Feel the Need, the Need for Speed? | Pelvic Floor Exercise
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Feel the Need, the Need for Speed?

Posted in Pelvic Floor on the 12th January 2015

Do you feel the need, the need for speed when getting to the toilet to pee?

An urgent need to get to the loo is a common thing and often mistakenly called a "weak bladder" and excuses are made  'I have been like this since I was a child'  or 'it is only since I had the kids'

There is no such thing as a weak bladder. There are weak pelvic floor muscles, there is stretched fascial tissue, there is a low compliant bladder (the muscular wall of the bladder is stiff and won't stretch well - like blowing up a balloon for the first time), there is an overactive detrusor ( bladder wall muscle which contracts when it shouldn't)  but you don't have a weak bladder - it is the support and control mechanisms that are not working properly.

Bladders become sensitive for many reasons usually because it is irritated by things such as going 'just in case' , high caffeine intake, low fluid intake, spicy foods, smoking, alcohol, some medications, constipation, some medical conditions like diabetes....and the list goes on.
An irritated bladder will want to empty more regularly and will often give you that leg crossing, toe curling sudden need to go ...now! This may or may not involve a leak but usually the fear of a leak will keep you running for the loo and create a cycle of never really allowing the bladder to expand to its proper capacity ( which should average about 1-2 cups)

Normally your bladder relaxes as it stretches and fills. An overactive , or irritated bladder will randomly contract as it fills - and often at inappropriate moments like when you are in the queue at the supermarket. This may catch you unawares and cause a small leak ( this is very different to stress urinary incontinence) and this may cause you to abandon ship ....and your icecream , eggs and soap powder, to dash to the nearest loo. This will often happen even though you already did a  'just in case' before entering the supermarket.

The fear of having an accident often drives us to frantically run for the loo, which only feeds the bladder contractions. Sometimes the urge makes you run.....and you almost make it but dribble before you do the 'wee dance' ( the frantic little jig we do to get our clothes undone and down in record time before plonking down on the loo) If the loo was 5 meters further down the hallway you would still almost make it.  It becomes a mind over matter situation.

Without going into the complexities of the neural control of the bladder suffice to say that you generally won't get the sudden urges when your mind is occupied elsewhere and busy.

REMEMBER - when the urge hits, you still have the same amount of urine in your bladder as you did the second before and you were holding that comfortably weren't you. As the bladder contracts , it just means there is the same amount of urine but it is now in a smaller space, so the pressure goes up and gives you that unbearable feeling ....it is all about physics.

So what is the solution? No easy answers but check out these tips to help get back in control:

  1. Have a check up as urgency can be due to other medical conditions, the most common being a urinary tract infection and diabetes.
  2. Once cleared medically , bladder training under the guidance of a pelvic floor physiotherapist or continence nurse will help most people.
  3. It is not just as case of do some pelvic floor exercises or Kegels. In this type of incontinence they can be the cause not the cure! An overactive or hypertonic pelvic floor can cause irritation to the bladder and hence urgency. This needs to be properly assessed
  4. Your continence physio or nurse will probably get you to do a bladder diary so you can see just how badly your bladder is behaving and helps you to set goals towards taking back control
  5. Learning to defer the urge until the bladder contraction eases and gaining the confidence that you won't leak. One of the biggest drivers of urgency is the fear of leaking
  6. Drink bladder friendly fluid such as water
  7. Address any issue with constipation - a loaded rectum can irritate the bladder.
  8. Reduce bladder irritants - your diary will help show up what is irritating it as urges will coincide with consumption of an irritant, and urine colour will show if it is too concentrated or not.
  9. The answer isn't reduce the amount I drink and it will reduce the amount I pee....in fact the opposite is true as concentrated urine irritates the bladder.

 

  • STOP
  • tighten the pelvic floor ( it has an inhibitory effect on the bladder , that is how you hold on) 
  • scratch the back of your leg, curl your toes , go up and down on your toes
  • get some pressure on the perenium - in other words hold onto yourself or sit on the edge of a chair
  • do the alphabet backwards in your head or a similar mental distraction until the urge passes - which happens when the bladder relaxes and the pressure returns to normal.
  • THEN decide if you are actually full or if your bladder was telling you a lie.

 

 

........so let's leave the speeding to Maverick and Goose and get your bladder behaving .

Tags: urinary urgency, weak bladder, pelvic floor muscles, leaking bladder. lbl, pelvic floor exercises, kegels

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