Hello ladies of Her!

Today I wanted to chat about something that we see so much of in the clinic, but we seem to always have to explain it to everyone that has it. The dreaded bladder urgency. You’ve just gone 30 minutes ago, but all of a sudden you feel the need to go again. You try to ignore it, but ignoring it only makes it worse. All of a sudden you’re busting, you’re racing to the toilet, only to sit down and … plink plink plink. 

THAT’S IT?!

There are a number of reasons the bladder gives us signals to go when it really isn’t the right time to go. And to understand these, we must first understand the bladder. 

The bladder has 2 main phases: Filling and Voiding.

• Filling Phase:
  • The bladder muscle (Detrusor) remains relaxed to let the bladder gradually stretch and fill with urine. The pelvic floor and urethral sphincter muscle are contracted to keep urine in
  • Stretch receptors in the bladder wall send signals through nerves to the spinal cord and brain, creating a sensation of needing to urinate. The brain then decides whether to delay voiding or allow the bladder to empty
• Voiding Phase:
  • If the brain has decided it is an appropriate time to empty, it signals the detrusor muscle to contract, and the pelvic floor and urethral sphincter relax to allow urine to flow out

Bladder urgency can occur due to:

• An overactive bladder – the detrusor muscle contracts involuntarily while the bladder is filling, creating a sudden urge to urinate
• Bladder irritants: caffeine, spicy food, alcohol, sugary food and drinks
• As a result of inflammation (pelvic surgery, UTI, catheter removal) or hormonal/pressure changes (pregnancy)

I had a lady present with bladder urgency a few weeks ago, and I remember her saying to me ‘I know it’s probably because my pelvic floor is weak, but I can hold onto it and never leak!’

It’s a common misconception that urgency is only because of weak pelvic floor muscles, and although this might contribute, it is usually coming from an overload of neural connections to the detrusor muscle of bladder, and as we build the habit of going again and again when the stretch isn’t there, the nerves then don’t need to determine as much of a stretch to signal for us to go, and there we have urgency!

This lady picked up the habit from something as simple as switching to working from home. All of a sudden she could go to the toilet whenever she wanted and had minimal distractions, and was using the toilet as a way to break up her computer work (I mean, we’ve all done it). Her brain and bladder got used to it, and gave her urges more often with a smaller stretch of the bladder wall, and then it took control!

Once I explained the mechanism around her urgency, she felt SO relieved that it was mind over matter. We even found out that her pelvic floor was on the tighter side, and this was because she was squeezing her pelvic floor so much to try and hold on longer, and because she thought it was the right thing to do!

Bladder urgency management involves tackling the issue from a few different directions:

• Timing toilet trips/voids:
  • Normal bladder fullness should occur around every 3-4 hours
  • Try to keep voids evenly spaced throughout the day, aiming to work up to every 3-4 hours over time
  • Avoid going to the toilet ‘just in case’ – reason with yourself as to WHY you’re feeling the need to go
  • If you are experiencing urgency when attempting to hold on for longer, use your urgency tactics below to help extend time between voids
• Urgency tactics:
  • Sit down or lie down
  • Connect to your breath and focus on deep inhalation, relaxing the pelvic floor, jaw, and shoulders. Exhale to gently squeeze and lift from the anus. Continue these, for 10 breaths, focusing on relaxation phase to calm the nerves and muscles in the pelvis region
  • Gently put pressure on your perineum (space between vagina and anus). This can be by sitting on the edge of a table/couch arm, cupping your hand over the vagina and lifting gently (if by yourself), or crossing your legs and leaning forward
    • This stimulates sensory receptors that can reflexively inhibit bladder contractions and increase urethral closure pressure = helping the nervous system to override urgency signals
  • Do some standing or sitting calf raises/heel lifts, or scrunch your toes and lift the arch of your feet. Continue these until the urge reduces in intensity
    • Contracting the calf and foot muscles stimulate the posterior tibial nerve (which originates from the same spinal level as the bladder nerves), and the repetitiveness helps to modulate sacral nerve activity and inhibit detrusor overactivity
  • Distract yourself – make a grocery lift, count backwards from 100 in 9’s, change up your environment etc
  • If the urge does not subside within 60 seconds, walk calmly to the toilet and breath slowly
• Avoid bladder irritants:
  • Caffeine, sugary and/or carbonated drinks, alcohol, spicy foods, citrus
    • These irritate the bladder wall and can make it ‘spasm’ 
  • Ensure you’re drinking 2-3L of water at regular intervals during the day (unless otherwise advised)
• Ensure you are emptying your bladder fully:
  • Do not hover over the toilet seat
  • Breath deeply while focusing on relaxing your pelvic floor down into the toilet bowl, not pushing the wee out
  • Lean forward and backwards, circle your upper body around in different directions, stand then sit back down, or simply wait and relax to ensure you fully empty
  • Do not rush, take your time

On implementing these simple but effective strategies, this lady had reduced her urgency by 80% in 3 weeks! And by 6 weeks, she had no bladder urgency symptoms unless she had too much caffeine early in the morning!

Her biggest takeaway was being able to sit through a movie with her daughter for the first time in months; what a win!!

Most pelvic floor concerns are a combination of lots of different factors, some being an easy fix, and some requiring a little more work and investigation. 

If you’re experiencing bladder or pelvic floor symptoms that you’re not sure about, or you’re trying to self-manage and not succeeding, our experienced physiotherapists can chat to you for free to help determine if Pelvic Floor Physiotherapy is beneficial for you.

Book your free discovery call here to start your journey to feeling yourself again.

Book your appointment here if this resonated and you’re ready to get your urgency under control! We have 5 amazing Physios who are all here to help. 

All our love,

Her x