When it comes to bladder issues, no two stories are the same, but those who are controlled daily by the whims of their bladder agree that life changes drastically.
Do you regularly map out the bathrooms wherever you go? Are you prone to planning road trips around pit stops? Or, perhaps, you find it impossible to put off urges to go for 20-30 minutes. It probably feels like your bladder has hijacked your life!
A healthy relationship with your bladder is one where you're in control. So, who's running the show? If your answer is a resounding "my bladder," or even if you're second-guessing your answer, then keep reading! We are going to break down two common bladder issues: urge urinary incontinence and overactive bladder disorder.
URGE URINARY INCONTINENCE (UUI)
What is UUI?
Urinary incontinence is any involuntary urine leakage. (Weber, 2001) We could separate it into several categories, but we're going to focus on a type called urge urinary incontinence (UUI).
If you’re suddenly hit with an intense need to rush to the bathroom, this sensation is called urgency. (Drake, 2018) With urge urinary incontinence—whether it is a small drop or a large amount—leakage is accompanied by this sensation of urgency.
Imagine that your bladder is a water balloon. If the water balloon doesn't close all the way, leaking will happen when you squeeze it.
The same thing happens with your bladder. The pelvic floor muscles wrap around the urine exit canal, also called the urethral canal, to close it off and prevent leakage.
The bladder and pelvic floor muscles are designed to coordinate together. When the bladder squeezes to empty urine, the pelvic floor muscles should relax to let the urine pass. The opposite is also true: when the pelvic floor muscles squeeze, the bladder should relax and store urine.
Who is affected by UUI?
Women are diagnosed with UUI two times more than men. (Buckley, 2010) Due to reproductive health events unique to women such as pregnancy, childbirth, and menopause, the bladder, urethra, and other muscles that support these organs are affected. (womenshealth.gov, 2019)
According to the U.S. Department of Health and Human Services, more than 4 in 10 women 65 and older have urinary incontinence. (Buckley, 2010)
Although older women are most impacted by urinary incontinence, urge urinary incontinence also affects younger women and some men as well.
How UUI can affect your life
Some factors that may cause urge incontinence are pregnancy and childbirth, menopause, prostate surgery, obesity, muscle aging, tobacco use, bladder infections, dietary irritants, constipation, and everyday habits. (Mayo Clinic, 2019)
When your bladder fills, tiny stretch receptors send messages to tell your brain that it is time to go pee. As it continues to fill, the reports become more urgent and more frequent. Normally the first sensation to void is when the bladder is 40% full, and the first desire to void is when the bladder is 60% full. (Fowler, 2006)
If you choose to empty your bladder after the first signal, you aren't letting your bladder fill to its normal capacity. Over time, this can cause the bladder to become more irritable and hold less urine. At this point, your brain begins to think it's full when it isn't!
Urine leakage should not occur when your body sends you the message that you need to urinate--you should be able to wait until it is a convenient time and place for you to pass urine. After all, if things are working properly, your bladder isn't even half full when you get the first signal.
Unfortunately, urine leakage usually does not fix itself, and it frequently gets worse with age. UUI affects up to 71% of individuals over the age of 60. (Buckley, 2010)
If urge incontinence is disrupting your daytime or nighttime activities, you may consider retraining for your bladder and/or pelvic floor muscles. But before we get into treatment, let's talk about our second diagnosis.
OVERACTIVE BLADDER DISORDER (OAB)
What is OAB?
Overactive bladder syndrome is a set of urinary symptoms, including: a strong "gotta go” sensation (or urgency) and this can result in unintentional leakage, or urge urinary incontinence. Full circle! OAB often includes needing to pee multiple times during the night. (Buckley, 2010)
The bladder might contract even when it doesn’t need to; for example, if your bladder only has a small amount of urine in it or over-sensitivity. (Haylen, 2009)
Remember those stretch receptors we mentioned? With OAB, the receptors are telling your brain that it's time to empty when the bladder isn't full. This miscommunication often pairs with a feeling of urgency, usually at an unhealthy frequency.
How often is too often? You can define urinary frequency as using the bathroom more than eight times in 24 hours. (ICS)
Causes of OAB
OAB occurs in both men and women. Risk factors include:
Neurologic disorders or damage to the signals between your brain and bladder
Hormone changes
Pelvic muscle weakness or spasms
A urinary tract infection
Side effects from a medication
Diseases that affect the brain or spinal cord, like stroke and multiple sclerosis (Urology Health)
Injury, infection, sensitivity to food or drink, and fear of accidents are factors that often trigger urinary frequency. (National Health Service, 2019)
How OAB can affect your life
Urinary frequency can be very disruptive to your lifestyle and rarely improves on its own. You should be able to choose when and where you want to use the bathroom.
The fear of having an accident causes those suffering from overactive bladder disorder to schedule their lives around bathroom access and limits their activities or travel.
Up to 12% of people experience pain, discomfort, embarrassment, and the fear that urinary frequency can cause. (ICS)
27% women have to void at least every 2 hours. (Lukacz, 2009)
TREATMENT
If any of the circumstances we’ve talked about match your lifestyle, we want you to know that there is hope!
Let’s talk about some of the first step interventions that can help.
Pelvic Floor Therapy
If you could have more bladder control and less fear of accidents, wouldn’t a few hours each week be worth it?
