Bladder health is a multifaceted discussion. Bladder symptoms go far beyond whether you are leaking urine or not. I
would like to break down the various symptoms associated with bladder dysfunction and give you tools to start
managing these signs of distress.
First, it’s good to know what “normal” healthy bladder function looks like. A healthy bladder can typically hold about 2
cups of urine and void about 6-8 times per day (around every 3-4 hours). This process slows when we are sleeping
so you should be able to go to the bathroom at night 0-1 times. These numbers will vary depending on how much
you are drinking and how active you are. Some interesting statistics from the NFAC:
Let’s look at a few common bladder symptoms you may be experiencing.
Urinary Incontinence (loss of urine)
This is a loss of urine with applied stressors or forces such as a cough, sneeze, laugh, jump, bending, movement. Have you had a little urine come out when you step off the curb, getting out of bed, or rushing to scoop up a little one? These are all indications of SUI. We also are seeing SUI in high intensity exercise with heavy lifting, box jumps, jump rope, and running
The reason for this loss of urine is a greater force being applied to our ability to maintain closure on the urethra. When we talk about management, we start to look at how the pelvic floor muscles and connective tissue are functioning, and how are you managing your abdominal pressure from above. Posture and breathing play a major role in managing these pressures.
This is loss of urine associated with a strong urge and/or sudden urge to urinate. You may find that your body is not giving you enough time to make it to the bathroom, or you lose urine right before you sit down on the toilet. Here, the bladder and/or pelvic floor muscles may be spasming. Managing UUI looks at the pelvic floor and connective tissue function, urge reduction strategies, bladder retraining, stress management, and diet/lifestyle modifications.
a combination of SUI and UUI.
Urgency, Frequency, and UTI like symptoms
These symptoms can exist without the presence of urine loss. The bladder communicates with the brainstem and can pick up information from our habits. An example of this would be “just in case” pee’s such as going to the bathroom before you run to the store even though you just went 15 minutes ago. The brainstem takes this information and tries to figure you out for the future. It starts to give you the urge based on time rather than a true full bladder. A voiding diary is a useful tool to track how often you urinate, how much comes out, if you had an urge, and what you are drinking.
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The brainstem will also start to pick up environmental triggers such as pulling into the driveway, putting the key in the door, washing the dishes, brushing your teeth, or in the shower.
Burning, itching, urgency, frequency, and pain can all be signs of pelvic floor muscle tightness or connective tissue restrictions. Decreased mobility of these structures can be uncomfortable and create symptoms similar to having a UTI.
Healthy Bladder Tips
Drink enough water (about 40-60 oz/day) and hydrate evenly throughout the day. Try to avoid overloading the bladder with a lot of water all at once. Avoiding drinking to avoid leakage will only make the bladder cranky and the contents concentrated and irritating which can lead to bladder spasms and leakage anyway!
Avoid beverages and foods that may be irritating to your bladder lining. Examples:
- Coffee, black tea
- Caffeine
- Alcohol
- Carbonated beverages
- Artificial sweeteners
- Citrus
- Spicy food
- Chocolate
- Vinegar
Sit (don’t hover as your pelvic floor muscles are engaged to hold this position) and allow for your pelvic floor muscles to let go and lengthen to void.
This can interrupt the mechanisms that communicate for voiding.
pee’s
If you ignore the urge too often, the brainstem will learn this poor habit as well and stop giving you the urge. Here you can develop overflow leakage because your body stops giving you the urge when the bladder is full
If you know you do not have a full bladder but your body is sending you the urge because of some learned poor habits, you can try some of these to suppress the urge and start to move back to a healthy urge pattern:
- Pelvic floor lengthening and diaphragmatic breathing
- Quick mini pelvic floor contractions x10
- Singing, whistling, humming
- Change your environment
- Change position (sit down if you are standing)
- Forward bending, deep squat
- Gentle compression to the perineum
We will review all this information Tuesday 5/5/20 at 11:00 am EST. We will also take a closer look at how to
lengthen the pelvic floor muscles to decrease tension and urgency. As a pelvic rehab therapist, I look to assess if the
pelvic floor muscles are overactive (tightness), or underactive (weakness) and develop a treatment plan to balance
these muscles and the other structures involved.
Be healthy, happy, and well!
Laura Rowan, OT/L
Pelvic Rehab Specialist
Essential Pelvic Health
I have so many patients at my hospital that would benefit from pelvic health. So often we are told we have a GI problem that needs to be fixed with surgery or medication. Most doctors don’t even talk about pelvic therapy as a way to help constipation, bladder issues, pain with sex, or other pelvic issues. Thanks for the insightful post.