Note: This article is designed to be educational and informative and should not be used to make decisions about any health-related issues. An appropriate health professional should always be consulted when seeking to diagnose, treat and make decisions about your health.
When the bladder fills with urine, the bladder wall (detrusor muscle) remains relaxed; simultaneously the pelvic floor muscles (PFMs) contract, this allows your bladder to fill with urine without leakage. When the bladder is full, a signal is sent to the brain where a decision is made about whether it is an appropriate time to urinate.
When we are on the toilet, the bladder wall (detrusor muscle) starts to contract and at the same time the PFM will automatically relax to allow for the flow of urination. This system is great when both the bladder and PFMs are working correctly. However, with Overactive Bladder (OAB) the relationship is often dysfunctional. Typically with an overactive bladder, the detrusor muscle contracts inappropriately (ie not when the bladder is full) causing the person to feel a sudden, and sometimes overwhelming urge to urinate.
What are the symptoms of overactive bladder?
Overactive bladder syndrome consisting of urinary urgency, is usually accompanied by frequency and nocturia, with or without leakage, in absence of urinary tract infection (UTI) or other obvious pathology. (1)
URGENCY - The sudden strong urge to urinate. Urgency is often triggered by events such as putting the key in the lock, running water or seeing a bathroom.
FREQUENCY - It is normal to pass urine 4 - 8 times in a 24 hour period, including once or perhaps twice at night (depending on your age). If your detrusor muscle is contracting when your bladder isn’t full, you may need to urinate more frequently, usually to pass small amounts of urine.
URGE INCONTINENCE - Making it to the toilet on time can be difficult for some people as their bladder gives them very little or no warning, resulting in urine leaking. This can range from a few drops to a full bladder.
NOCTURIA - If your detrusor muscle is contracting more frequently, you may find that you are waking at night to pass urine more than what is considered normal. It is normal to wake to void up to twice at night (depending on your age)
Lifestyle modifications
Lifestyle modifications, including a variety of behavioral changes can reduce OAB symptoms.
Regulating your fluid intake; Too much fluid can overfill the bladder and too little can concentrate the urine, which irritates the bladder. (2)
Limit bladder irritants; Limit Alcohol, caffeine-based drinks, artificial sweeteners, spicy foods and carbonated drinks which can irritate the bladder, further exacerbating symptoms of overactive bladder. (3) (4) Alcohol also has a diuretic effect, which can cause more frequent urination.
Avoid Constipation; constipation can trigger or worsen symptoms of overactive bladder. Straining to open your bowels can weaken the pelvic floor. (2)
Keep your weight in the healthy range; evidence suggests that losing weight can decrease the severity and frequency of symptoms. (5)
Avoid smoking; ceasing smoking can reduce urinary frequency. (6)
Bladder training
Step 1. Increasing bladder fill volume. (7)
The aim is to increase your urine volume by visiting the toilet less often. How do I do this?
When you first feel the need to go to the toilet, try to ignore it. If the ‘need” is a strong urge, use the strategies below to defer the urge. Put off going to the toilet until the next time you feel the urge. Initially this may only be a few minutes. As you improve, you should be able to defer for 30 minutes or longer.
During the night if you wake with the urge to go, get up and go immediately.
Step 2. Deferral strategies:
These strategies aim to dampen or suppress the overwhelming urge associated with OAB. We recommend you experiment with the below strategies and find the one that works best for you. Continue with your most effective strategy until the initial urge has passed. Then you can make a decision, if you need to go to the toilet or perhaps you can now wait.
1. Pelvic floor muscle contractions: Stop, relax, breath and engage your pelvic floor.
This is one of the most effective methods, as a pelvic floor contraction can turn your detrusor muscle off. Try taking a relaxed breath in and slowly engaging your pelvic floor for 10 seconds or 5-6 rapids contractions until the urge has subsided. (2)
2. Use perineal or clitoral pressure, (hand pressure over the crotch), while sitting on the edge of a chair or table.
3. Roll up a bath towel and keep it on a chair. Sit on this roll when you have a strong urge to urinate. Tighten and hold your Pelvic floor muscles until the urge passes. You may even choose to place the chair in a place where triggers happen, i.e. at the front door.
4. Squeeze the skin under your nose, Toe curling, Walk on toes - These can be a great way to distract you from the urge to urinate.
It is important to celebrate every time you reduce the urge to go to the toilet! Even if you last one minute before you need to head to the toilet. This is a positive step towards changing the relationship you have with your bladder.
Step 3: Decrease your sensitivity to triggers.
Firstly identify your triggers, the most common are running water, arriving home and putting your key in the lock, or entering the bathroom.
To help decrease the sensitivity of your triggers, try approaching the trigger with an empty bladder. Then, slowly approach the trigger with increasing periods of time after voiding. For example, if your trigger is ‘the running shower’, try going to the toilet prior to turning the shower on, then slowly start to increase the time period before turning the shower on.
How can osteopathy help with overactive bladder and urgency?
As osteopaths we look at the person as a whole, we will assess overall alignment, movement patterns, breathing, pelvic floor function and deep core engagement. We will endeavour to work out why your symptoms arose in the first place and create a specific treatment plan that will include an osteopathic treatment.
As a part of our treatment plan we may give advice on a specific bladder training program, urgency deferment strategies, lifestyle modifications, pelvic floor muscle rehabilitation (strengthening or relaxation), and mindfulness.
With the use of real time ultrasound, your osteopath can check to see if you are correctly/fully emptying your bladder.
Some patients with an overactive bladder also have tight pelvic floor muscles. A tight pelvic floor can increase the sensations of urinary urgency. You may be asking your pelvic floor to work extra hard to prevent leakage, which can cause your pelvic floor to become overactive and tight. When in this state, the pelvic floor is no longer able to positively influence the bladder (i.e. turn the detrusor muscle off), which can make the symptoms of OBA worse.
If this is the case for you, your osteopath will help you to address this before any strength training.
Referneces
ICS terminology report, 2010
Evaluation and management of overactive bladder: strategies for optimizing care. Marcella G Willis-Gray, Alexis A Dieter, and Elizabeth J Geller
Dietary caffeine intake and the risk for detrusor instability: a case-control study.Arya LA1, Myers DL, Jackson ND.
Caffeine and urinary incontinence in US women.Gleason JL1, Richter HE, Redden DT, Goode PS, Burgio KL, Markland AD.
The prevalence and risk factors of overactive bladder symptoms and its relation to pelvic organ prolapse symptoms in a general female population. de Boer TA1, Slieker-ten Hove MC, Burger CW, Vierhout ME.
EFFECT OF SMOKING CESSATION ON OVERACTIVE BLADDER SYMPTOMS IN ADULTS: A PILOT STUDY. Wyman J1 , Allen A2 , Hertsgaard L2 , Overson E2 , Allen S2 , Hatsukami D2 1. School of Nursing, University of Minnesota, 2. School of Medicine, University of Minnesota
Bladder training for urinary incontinence in adults. Wallace SA1, Roe B, Williams K, Palmer M.