The American Urological Association recommends behavior therapies as first-line therapy for these issues. These include:
Bladder training
Bladder control strategies
Pelvic floor muscle training
Fluid management
These are all interventions that a Pelvic Floor Physical Therapist can implement.
(American Urological Association)
Bladder training and pelvic floor muscle training taught by a pelvic floor physical therapist are an appropriate first step. One study demonstrated continence in 89% of women with incontinence after completing pelvic floor physical therapy. (Knorst, 2013)
Bladder Diary
If you’re thinking “Dear Diary” and pages full of secrets, that’s not quite what we have in mind. A bladder diary is a daily record of your bladder activity.
We mentioned before that no bladder story is exactly the same. A bladder diary is a glimpse into your personal daily actions, recorded at the time it occurred. This provides useful insight for you and your therapist to determine the best solutions for you and your bladder story.
Your bladder diary may include:
How much and what type of food or drink
Urine volume (Count number of seconds or use a urine hat for precise measurements)
Type of poop (Bristol stool scale)
Urgency level
Leaking frequency
Activity with leaking
Pain
How many pads used per 24 hr period
With your completed diary, your therapist can better assess your fluid intake, help figure out possible irritants on your bladder, and so much more. You can download a free bladder diary from the Urology Care Foundation.
How Do We Treat UUI?
Using information from your bladder diary, we can start to develop strategies to cope with and eliminate incontinence. Here are just a few things a pelvic therapist might work with you on:
Bladder retraining--this involves breaking "bad" habits and forming new ones. "Bad" habits can include: going to the bathroom every time you walk in the front door, every time you hear running water, and so many more. We can train the brain and the bladder to work together again to tell you to go, only when the bladder is full.
Avoiding certain foods/drinks that are bladder irritants
Correcting the source of the problem the natural way saves money and resources by reducing or eliminating the need for costly pads, medications, and surgeries.
Have more questions about how physical therapy can help you?
Ask your provider for a referral to a pelvic therapist.
Find a pelvic therapist on your own at myPFM.com. We have links to 4 free searchable databases under Find a PT.
Watch our YouTube video, Leaking with Exercise? for more tips.
Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics: Learn where the pelvic floor muscles are, what they do, and how they work
Sign up for our email newsletter!
Visit our Instagram page for more on pelvic health.
You can also learn more from:
Do you have a bladder story to share? Join us in the comments section below.
By Zemrie DaCosta with Jeanice Mitchell, PT and Emily Reul, PT, DPT
SOURCES
Urinary Frequency. Bladder & Bowel Community website.
https://www.bladderandbowel.org/bladder/bladder-conditions-and-symptoms/frequency/. Accessed November 19, 2019.
Urgency and Urge Incontinence. Bladder & Bowel Community website. https://www.bladderandbowel.org/bladder/bladder-conditions-and-symptoms/urgency-and-urge-incontinence/. Accessed November 19, 2019.
Urinary Incontinence. Mayo Clinic website. April 13, 2019. https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808. Accessed November 19, 2019.
Urinary Incontinence. Office on Women's Health website. Updated January 31, 2019.
https://www.womenshealth.gov/a-z-topics/urinary-incontinence. Accessed November 19, 2019.
Incontinence: symptoms & treatment. Urology Care Foundation. Urology Health website. https://www.urologyhealth.org/urologic-conditions/urinary-incontinence. Accessed November 19, 2019.
Urinary incontinence - causes. National Health Service. https://www.nhs.uk/conditions/urinary-incontinence/causes/. Updated November 7, 2019. Accessed November 19, 2019.
Hersh L, Salzman B. Clinical management of urinary incontinence in women. Am Fam Physician. 2013 May 1;87(9):634-640.
Overactive bladder (OAB) and urge urinary incontinence (UUI). The Simon Foundation for Continence website. Available at: https://simonfoundation.org/overactive-bladder-urge/. Accessed November 19, 2019.
Lukacz ES, Whitcomb EL, Lawrence JM, Nager CW, Luber KM. Urinary frequency in community-dwelling women: what is normal? Am J Obstet Gynecol. 2009;200(5):552.e1-7. doi:10.1016/j.ajog.2008.11.006
Gormley EA et al. Diagnosis and treatment of non-neurogenic overactive bladder (OAB) in adults: AUA/SUFU guideline. Published 2012. Updated 2014, 2019. http://www.auanet.org/guidelines/overactive-bladder-(oab)-(aua/sufu-guideline-2012-amended-2014). Accessed February 6, 2020.
Weber AM et al. The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J. 2001; 12:178-186.
Knorst MR, Resende TL, Santos TG, Goldim JR. The effect of outpatient physical therapy intervention on pelvic floor muscles in women with urinary incontinence. Braz J Phys Ther. 2013 Sept-Oct; 17(5):442-449. http://dx.doi.org/10.1590/S1413-35552012005000117
Buckley BS. et al. (2010). Prevalence of urinary incontinence in men, women, and children-current evidence: findings of the fourth international consultation on incontinence. J Urology. doi:10.1016/j.urology/2009.11.078
Drake MJ. Fundamentals of terminology in lower urinary tract function. Neurourol Urodyn. 2018; 37:S13-9. doi: 10.1002/nau.23768.
Fowler CJ, Griffiths D, de Groat WC. The Neural Control of Micturition. Nat Rev Neurosci. June 2008:9(6): 453-466.
Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICE) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J (2010) 21:5–26. doi: 10.1007/s00192-009-0976-9.