Before reading on if you want to know what bladder urgency and frequency is, have a look at the page about urgency and frequency in our resource section. Bladder urgency happens because, for many reasons, your bladder contracts when it shouldn't. The only time it should contract is when you give it permission to when you are on the loo or squatting behind a bush.
Bladder urgency can rule your life but it doesn't need to. Here is how I explain it to my patients and a few strategies to help calm the bladder, once urgency has been diagnosed. However please ensure you have had a full medical check and been properly diagnosed prior to attempting any bladder training as there are some medical causes of frequency and urgency that need to be treated medically.
How do I normally explain all this to my patients?
I like to use analogies to explain what is happening when you have urinary urgency. It's all about the physics!
Let's look first at how your bladder works normally and then at what is happening when you experience bladder urgency (think of that as your bladder behaving badly)
Normal bladder function
- voiding 4-6 times a day and once a night ( although sleeping through is preferable)
- passing 300-500mls each void but able to hold more if unable to get to the toilet (eg when stuck in a traffic jam)
- urine is pale, not dark ( looks like a glass of chardy not a glass of beer)
- if urine is clear you are probably drinking too much fluid
- bladder filling and emptying is not painful
- there is no sudden urgency to go, rather a strong urge to pass urine once bladder is full
- flow is strong
Think of your bladder like a balloon which slowly fills but, as it does, the walls remain relaxed so the pressure within the bladder is low.
Whilst this is happening, the urethra stays closed ( via sphincters and pelvic floor) so the pressure in the urethra is high.
HIGH pressure always wins over LOW pressure... those are the laws of physics.
When you decide to empty your bladder because it is feeling comfortably full, you sit on the toilet (or men will stand) the pelvic floor relaxes, some urine enters the bladder neck which triggers the micturition reflex. In other words a signal goes to the brain to say you are on the loo and ready to empty and a signal comes back to the bladder telling it to contract and empty out the urine.
At this point the pressure within the bladder is HIGH as the detrusor muscle contracts the bladder wall and the pressure in the urethra is LOW because the pelvic floor and sphincters are relaxed ...fluid flows from the high pressure zone to low pressure zone....those are the laws of physics.
BUT what happens when a sudden urge hits you?
The urethra is closed so in a state of HIGH pressure
The bladder is contracting when it shouldn't so is also in a state of HIGH pressure
The HIGHEST pressure will win = you will leak if your bladder pressure is greater than your urethral pressure. You won't leak if it is the other way round but you will be very uncomfortable and running to the loo. This in itself drives the need to go and makes it feel even more urgent.
Learning to control the urgency and gradually teaching your bladder to calm down will reduce the episodes and get you back in control of your bladder.
Think of your bladder as a kid having a tantrum - best way to deal with a tantrum is ignore it, not feed it by giving in.
Even though it feels awful, just remember there is no more urine in your bladder than there was a minute ago when you felt perfectly comfortable. It is just that now the urine is in a smaller space because the bladder has contracted and the pressure has gone up making you feel like your bladder is really, really full and this drives that sense of urgency.
If you use your calming techniques listed in deferment below, the bladder will relax and the pressure will return to normal at which point you can decide if it really is full or not and whether you need to go to the loo now or not.
RELAXED BLADDER AND CONTRACTED BLADDER
How is bladder urgency treated conservatively?
Once medical causes have been ruled out, or successfully treated, and if bladder urgency persists, the next step is usually to do a detailed sensation-based bladder diary. This should be done under the guidance of a health professional with training in continence management.
Bladder training can be started based on the results of the bladder diary.
Lifestyle changes are often suggested:
- manage constipation which can be a big driver of an overactive bladder
- monitor fluid intake. Too much or too little can both cause urgency. If you are consuming more fluid than you need, your kidneys will just turn it into urine and you will need to go more often. If you reduce your input significantly thinking that if you drink less = less urine then you are in fact doing the opposite because your urine will become more concentrated. Concentrated urine can irritate the bladder and an irritated bladder wants to empty more often
- some people are sensitive to the rate at which their bladder fills. If it fills quickly, the bladder wall stretches quickly to accomodate and may be uncomfortable, setting off a bladder contraction resulting in a sudden sense of urgency. You may be better taking fluid in slowly over a period of time if this is the case
- reduce caffeine intake IF it irritates your bladder. For some people it does, for some it doesn't cause irritation but always worth trialling a reduction
- other common bladder irritants can be acidic foods, spicy foods, artifical sweeteners, carbonated drinks and alcohol
- stop smoking - yet another health reason to do so as it can contribute to OAB
Method will depend on outcome of bladder diary.
the two main types are :
→bladder drills - going at regular intervals so you don't reach the point of sudden urges, this does mean you are going when you don't always feel any urge but gradually the time between voids is increased
→ deferment techniques - help you to settle the bladder urge down without rushing to the loo and ultimately become the boss of your bladder again rather than it being the boss of you
Some commonly used deferment techniques which all have an inhibitory or quietening effect on the bladder are:
✓ contract your pelvic floor
✓ curl your toes
✓ rub the back of your thigh
✓ if standing, go up/ down on your toes
✓ pressure on your perineum with hands 'hold onto yourself' or sit on a rolled towel or the edge of a chair
✓ at the same time you need to distract your brain from alerting attention to the bladder. Try reciting the alphabet backwards in your head.
Once the sense of urgency passes, you can then either calmy walk to the loo or, if comfortable, keep doing what you were until your bladder fills a bit more.
The reason these deferment techniques can help is that they all target the same sensory nerve pathways as the bladder. ie the nerves that make your toes curl, activate your calf muscles and give you sensation on the back of the leg, branch off the spinal cord at the same level as some of those to the bladder. So, in effect, you are causing a traffic jam of sensory input up to the brain so instead of it focusing just on the bladder it focuses on all of the information it is receiving.
So you need to ak yourself IS YOUR BLADDER TELLING YOU THE TRUTH? and if not, you need to do somethng about it.
If conservative treatment doesn't work, your doctor may reccomend medication to help. Your physiotherapist may also include TENS placed either on your ankle or your sacrum (tailbone area) to help calm the nerves to the bladder. Again, this sends sensory input along the nerves involved with the bladder but it is a nice calming sensation, not the sudden horrible urgency sensation. As these nerves calm down and become less jumpy, your bladder stops contracting at the drop of a hat.
For some people more invasive treatments may be needed.
The material presented here is intended as an information source only. The information is provided solely on the basis that readers will be responsible for making their own assessment of the matters presented herein and are advised to verify all relevant representations, statements and information. The information should not be considered complete and should not be used in place of the advice of a health care provider. Pelvic Floor Exercise does not accept liability to any person for the information or advice provided , or for loss or damages incurred as a result of reliance upon the material contained herein.
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