“My bladder rules my life! It’s a joke with my friends and family that I know where every bathroom is between here and Timbuktu!”
Check “Over Active Bladder (OAB)” on the internet and you will see multiple ads for medications! Let’s consider what OAB is, and some other options for treating it!
People describing OAB might experience frequent and sudden urge to urinate that may be difficult to control. Or they might feel the need to pass urine many times during the day and night and may also experience urgency incontinence. (Mayo Clinic)
Hmm. Is it really the bladder? Or is the bladder doing what we are asking it to do, or what we have trained it to do? Maybe it truly is OAB but MAYBE it’s something else! Either way, we can make changes!
- “Going Just In Case”. Yep. For years kids and then adults have been told to “Go just in case” before you leave the house. EVEN if you only went and have no urge. Similarly, you may have been told not to let your bladder get “too full” and so you (and your bladder) have been trained to go to the bathroom every time you begin to feel urge. The bladder is a muscle, and we can train it to be efficient…or not!
Or perhaps because of fear of leakage you try to make sure that your bladder is as empty as possible and you have less fear of leakage with activity. (BTW, unless you have an indwelling catheter, the bladder is never totally empty. We do have standards for the amount of residual urine in the bladder after peeing. That’s one of the ways that we use the Ultrasound at Embody- we can see how much urine is present before you empty and then after. Sometimes you need to see to believe!)
- Is your bladder being squished? Constipation can contribute to pelvic pressure and because the colon and rectum “sit” on top of the bladder if you have a chronically full rectum/sigmoid/colon your bladder may not have room to expand, and you feel like you need to pee ALL of the time. But when you go, just a little bit. Hmm….OAB? Or Squished?
- Is your bladder being smooshed? The bladder is towards the base of the pressure system. The bladder is like a balloon and relaxes to expand and fill. If we are breath holding and/or “sucking the tummy in” there can be increased pressure from the diaphragm and upper core (even the jaw, throat, and glottis!) and the bladder is smooshed. If it is constantly saying “Pressure”, our response is to try to relieve it, and like with constipation, try to empty but only a little bit is there.
- Tension. The bladder responds to input above (the core muscles and pressure above) and to tension from the pelvic floor muscles. Makes sense, doesn’t it? If we are creating pressure above, the pelvic floor support system has several option….it can let go (oops! Leak!) or it can hold on for dear life! When there is over-tension (the pelvic floor is a postural support group so they need to work and not relax, but we don’t want them to be ON at full tilt constantly) the bladder may go into overdrive.
- How much are you asking your bladder to do? As noted above, the bladder is like a balloon. It relaxes to fill, and at a certain point of fullness (again, there are standards) it starts to suggest that you empty. Healthy kidneys are constantly creating urine and filling the bladder. So if you are drinking a lot of water or other fluids, you will need to go more. There is NO magic volume of fluid that you should take in, it really does vary from person to person and also depends on your activity level. But we don’t want to float the boat!
Let’s take a minute to talk about caffeine and alcohol. These chemicals are diuretics. That means that they instruct your kidneys to create more urine. Is coffee, tea or alcohol irritating to the bladder? Maybe; it depends on each person. HOWEVER, drinking these substances will cause the kidneys to create urine. It goes to the bladder and yes, you will need to pee. BUT if your bladder is full because of the urine from the kidneys, is it overactive or doing its job??
Nervousness and short term stress can also cause the kidneys to create more urine, so you may need to pee more then. And of course some medications cause us to urinate more; think “water pills” and some others. It’s important to know what the meds do, why, and how best to manage. Usually, drinking less is not the answer!
Let me be clear, there ARE reasons that the bladder can become irritated, super sensitive, overactive and can drive your life. Recurrent UTIs, certain medications, prostate problems, adhesions in the pelvis that limit the ability of the bladder to expand, Interstitial Cystitis and more can cause bladder irritability, pain, and increased need to void. Prostate changes or prostatectomy can also create increased urgency (Yes! Men have pelvic health concerns, too!)
The good news is that there are treatments to address a bladder that is driving you, often without medications! A Physical Therapist with knowledge about the interaction of the core, pelvic floor, pressure system and organs and how they should work together can help you to take back control of the bladder! We assess mobility, strength, tension, pain, and habits, and in the case of Embody, can use to the Real Time Ultrasound to help assess the muscle function, how the bladder is filling, and to retrain. At Embody education is a primary way to help you regain control. Understanding anatomy and how it all works together enable us to create change. If you have had abdominal or pelvic surgeries (such as C-section or laparoscopic) we are able to use mobilization techniques to improve mobility.
Are you ready to give the bladder a break, and to NOT know where every bathroom is? Contact Embody Physiotherapy & Wellness to learn more. If you do not live in the Western PA area and are looking for a therapist who can assist:
https://specialization.apta.org/find-a-specialist (use pelvic health or women’s health as a filter)
Rebecca Meehan PT WCS PYT is the owner of Embody Physiotherapy & Wellness. She is a Physical Therapist with Pelvic Health Specialist Certification and is a member of the APTA Academy of Pelvic Health. Rebecca has a passion for helping her clients, patients and students regain the highest level of pelvic health and pelvic fitness in order to function without being controlled by pain, leakage, or pelvic pressure and heaviness.
You can contact Rebecca at firstname.lastname@example.org