I am having trouble with urinary urgency – help!
Urinary urgency, sometimes associated also with leaking, can be a debilitating problem. Urinary urgency can stop people from exercising, stop people from leaving their home, and stop people from doing the things they love to do – or if they want to do it they need to wear a pad.
If you are suffering from what was mentioned above, sudden urinary urgency, or urgency associated with urinary leaking (or complete bladder loss) – have a chat to your GP. Your GP will be able to talk through some of your symptoms and assess whether you need to go and see a urologist or urogynaecologist – these are specialists in this area. Your GP will also be able to discuss with you whether a physiotherapist may be able to help, or perhaps you could bring this up and ask if your GP thinks this could be an option.
You may be wondering how a physiotherapist could know anything about the bladder – the reason is the pelvic floor muscles. Physiotherapists with extra training in this area will be able to discuss your symptoms with you, and do a physical assessment to test the function/strength/endurance of your pelvic floor muscles.
What to expect in a Consult
Your physiotherapist will ask you what it is you want to achieve with physiotherapy. It is good for you to come with a clear idea in mind – some examples of what women might want to achieve include
- Go to the shops without worrying about leaking
- Decrease the numbers of pads used each day
- Return to running without worrying about their bladder
- Go on a longer car drive without having to frequently stop
Your physiotherapist will have a detailed discussion with you about
- How long you have had your urgency symptoms
- What do they stop you from doing
- Do you have any urine leakage – is it a little or a lot
- Can you associate your urgency symptoms with any particular activities eg when you get home, when you wake up in the morning, when you walk past a running tap
- Your birth history
- Bowel history eg constipation
- They will ask you about your sex life, for example some people with urgency may also have pain with sex, or may not participate in sex due to fear of leaking
- What your fluid consumption is like
- If you consume any substances which may irritate your bladder eg alcohol, caffeine
Your physiotherapist will most likely ask you to complete a bladder diary. This is best done over three days. A bladder diary looks at fluid in, fluid out, leakage episodes, rating of your urge to urinate. This helps your physiotherapist look at
- Does the rate of urge correlate with the amount of urine passed
- Is there any times of day which are worse
- Does your urgency change depending on what you drink
Discussion around Fluid Intake
Sometimes you get bladder urgency because you drink a lot of water. There is a lot of hype in the fitness industry around drinking enough water – and it is warranted because there are people who are chronically dehydrated. Some people also drink excess water, which can be ok if it does not have any adverse effects for you, but the more water you drink the more you will have to urinate.
Sometimes timing of fluids can play a roll, for example if you do not drink much during the day but try to make up for it at night, it is likely you will wake in the night time and need to urinate.
Where we need to investigate is if you have a small amount of fluid, and shortly after you have a strong urge to urinate.
Discussion on the type of Fluid Consumed
Different drinks can have different effects on the muscles of your bladder. Some women have sensitivity to caffeine, sugar and alcohol (Gleeson, J. 2013 & Imamura et al, 2015). A bladder diary can help you investigate if there is any correlation between these.
Discussion around Urgency Triggers
Urgency triggers are things that we do or encounter that sends a feed forward message from out brain to our bladder that we need to urinate, even if there is not enough fluid in our bladder to warrant such an urge. Typical triggers include
- Key in the door
- Hearing running water
Sometimes you can do things to try and retrain these triggers so they do not have as much of an affect. Your physiotherapist can give techniques which will work best for you (eg pelvic floor muscle contraction, calf raise, count back slowly from 10 etc).Urgency triggers are things that we do or encounter that sends a feed forward message from out brain to our bladder #physiowithafinishline @pogophysio Click To Tweet
Pelvic Floor Muscle Assessment
Your physiotherapist can perform an internal exam to assess the strength, endurance and function of your pelvic floor muscles. Pelvic floor muscle training seems to help urinary urge in that women can perform a more coordinated pelvic floor contraction when they feel the urinary urge, and performing pelvic floor muscle exercises aids in building muscle bulk which will help to support the pelvic organs (Bø, K. 2004).
Emily Georgopolous (APAM)
Masters of Physiotherapy
Featured in the Top 50 Physical Therapy Blog
Ayeleke RO, Hay‐Smith EJC, Omar MI. Pelvic floor muscle training added to another active treatment versus the same active treatment alone for urinary incontinence in women. Cochrane Database of Systematic Reviews 2015, Issue 11. Art. No.: CD010551. DOI: 10.1002/14651858.CD010551.pub3.
Bø K. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work?. International Urogynecology Journal and Pelvic Floor Dysfunction 2004;15:76‐84.
Gleason, J.L., Richter, H.E., Redden, D.T. et al. Int Urogynecol J (2013) 24: 295. https://doi-org.access.library.unisa.edu.au/10.1007/s00192-012-1829-5
Imamura M, Williams K, Wells M, McGrother C. Lifestyle interventions for the treatment of urinary incontinence in adults. Cochrane Database of Systematic Reviews 2015, Issue 12. Art. No.: CD003505. DOI: 10.1002/14651858.CD003505.pub5.