Train Your Bladder to Hold More

How many women do you know that stop at every bathroom they pass or interrupt an exercise class or run to use the bathroom? Urinary urgency is the sudden, uncontrollable need to use the bathroom, which can lead to urinary leaking and negatively affect quality of life.

There is a very specific neurological relationship between the bladder and the pelvic floor muscles called the sacral micturition reflex. The bladder is a smooth muscle and is under control of the autonomic nervous system, as opposed to the somatic nervous system, which allows for volitional control. However, we can "tell" the bladder what to do via the pelvic floor muscles through the sacral micturition reflex. The bladder and the pelvic floor muscles have an inverse relationship.

During normal urination, the pelvic floor relaxes which signals the bladder to contract. When the pelvic floor is tight or dysfunctional, the bladder is "confused" and doesn't contract properly to expel urine. This can lead to urinary retention in which there is excess urine remaining in the bladder, and the likelihood of developing a bladder infection or urinary tract infection (UTI). If the pelvic floor muscles have been chronically tight, the bladder is continuously irritated and cysts can develop over time leading to a condition called Interstitial cystitis (IC). IC is characterized by frequent urination, urinary urgency and "bladder pain." Tight pelvic floor muscles can be the source of pain, especially if Hunner's ulcers (diagnostic criteria for Interstitial Cystitis diagnosis) are ruled out via cystoscopy.

Likewise, when it is not convenient to urinate, normal pelvic floor muscle function signals a reflexive inhibition of the bladder to relax. In addition, by performing 3-4 Kegel contractions, the bladder responds by lessening the urge until an appropriate time to void occurs (not in the checkout line at the grocery store). This automatic function cannot happen if the pelvic floor muscles are too tight or too weak, and treatment by a skilled women's health physical therapist may be necessary. Urges come in waves and usually last less than a minute. Sometimes the urge is so strong, the bladder starts to contract and urine is expelled, leading to incontinence. Anxiety about not getting to the bathroom in time only increases the urgency and potential for leaking. Urge suppression techniques can reduce the urge to avoid leaking.

On the contrary, waiting too long and postponing urination can lead to urinary retention. This is common in occupations including teaching and nursing. I have treated many teachers and healthcare workers over the years who delay voiding or limit fluid intake so they do not have to stop to use the bathroom. This is a bad habit! As the bladder fills, the pelvic floor reflexively contracts more and more. In the case of a full bladder, it might be difficult to start the urine stream due to the pelvic floor muscles in state of contraction. This can also happen first thing in the morning when the bladder is full.

Urinary urgency can also occur as a result of consuming bladder irritants, such as caffeine, carbonated beverages, artificial sweeteners, and certain fruits and vegetables, such as watermelon or asparagus. Concentrated urine, lack of exercise and anxiety can also contribute to urgency.

URGE SUPPRESSION TECHNIQUES

Urges come in waves and the optimal time to eliminate is AFTER the urge wave passes (X in photo above), in order to gain cerebral control from your brain instead of from the bladder. Sometimes it feels like the urge is so strong, not going is going to cause a leak. It might be a good idea to practice some of these techniques at home or in a shower. Turn the water to the hottest setting or coldest, depending on what typically causes urgency. When you experience the urge, practice the suggestions below. You might be surprised how quickly the urge suppresses and your bladder "forgets" that it has to go. Keep in mind, the next urge wave might be larger (as shown) and you might be unable to turn off, or suppress, the urge as it gets stronger.

Here are some tips to turn off, or suppress, the urge to void:

1. Stop what you are doing and sit down, if possible.

2. Relax by taking several deep breaths to settle down the ANS or flight or fight response.

3. Perform a complicated math problem in your head, such as subtracting by 7s from 100.

4. Rub your hands together (hand warming) to settle down the fight or flight response and bring blood flow away from the organs to the extremities.

5. Perform 4-5 Kegels or pelvic floor contractions to facilitate reflexive bladder inhibition.

NORMAL BLADDER HABITS

Often as we have adapted to the changes in our body over time, we forget what is "normal". How do you know you have a problem if you are using yourself as your only frame of reference? Here is what should serve as a barometer for a change in habit or when to seek help:

  • Urinate less than 8 times in a 24 hour period.

  • Urine stream should last at least 8 seconds or the bladder wasn't really full.

  • Avoid JIC voiding or "Just In Case" voiding such as every time you pass a bathroom or leave home.

  • Avoid getting up in the middle of the night, even if you are up for other reasons. Many women still get up after the baby is sleeping through the night and it is often at the same time like an alarm. This can also occur if the bladder is unable is stretch or fill appropriately due to scar tissue around the bladder, such as after a c-section, and deep scar mobilization is often necessary.

  • Avoid bearing down or straining to urinate. Urination is a passive process and straining contributes to abnormal muscle patterns and further dysfunction.

  • Never strain to have a bowel movement. Straining contributes to abnormal muscle patterns and tightening the pelvic floor muscles instead of relaxing, which is necessary for proper elimination.

  • URINARY INCONTINENCE IS NOT NORMAL AT ANY AGE! Urinary incontinence is the leading cause for nursing home admissions and it is estimated that over 50% of nursing home residents are incontinent.

  • Get 20-30 minutes of exercise or activity every day. This helps to regulate the autonomic nervous system (fight or flight) and promote normal smooth muscle tone.

  • Avoid bladder irritants. The smooth muscle (detrusor muscle) inside the bladder contracts to expel its contents when it is irritated. Bladder irritants can include caffeine, alcohol, acidic foods (tomato, citrus foods), carbonation, artificial sweeteners (Aspartame, etc.), tannic acid from decaffeinated beverages (decaf coffee or tea), and concentrated urine or dehydration from not drinking enough clear fluids.

EXERCISE TO SUPPORT BLADDER HEALTH

In addition, simple exercises can improve bladder control. Read our blog and click here for more information.

If you continue to struggle with bladder issues despite putting these suggestions to use, it is time to be evaluated by a urologist and start physical therapy with a qualified women's health therapist. To locate a women's healthy physical therapist near you, click here. Remember that medication may help only temporarily and serve as a protective bandage, but comes with side effects and is not a long-term solution. Get to the bottom of your bladder issue and learn how to put your pelvic floor to use!

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