Urge incontinence is a sudden and strong urge to urinate resulting in varying degrees of involuntary loss of urine. Also called “overactive bladder” or OAB, this condition can happen anytime, anywhere, and to anyone. The unpredictability of OAB leads to feelings of anxiousness, embarrassment, and negatively impacts one’s quality of life. The fear of being unable to stop oneself from emptying their bladder when out in public can result in isolation and avoidance of social situations. Sometimes it feels like you are at war with your own body! Pelvic floor physiotherapy can help. With a diagnosis of OAB, there are many physical and behavioural impairments that contribute to this condition. They can be addressed and resolved.
Your bladder is a muscle. It has a complex neural communication system between the brain and the pelvic floor muscles that surround it. There is both an involuntary (reflexive) and voluntary communication system that tells the bladder when to relax, expand, and store more urine or when to contract and empty. With OAB, these signals are not coordinated properly and may be upregulated, or overactive. Once the message starts, the cascade of messages are amplified and augmented through behavioural responses such as anxiety or stress associated with rushing/finding a toilet. The bladder receives all of these messages to “SQUEEZE!!!” and the pelvic floor musculature does not have the strength, coordination, or proper messaging to inhibit the bladder’s contractions. There is a disconnect between the brain (which controls the muscles), and the muscles (which produce the action). Both have to be addressed to adequately solve an OAB.
Treatment for urge incontinence includes the completion of a bladder and bowel diary (over the course of 2-3 days). This journal provides important information and identifies patterns regarding dietary habits, hydration, activities and behaviours that may be triggering or contributing to this condition. Bladder and bowel diaries may be completed multiple times throughout the course of treatment as it is able to track improvement and progression over time. With this information, we talk about behavioural changes that can be implemented regarding dietary adjustments. Many foods are known to irritate the sensitive bladder lining and can contribute to bladder overactivity. Persistent constipation takes up space within the pelvis and the distended rectum pushes on the bladder. When the bladder has less space to expand, this can throw the neural signals to the bladder out of whack as well. If constipation is identified, we will discuss ways to resolve this through diet, toileting postures and optimal strategies for emptying. If appropriate, you may be expected to adhere to toileting every day at the same time to establish a routine and pattern for the bladder. Behavioural training is an imperative aspect of recovery and includes education on effective urge delay strategies that will help inhibit or downregulate the overactive system of signals that feed into the strong bladder contractions.
Not only is there a behavioural component to treating urge incontinence, pelvic floor physiotherapy identifies what muscles and soft tissue (internal and external) may be contributing to OAB symptoms. It is quite common for those with urge incontinence to have abnormal tension and tightness within the abdominals, adductors, and even hip flexor muscles (to name just a few).
The pelvic floor muscles communicate intimately with the bladder. Therefore, we can tap into optimizing this communication system by identifying issues with pelvic floor strength, flexibility, and coordination. By addressing muscle imbalance, tone, and incorrect activation, you are addressing the factors contributing to an OAB.
Treatment then focuses on increasing the flexibility/mobility of the external and internal musculature through hands on manual therapy as well as providing a guided home exercise program for maintaining the flexibility gains made during treatment.
Bladder training and treatment for urge incontinence involves a lot of commitment and persistence. With continued guidance and support from a pelvic health physiotherapist, client’s are able to regain control of their bladder again and feel much more confident in social environments.
If you find you are frequently worried and anxious about finding the closest bathroom, or you leak urine when you are on the way to the toilet, stop letting your bladder control you and book an appointment with Leeanna Maher, Registered Pelvic Health Physiotherapist today!
Leeanna Maher
Registered Pelvic Floor Physiotherapist
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