24 Nov Controlling the Overactive Bladder
I have had a few patients recently suffering with urinary urge incontinence. This is where you experience a sudden need to urinate, and then lose some (or all!) of the urine in your bladder as you are making a mad dash to the toilet. These are people that tend to check out the location of the toilet as they arrive somewhere, they tend to go to the toilet ‘just in case’ to try to minimise leaking, and find themselves racing to the toilet, only to feel it running down their leg as they make their mad dash.
There are some strategies you can put in place that will give you back control over your bladder, and in the words of a recent patient, after using the tips I am about to share with you, she is not needing to wear liners for the first time in 2 years and she says she is back in control. All after some simple education on how to manage the sudden urge to wee!
If this sounds like you, there are some steps you can take to try to take back control.
One of the reasons you could be experiencing this, is if the bladder muscle has become overactive, and contracts at intervals while the bladder is filling. This is called ‘detrusor overactivity’. In normal bladder filling, the muscle does not contract until we are sitting on the toilet and ready to empty.
If you do feel like you need to run to the toilet, it is important to teach the brain that you can get there without leaking, you are experiencing a bladder ‘spasm’. It will be difficult, but you need to stop running! There is already a lot of pressure on your bladder from the spasms, if you add running to the mix, you add even more force onto your bladder. But if you can stop, and get the urge under control, it will often pass. If you can then walk calmly to the toilet, you are less likely to leak. So, stop, don’t run, and try one or more of the following to stop the bladder contracting:
1. A handy thing to know is that the body is not very good at using a single part of the spinal cord to do two things at the same time. If you can get the area of the spinal cord that tells your bladder to contract to do something else, it will dampen down the message it is sending to your bladder. One way to do this is to apply pressure to your perineum. Kids do it all the time! As an adult it is not as socially acceptable to grab your crotch and jump up and down, but you could sit down on the arm of a chair or on the heel of your foot, which will do the same thing.
2. Another way to confuse your brain into letting your bladder relax, is to clench your toes or rise up onto the balls of your feet. The nerve that enables you to do these movements also attaches at the spinal cord as the same level as the bladder nerves, so it will work similar to the first option.
3. Another technique you can try is distraction. This is because the frontal cortex of the brain helps to keep the bladder relaxed, but when we feel panicked by feeling a sensation of urgency to get to the toilet, we start using the emotional part of our brain and switch off the frontal cortex. If you can keep the front part of your brain working, this will help to keep the bladder relaxed. The front part is also responsible for organisational activities, so concentrating on numbers or making lists is a good place to start. Count backwards from 100 in 7’s is enough to challenge me to use my frontal cortex!
4. Contract your pelvic floor muscles. These muscles help to restore a reflex called the ‘detrusor inhibition reflex’. This reflex helps to stop the bladder muscle from contracting. In some cases, the sensation of urgency can be related to an overactive pelvic floor, so if you find a contraction of the pelvic floor makes your feeling of urgency worse, let your women’s health physiotherapist know.
If you need any further assistance contact us or your local women’s health physiotherapist.