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:
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 become stiffer and more uncomfortable to "stretch", 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. Don't assume you "just need kegels"... So many people come into my office reporting that they tried doing “kegels” to improve their Urge Incontinence with no improvement. But you have to remember that urgency is not simply a weakness problem, it's often a bladder-overactivity problem. A lot of the time, people with urgency come to recognize issues like habitual pelvic floor clenching, and learn to relax the muscles of the pelvic floor (aka “reverse kegels”) with stretching and breathing exercises. Others may benefit from strengthening to some degree, but there's not a one-size-fits-all solution. It often helps to look deeper at factors that may be contributing to the overactivity in the nervous system, like stress or poor sleep quality, or an amplified stress response system. This is where individualized assessment and treatment can be very helpful.
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. Breathe deeply into your diaphragm, as this stimulates activity in the vagus nerve, which sends calming signals to the tissues in the body.
iii. Try 5-10 calf raises (going up and down on your tippy toes). The nerve root that leads to activation of the bladder muscle also happens to innervate the calf muscles, so we can "distract" these nerves by pulling their electrical activity down toward the calves. For many people, this buys them a few extra minutes to get their urgency under control. (Isn't anatomy so cool?!)
iv. Rhythmically contract and relax the pelvic floor muscles. The pelvic floor muscles have some influence over the activity of the bladder muscle, and contracting and relaxing repeatedly can activate the messaging that instructs the bladder muscle to relax and stop trying to empty.
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 we are trained to understand in depth the nature of the bladder cycle and the many systems that influence it. Often people benefit from developing awareness and control of their pelvic floor muscles if this is a contributing factor. 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. Your physiotherapist can also help identify overactivity in the nervous system as a whole that might be contributing to your bladder's overactivity, and can provide suggestions to help you restore balance to this system. Pelvic Health is a special clinical focus within physiotherapy, so be sure to find a physiotherapist with post-graduate training in Pelvic Health.
Since there are so many effective strategies you can implement on your own, this type of problem can be extremely responsive to virtual physiotherapy guidance! Whether in person or via a virtual platform, the most important thing is that your physiotherapist takes a whole-person approach, and considers all relevant systems in the body (it's not just about kegels!).
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 or email me at cmacmillanpt@gmail.com.
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