Do you feel like your bladder calls all the shots?
Feel that “gotta go” feeling when you pull your car in the garage?
Go to the bathroom whenever you see one “just in case”?
Have gotten in the habit of wearing panty liners for fear of leaking?
When you have trouble controlling your bladder, you never know when the sudden urge to go the bathroom will hit. For some this might mean missing out on social events, avoiding people they see at the store, or dreading that 2 hour office meeting. Some people may have a little leakage if they don’t make it to the bathroom in time, or some may not have any leakage at all. It’s that feeling that they MIGHT leak which takes over their life.
BLADDER TRAINING- NOT JUST ABOUT THE KEGEL
The almighty kegel is normally the first thing that comes to mind when it comes to preventing incontinence. If we are given any advice, (if at all) when it comes to not peeing ourselves, it is to “do your kegels.”
However kegels are not the “be all end all” when it comes to incontinence. It’s assumed that by strengthening the pelvic floor muscles you can stop or prevent leakage. While strengthening the pelvic floor may help, the bladder itself can be the culprit. Many people are not aware that the bladder is composed of muscle. Under normal circumstances when the bladder becomes full, it sends a signal to your brain to go to the bathroom. The muscles of the bladder contracts and pushes the urine out.
When the pelvic floor muscle are weak, this can lead to leakage in that the normal resting tone of our pelvic floor becomes weak. This resting tone is responsible for maintaining pressure around the urethra, (where we pee out of) which keeps us dry.
However as a result of fear of leaking the pelvic floor muscles learn to become guarded or “tight” overtime. This makes it hard for the muscle to effectively do its job, as the pelvic floor muscle needs to relax or elongate in order to shorten or contact. Imagine doing a bicep curl with the elbow already bent. Your arm is not going to move very much or generate a lot of force because it’s not able to move through the full range of motion. The same occurs with the pelvic floor muscles.
Learning how to relax the pelvic floor muscles can be a good start in regaining control of your bladder. Although doctors have good intentions when advising us to do kegels, in some cases this can perpetuate the feelings of urgency and leakage. Most doctors including OB/GYNs will not check for this during exams. A women’s health Physical Therapist can assess the pelvic floor muscles and give you specific recommendations.
Other things that can contribute to tight pelvic floor muscles include history of pelvic pain, constipation, low back pain and even stress.
In cases of urge incontinence or an overactive bladder, there may be other triggers that send this “gotta go” signal to your brain many times a day. This is when your bladder “takes over,” and you feel the urge to urinate often.
By knowing these triggers and changing our bladder habits, we can TOTALLY retrain our bladder and tell it who’s boss….
3 WAYS TO HELP RETRAIN YOUR BLADDER
KNOW YOUR BLADDER IRRITANTS– Some bladder irritants are found in food and drinks. These can irritate the lining of our bladder, making our bladder involuntary contract, in turn giving us the urge to go to the bathroom. Some of these include:
Chocolate
Alcohol
Caffeine and decaf products
Milk
Artificial sweeteners
Citrus fruit or juice
Vinegar
Spicy foods
Keep a journal of what you drink and eat for a few days. You can also keep record of how often you feel the urgency as well as number of times you go to the bathroom and see if there are any connections between the urgency and what you consume. You can also try eliminating certain things as well from your diet, and see if you notice any differences. By simply knowing what irritants affect you the most, you can plan your day accordingly.
Some specialists will advise to totally eliminate any bladder irritants from your diet. I have more of a “get real” approach. Do you really think I want to give up chocolate? Uh, no….but knowing what triggers affect my bladder helps me make the right decisions based on what I have going on that day.
For example, a bladder irritant for myself is diet coke. When I am watching a long movie at the theater or in a crowd like at the Indianapolis 500, I know not to drink diet coke or any sodas for that matter. I do not want to fight a crowd or leave a movie to go to the bathroom.
In some cases a total elimination of certain foods and drinks may be necessary if urgency and leakage have totally taken over your life. This would help you “reset” your bladder, and then once you have established good habits and the urgency and leakage have subsided, you can gradually add back in certain things to see how your body reacts.
