Do you feel like you are always on the look out for a toilet? You might be suffering from urinary urgency.
Urinary urgency (UU) is the sudden urge to urinate, due to involuntary contractions of the bladder muscle (detrusor). Although normal bladder habits vary between individuals, it is considered normal to empty your bladder 6-8 times in a 24 hour period. A healthy bladder holds about 400mls of urine throughout the day and slightly more at night. Voiding frequency tends to increase in older people who may need to pass urine more often overnight.
Treatment for urinary urgency is largely dependent on the cause. This can be ascertained with a comprehensive assessment with your women’s health physio who may require further investigation from your GP.
Depending on the cause of your symptoms, and this may be multifactorial, treatment options include:
1. LIFESTYLE FACTORS
Weight control
Obesity (BMI > 30) is associated with an increased risk of urgency. Increased abdominal pressure leads to chronic strain/ stress on the pelvic floor and weight loss should be the first line of treatment for urinary urgency
Manage bowel regularity
Always try and respond to the urge to open your bowels. This will reduce the need to strain and promote healthy bowel habits and pelvic floor. Engaging in exercise and increasing dietary fibre can also be very beneficial.
Manage fluid intake
Too much or too little fluid can affect both the bladder and the bowels. A general guide of 1500ml or 30ml/kg of body weight/ 24 hours is usually sufficient (strenuous exercise and breastfeeding mothers may require a higher intake).
If voiding overnight (nocturia) is a problem aim to limit any fluid 3-4 hours before you fall asleep.
Eliminate bowel irritants
Caffeine, carbonated drinks, artificial sweeteners and citrus foods are all recognised foods that can irritate the bladder and increase urgency and frequency.
Cease smoking
Smoking is associated with urinary urgency and incontinence in women. This is possibly due to chronic cough and the pressure placed on the pelvic floor.
Optimise pelvic health
Optimising hormonal health, in particular oestrogen, is important to improve overall pelvic health and pelvic floor strength, an important factor in the management of urinary urgency.
2. TRAINING TECHNIQUES
Bladder training is a progressive, timed voiding schedule irrespective of the desire to urinate. The aim of this is the establish normal voiding intervals. Bladder training can be guided by your women’s health physio and should be used in conjunction with optimising lifestyle factors, distraction and relaxation techniques (explained below) and pelvic floor muscle training.
Bladder training can help to:
Reduce frequency
Increase the time between voids
Increase the volume of urine you pass in each void
Urge suppression techniques: research shows that performing general relaxation techniques can reduce the intensity of urgency, allowing voiding to be delayed. Examples include:
Breathing: Concentration on your breath can be a useful distraction tool and can also aid in relaxation of the neural pathways firing to your bladder.
Complex mental tasks e.g counting down from 100 by 7’s, reciting poetry
Heel raises (neuromodulation of L4-S1)
Sit down (improved pelvic floor control and aids in relaxation)
Peroneal pressure
Pelvic floor muscle contractions; Perform a 10 second pelvic floor contraction or 5-6 reps of strong powerful contraction. Contractions can help to prevent internal sphincter relaxation
Of course, sometimes you really do need to go! If you are unable to supress the urge after a few minutes, make your way to the toilet calmly. When you go, sit down with two feet on the ground and make sure the pelvic floor is fully relaxed before voiding.
Urinary urgency is a common problem for women. Sometimes it can be easily fixed, other times it is more difficult. However, improvements can certainly be made and we would love you help you on your journey.
