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  • Christine MacMillan, PT

6 Things You Can Do To Treat The Urgent Bladder

Updated: Aug 21, 2019

If you’re reading this, it’s likely you’ve got an “Urgent Bladder”. If you suffer from a strong and overwhelming urge to pee that you find difficult to ignore (that may or may not lead to leakage of urine), you might have Urinary Urgency. But fear not! – armed with the right information and the right types of exercises, Urinary Urgency is very fixable! (To read more about the common contributors to Urinary Urgency and Urge Incontinence, read my blog post The Urgent Bladder here!)


So what can you do if you’re experiencing Urinary Urgency, or Urgency Incontinence? Below are the 6 tips I give to everyone coming to see me about Urgency:



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1. Watch out for those "bladder irritants". What is irritating to some is not irritating to everyone. If you take a look at what you’re drinking in a day and experiment by eliminating some of those non-water beverages, you may notice a difference in your bladder control. (The most common irritants include caffeine, artificial sweeteners, citrus and carbonated beverages.) Just for a few days, try eliminating that big morning glass of fruit juice, or your lunchtime diet coke, or – cringe – go caffeine-free for a week. Just observe if your bladder behaves differently with these changes. I’m not saying this change needs to be permanent, but it can be helpful to watch what happens when you replace one or more of these beverages with water. You will be able to identify which types of fluids may be irritating your bladder.


2. Drink more water, period. The number one mistake I see people with urgency make is they limit their water intake, assuming less volume in the bladder will mean less leakage. Not so! Water acts to dilute the contents of the bladder, and limiting your water intake will only result in more concentrated, irritating urine that the bladder will want to eliminate! Our kidneys are constantly filtering our blood and delivering urine in small amounts to the bladder, so like it or not you will be producing urine all day long. The best thing you can do is keep your urine as dilute as possible to keep the inner lining of your bladder happy and comfortable. Of course there is an upper limit to how much water we should be consuming (usually around the 2 litre mark), but in my experience, most of us are nowhere near hitting those volumes!



3. Don’t “Just In Case” pee! This is another honest mistake that people with urinary urgency make. They make a habit of going to the bathroom before they feel the need to pee, "just in case" they can't find a bathroom when one is needed. But here's the thing: when we empty our bladders more frequently than we really need to, the bladder can physically shrink in size. Its walls are made up of smooth muscle that need to be “stretched” (i.e. by filling the bladder fully) regularly in order to maintain the size and fluid-holding capacity of the bladder. When we pee all the time, “just in case”, we are removing the filling/stretching of the bladder to the point that it can “shrink”, and will start to feel fuller, sooner.



There are other reasons not to “just in case” pee that include important neural reflexes of the bladder that happen with filling/stretching, that can weaken if they aren’t “practiced” regularly – think “use it or lose it”! – so consider that our habits can create physical changes in the body which will affect our bladder function. (Rest assured, these types of changes are reversible! By allowing your bladder to fill more before you empty, you will start to stretch those smooth muscle walls and activate these important reflexes once again!)


4. Hold off on the Kegels. So many people come into my office reporting that they tried doing “kegels” to improve their Urge Incontinence with no improvement. But let’s just take a second to think this through. If you get tension headaches because you are a jaw-clencher, would you work on jaw-clenching exercises to get rid of your headaches? Of course not! The link between pelvic floor muscle tension and Urinary Urgency is less understood by most people but it’s a very similar relationship. Since the pelvic floor muscles sit directly underneath the bladder and the bladder neck, changes in muscle tension will be “felt” by the bladder. Very often it is excessive muscle tension in the pelvic floor that is a direct cause of urgency and urge incontinence, so doing daily kegel exercises will only make this problem worse. Most of the time, people with urgency need to learn to recognize their habitual clenching, and learn to relax the muscles of the pelvic floor (aka “reverse kegels”). This is a skill that takes some time and patience to learn, but it is well worth the effort to regain control of this very important muscle group.


5. Practice “Urge Delay” strategies. When you feel urgency setting in, DON’T PANIC, and don’t rush. Rushing just ramps up the tension in your body (i.e. the tension in your pelvic floor) and contributes to the sense of urgency. (And for most people who experience urge incontinence, they will tell you that running faster to the bathroom doesn’t prevent their leakage!) Instead of rushing and panicking, instead try this sequence of steps:


i. Stop what you’re doing and stand still. If you can, lean against a wall or sit down.


ii.. Take a few deep breaths to keep the body calm.


iii. Do a few quick “kegels” (aka pelvic floor contractions – like the feeling of stopping yourself from peeing or passing gas) to squeeze the urethra closed


iv. Now let go of this contraction. Imagine letting the muscles relax their grip on the

bladder to remove the tension. This is the hard step! Most people with pelvic floor

tension actually don’t know how to relax this muscle and are fearful of trying. But

this is the key to “urge delay” and gets better with practice

v. Use some mental distraction while you wait calmly for the urge to subside. My

favourite is doing some tricky math, like counting backwards from 100 by 7.5. Other

people like thinking of something fun, like planning their next vacation ;) Whatever

you choose, get your mind off of your bladder.


vi. When the urge subsides – and it will! – you can calmly walk to the bathroom and

empty your bladder. Or if your bladder is not full, delay for a while!


6. See a Pelvic Health Physiotherapist. Of course, all of the above are all a lot easier said than done, and a little bit of guidance goes a long way. The main reason we as Pelvic Floor Physiotherapists have a role in this type of bladder dysfunction is that most of the time people need help developing awareness and control of their pelvic floor muscles. Most people benefit from learning how to contract and relax their pelvic floor, how to recognize tension, and what kinds of stretches and breathing techniques can help to release the tension around the bladder. Pelvic Health is is a special clinical focus within physiotherapy, so be sure to call your local physio clinic and ask if they have a physiotherapist with post-graduate training in Pelvic Health.


If you’ve got an urgent bladder, know that this can be corrected! By recognizing the things in your life that are contributing to the problem, you can take steps toward regaining control. If you’d like more information about pelvic floor dysfunction, or about my practice and how you can work with me, check out www.thepelvicfloorpt.com.

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