least six weeks of bladder training, and many women notice fewer urges and longer gaps between toilet trips within that time. Longstanding symptoms can take a few months to settle fully, and Olivia will review your progress and bladder diary at each appointment.

See your GP first if you have blood in your urine, pain or burning when you wee, cloudy or strong-smelling urine, a fever, pain in your lower back or side, or if symptoms came on suddenly, as these can be signs of a urine infection or another condition that needs checking. Your GP can also discuss medication if physiotherapy alone isn’t enough. Olivia will refer you on if anything in your assessment needs medical review.