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By: Simone Dinovitz, PT, DPT, PCES
Urinary urgency can be a frustrating symptom with various triggers. Those that are frequently seen
in the clinic include pregnancy, pelvic floor muscle tension, prolapse, constipation, poor hydration,
and psychological/habitual causes. Patients typically describe feeling a strong urge to urinate that
they cannot ignore. They feel that they must always know where the closest restroom is and go to
the bathroom “just in case” before leaving the house. Therefore, creating anxiety around voiding
and increased urinary frequency. Identifying the root cause of the increased urge will allow for
improved control and reduce frequent bathroom breaks.
Bladder Norms
On average, urination should be every 2-4 hours totaling in 6-8 times a day with no waking to
urinate at night. The bladder and the brain work in a feedback loop to inform you to calmly find a
bathroom and when you truly must void. If the brain is trained to perceive a need to empt the
bladder when it is not full, this can lead to mixed messages resulting in urgency with only a few
drops of urine. Utilizing the bladder norms can be a helpful guide to identifying true urges.
Common Causes
Pregnancy: Hormonal changes, increased blood volume, and the growing baby can heighten
urinary urgency! Due to physical pressure being a trigger for urgency I recommend sitting down
to offload the pressure and evaluate if the bladder is giving you a true signal. A pelvic physical
therapist can assess the pelvic floor and ligament tension to assess if manual release work may
be indicated to help calm symptoms.
Pelvic Floor Tension: Tightness can be found along the muscles surrounding the urethra or the
viscera around the bladder. Skilled pelvic floor therapists are trained in gentle techniques to
calm this tightness. It is important to understand why the muscles have increased tone to
combat this cause. Often patients put off their urge and the constant “holding” shortens the
pelvic floor muscles causing them to be tighter and weaker.
Prolapse: Approximately 50% of postpartum women experience prolapse, which is when
ligamentous changes causes pelvic organs to shift and add pressure to the bladder. Patients
will often report feeling that they have not fully emptied and if they try to void more they will
often have a little more urine. When experiencing symptoms of prolapse you can ensure your
void is complete by not hovering above the toilet seat and you may consider using a squatty
potty to help find an optimal position. Another option is to rock back and forth on the toilet after
urinating to see if you can help “unkink the hose.” Pelvic PT is the most effective and holistic
way to calm prolapse symptoms and find lasting relief.
Constipation: The buildup of stool in the colon puts pressure on the bladder affecting feedback
to signal emptying. The pressure from the stool can also constrict the urethra. Pelvic therapists
can guide patients to understand why constipation is occurring and how to improve bowel
health for overall pelvic health!
Hydration: Many patients incorrectly reduce fluid intake hoping it will decrease urgency.
However, dehydration can lead to concentrated urine which can irritate the bladder lining
causing more urgency! Aim for a minimum of half of your body weight in fluid ounces of strictly
water! Bladder irritants can be found in drinks/food and increase urgency. The most common
ones to be aware of are caffeine, carbonated beverages, alcohol beverages, spicy foods,
artificial sweeteners, acidic beverages, tomato products, and chocolate.
Psychological/Habitual Factors: If you find yourself frequently using the bathroom “just in case,”
in between meetings, every time you leave the house, before every workout, etc. you may be
training your brain to warn you about emptying the bladder much more frequently than needed.
The brain and bladder work in a feedback loop and if the bladder is constantly being emptied it
will train the brain to tell you that you have to empty when your bladder is not full. Use the
bladder norms to try to stay on track and avoid frequent urgency. If it has been under 2 hours
since your last void try to see if you can wait through distraction, change in position, or even toe
tapping. Practicing to calmly walk to the bathroom can be an effective practice due to rushing/
running to the bathroom often adding unnecessary muscle contractions and pressure.
Conclusion
Pelvic floor physical therapy can be an effective way to combat urinary urgency and take back
control. Your bladder should not guide your day and small changes can yield fast and effective change!
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