Fighting The Urge? How To Gain Better Bladder Control.

The most frequent complaint I field in workshops and see in the clinic is not being able to control the urge to pee! So much so that it causes people to leak a little (or a lot!). This is called urge incontinence also known as overactive bladder, when you experience a strong/sudden urge to urinate and it’s difficult to delay. One of the first lines of defense for overcoming this are working on your behaviors like bladder training, lifestyle modifications, voiding diary, avoiding bladder irritants. First, let’s fully understand why this is happening in the first place and second, outline how we treat this condition in physical therapy. 

Typical Bladder Function

The bladder stores urine and empties urine, but never all the way empty which is known as residual. The detrusor is the muscle of the bladder. When we are storing urine and the bladder is filling, the detrusor fills and we have sensors in the bladder that detect its filling/stretching. We get our 1st urge to go when our bladder is about ½ way full. We should be able to delay that urge to continue filling the bladder. The next urge occurs when the bladder is about ⅔ full and will be more persistent than the first. We typically go at this urge or delay it for a little bit longer. When it’s time to pee, we (regardless of gender) sit down on the toilet, and try to relax all of our muscles but the detrusor muscle is what squeezes to empty the bladder.

Going On the First Urge?

This can happen when you “just in case” pee and you’ve trained your bladder and brain that the bladder doesn’t need to fill completely. Your bladder becomes sensitive to smaller amounts of urine and this cascades into feelings of anxiety and urgency when going to the bathroom before leaving the house, or feeling triggered by running water, putting the key in the door or pulling into the driveway of your house. Although this can feel unmanageable, here is how we start to retrain the bladder: 

• Look at your water/liquid intake. Are you avoiding water to decrease bathroom trips? That actually can make your urine more concentrated and irritate the bladder to the point where it will make you feel like yo have to go or else!
• Urge suppression. Try delaying your bathroom trip by 5-15 minutes by distracting yourself. Perform 5-10 legals, applying pressure to the perineum or squeezing your legs together, or by doing deep breaths like the 360 Breath. The goal is to have 2- to 4-hour intervals between bathroom breaks.
• Keep a bladder diary. Taking a look at how frequently (or not) you are going during the week or in different environments. It is common to feel in complete control in one situation, but perhaps when you are home or relaxed, you lose the ability to control the urge. A diary that we provide you helps us see what we can modify in your day to day to overcome this and stop leaking.   
• Don't rush while peeing. Try not to push out the urine, or quickly get out of there. Take some deep breaths and allow your body to relax while your detrusor does its job!
• Start retraining on a day you're already home. If that’s the weekend or a work from home day, you may want to practice in the comfort of your home and not worry about public leaks or bathroom access. There is also no shame in wearing pad protection when practicing.
• Focus on successes! If that’s the weekend or a work from home day, you may want to practice in the comfort of your home and not worry about public leaks or bathroom access. There is also no shame in wearing pad protection when practicing.

This may seem like a lot to undertake, but try implementing some of these tips to help with your overactive bladder. Lastly, check out my previous post, “8 Bladder Habits You Need To Be Aware Of.”  If it is not improving or you are not seeing the results you are looking for, I would be delighted to guide you through this!

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In health, 

Dr. Krystal PT, DPT, CMTPT, RYT-200