I have helped many patients conquer their urgency in just a couple of visits by just having them eliminate certain things from their diet. This is huge as it gives them back their sense of control!
STOP GOING TO THE BATHROOM JUST IN CASE– So how many of us out there were raised by Moms that made us use the restroom whenever we passed one at the mall? Yes I was one of those!
While it may seem like a good idea at the time, what you are doing is training your bladder to hold very little urine. In time the bladder gets used to being emptied with this little amount of urine, and sends a signal to your brain it’s time to find a bathroom. So the cycle continues….you urinate…45 minutes later you feel the urge, the brain tells you to find a bathroom, you give in to the urge…cycle repeats.
The fact is your bladder can hold more than you think. Unless you consume a great amount of fluid in one sitting, you should be able to wait and go every 2- 3 hours.
A good way to test is count the number of seconds it takes from the start of your urine stream until it ends. Count 1 1000, 2 1000, etc and see how many seconds your stream lasts. If it is more than 8 seconds, then it’s a good indicator you should have gone to the bathroom. If it’s less than 8 seconds, you probably could have waited.
Bladder re-training involves deferring the urgency, so you train the bladder to hold more urine before it gives you the signal to go to the bathroom. If it’s been less than 2 hours since you went last, try and wait 5-10 minutes before you go to the bathroom. Try and increase this amount every few days. Many patients will say after a while they forgot they had the urge, and able to wait longer than what they first expected.
For example if pulling into the garage is a trigger for you, do not get out of the car right away. Wait 5 minutes, then walk CALMLY inside to the bathroom. You need to tell your bladder what to do, not the other way around!
AVOID CONSTIPATION– This one may be a surprise to some, however constipation can play a big role in urgency. When we are constipated and not going number 2 on a regular basis, like every day or every other day, we can get “backed up.” This is turn can cause pressure to be placed along the bladder, giving us the urge to go! 
Best ways to avoid constipation include the following:
Drink plenty of water every day. It’s recommended to drink between 6 and 8 glasses of water a day. Not drinking enough water can lead to constipation but can also make our urine more concentrated which can irritate the bladder as well. On the other hand, drinking a huge amount of water, (which is a popular trend these days,) can promote the urgency and frequency we are trying to control. Find the balance that’s right for you to manage your symptoms.
Get daily physical activity and exercise. Exercise helps to speed up the digestion process through our large intestine. It is best however to wait an hour after eating before exercise to allow blood flow to remain in the stomach and intestines to help your body initially digest the food.
Have a diet rich in fiber. This includes eating whole grains, fruits and vegetables. Examples of foods high in fiber includes berries, nuts, avocado, beans, sweet potatoes and oats. It is recommended to have between 25 and 35 grams of fiber a day.
Use a squatty potty or step stool during a bowel movement. Some may have trouble with eliminating their bowels which can lead to impaction and further constipation. Having your feet firmly planted on the ground as with a step stool or squatty potty helps to promote easier bowel movements. Also expanding the abdominals out while pushing, versus sucking in the stomach, can help facilitate a bowel movement.
It’s best to reach out to your doctor if you notice urgency symptoms that come on suddenly. They can test for a urinary tract infection, look at your hormone levels or rule out other conditions such as diabetes.
Once other diagnoses have been ruled out, seek a women’s health Physical Therapist that can fully assess your symptoms and provide you with specific guidance. Part of that assessment should be an internal vaginal exam, to help rule out pelvic floor weakness or “tightness” that might be contributing to your symptoms. They will also look at your diet and bladder habits and educate on what strategies would work best for you.
So next time your bladder tries the call the shots, use some of these strategies to help you show it who’s boss.
Bladder re-training can do wonders with eliminating urgency and regaining control again!
If you would like to talk with me about any symptoms you may be having, please email me at Camille@indywomenpt.com or call me at 317-689-0073. I do offer free phone consultation and would love to help.
Cheers,
Camille, Owner of Indy Women Physical Therapy
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