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Normal bladder function

A healthy bladder holds about 4OO-6OOmls during the day. It holds more at night before you feel the need to pass urine and get up to go to the toilet.

It's normal to empty your bladder:

• about 4-8 times during the day
• before bed at night
• once overnight
• when you get up in the morning.

The pattern changes in older people. They may make more urine at night and need to get up more than once to go to the toilet, or they may produce less during the day. Most people are able to hold on after they feel the need to pass urine, so they can reach the toilet in time.

What is urinary frequency?

The bladder is a muscle that expands to hold urine produced by the kidneys and squeezes to empty out the urine when it's full. If a person has urinary frequency, they have to empty their bladder more often than normal.

What causes urinary frequency?

Urinary frequency can happen because the kidneys are making more urine than normal. There are many reasons why this may happen.

It could be because the person has:

• had more to drink than normal
• drunk a lot of fluid over a short time
• drunk alcohol or drinks with caffeine in them, such as tea, coffee or cola
• taken a diuretic (fluid tablet)
• swollen legs or heart problems, so their kidneys make more urine when they lie down
• a dry mouth because they snore, breathe through their mouth or take medicines that causes this side effect. They may, therefore, drink more to help with this dryness.

Urinary frequency can also happen because the person's bladder can only hold a small amount of urine. Reasons for this include:

• The person's bladder isn't emptying completely, so it fills up again quickly after the person goes to the toilet. This can happen in men who have an enlarged prostate gland.
• The medicines the person is taking are stopping the bladder from emptying properly.
• The person may have urgency and their bladder empties before it's full. Over time, the amount of urine the bladder can hold reduces, so it fills up more quickly and the person may have to go more often.
• The person may have a urinary tract infection that irritates the bladder and stops it holding normal amounts of urine.
• The person may be constipated and the overfull rectum pushes on the bladder
• Nerve damage to the bladder that may result in either the muscles of the bladder not squeezing or squeezing too much or too frequency. This includes conditions such as, multiple sclerosis, Parkinson's disease or spinal cord injury.

How can you help?

There are many causes of urinary frequency. If the person you support hasn't had a continence assessment, talk with them, their family or your supervisor about organising an assessment with a continence nurse advisor or their general practitioner (GP). They will be able to look at what's happening and develop a management plan.

You can also help by:

• spreading fluids evenly throughout the day
• trying not to give fluids overnight or just before bed to reduce the number of toilet visits during the night
• making sure their clothes can be easily removed when going to the toilet
• watching the person for signs they need to use the toilet, e.g. moving around, looking uncomfortable, pulling at their clothes
• trying not to take the person to the toilet 'just in case'. Only take them to the toilet when they need to go.
• making sure continence products are worn correctly if they are on the care plan, and that other aids are in easy reach, e.g. walking frame, urinal or commode
• checking the person isn't constipated. If they are, get help from your supervisor or their GP
• moving the person to a room closer to the toilet to make access easier
• if the person takes diuretics in the morning, timing activities away from home in the afternoon rather than the morning when they will need the toilet more
• planning any jourey by using the National Toilet Map app, which shows where you can find public toilets including toilets for people with disability
• getting an Master Locksmiths Access Key (MLAC), which can unlock disability friendly public toilets
• preparing for any journeys outside of home. You may need to take a plastic bag for wet clothes or pads, wet wipes, disposable gloves, spare continence pads and a change of clothing and underwear.

Don't stop or make any changes to medicines unless the person's GP or a nurse practitioner asks you to.

Need more help? Call the National Continence Helpline on 18OO 33 OO 66 and talk to a continence nurse advisor.