LET’S TALK ABOUT PEE…
Does it feel like an emergency when you have to go?
Do you know where all the best bathrooms are around town?
Are you afraid to go anywhere because you sometimes don’t make it to the toilet?
Do you “wet yourself” when you sneeze, laugh, cough, jump, or even change position?
We are here to tell you, this is not the way you have to live your life!
Urge urinary incontinence can occur when intense, “out of the blue,” bladder urges hit you or even with intermittent unexpected passive dribbling. Meanwhile, stress urinary incontinence occurs when there is stress (or pressure) to the bladder beyond what your muscles can support such as when you sneeze, cough, laugh, jump, run, etc. And just to make it more frustrating, you may be victim to both stress and urge urinary incontinence. And let’s be honest – any little bit of leakage is frustrating.
WHY DOES IT HAPPEN??
There may be a number of reasons contributing to these events, but oftentimes the pelvic floor muscles are involved to some degree. One of the functions of the pelvic floor is sphincteric control, meaning that it helps to keep things in until we’re ready to empty them. The muscles of the pelvic floor may be weak OR tight and the tissues around the bladder in the pelvis may have increased laxity or restrictions which all influence how well your bladder can be managed. Far too often we hear people come in telling us that they were told by their provider or from an online resource to just do more Kegels. However, we’re here to tell you it’s not always just weakness, and Kegels may be the exact opposite thing you need to address your symptoms.
Connective tissue restrictions or laxity as a result of abdominal surgeries, injuries, pregnancy or other conditions not only influence the bladder directly, it can influence how the pelvic floor muscles are functioning as well. When the connective tissue around the bladder is compromised, this can create a change in the position and functioning of the bladder resulting in altered urge sensation, ability to empty and comfort. All of which can result in decreased control of your bladder.
Life events, such as pregnancy, childbirth, abdominal/pelvic surgeries or other pelvic conditions like endometriosis, interstitial cystitis or hormonal changes with perimenopause and menopause can all contribute to the onset of these symptoms. Additionally, so can extra weight, smoking, chronic coughing and constipation.
Foods and drinks may also contribute to the symptoms as well. Alcohol, caffeine, carbonated beverages, chocolate (sorry!), spicy and acidic foods, sugar and artificial sweeteners may irritate the bladder and may increase or contribute to incontinence. You can begin to see there may be a number of angles to consider when we are wanting to fully and effectively address bladder problems.
TIPS FOR IMPROVING BLADDER CONTROL
This is probably the most common line of defense that is recommended. But Kegels may not always be the most effective option to address your symptoms. Sure – they can be helpful. But first, it’s important to make sure that you’re even doing them correctly. This is where Kegels have gotten a bad rap over the years. You have to contract the muscles properly in order for good strengthening. And these muscles are a bit tricky because they are out of sight so more of, what we call, a sensory contraction – meaning that you have to know what it feels like to contract the muscles.
The other side of this discussion is determining if your muscles are actually weak or if they’re too tight and contributing to your leakage. This is where a pelvic health expert comes into play and can help you determine what avenue of care is best for you.
In short, Kegels, though helpful for some cases, are not always the answer.
Increase Your Water Intake
That’s right, increase it!
It may seem like you should decrease drinking fluid if you are trying to decrease your trips to the bathroom and stem the tide. However, increasing fluids can help urinary urgency and frequency by diluting your urine and helping to maintain the correct salt/water balance in your body. Water will be best, but non caffeinated and non-acidic beverages are okay too.
We recommend you consume half of your body weight in ounces of water each day. Make sure your intake is slow and steady, spread throughout your day. Drinking too much, too quickly may be contributing to urgency and frequency symptoms. Instead, take small sips frequently through your day rather than chugging large volumes all at one time.
If your water intake is quite low, it is important to increase it slowly and consistently. Begin by adding an additional 8 ounces per day until you reach your goal of half your body weight in ounces.
Squeeze Before You Sneeze
This phrase is just catchy enough to stick in your head! In short, squeeze (Kegel) before you sneeze – before an activity/event that you might cause leakage (cough, laugh, lifting, stand up from your chair, or jump, etc). Keep the pelvic floor muscles engaged while you complete the movement. This contraction is typically a reflex and with enough practice, you should be able to train your muscles to do this automatically – you know, like when you were younger, before you had kids and you didn’t have to worry about these problems :S
Change Your Position
Do you get to the toilet and what you thought would be a torrential downpour is just a trickle? Consider having a toileting stool. A “Squatty Potty” or similar stool helps to put your pelvic floor in the best position for complete emptying of your bladder and your bowels. You can also take slow, deep belly breaths to help the muscles of the pelvic floor open and relax to improve emptying.
DON’T Push Your Urine Out
“Power peeing” is something every mom has had to do as some point. Whether the baby suddenly wakes, the kids start fighting or getting into something they shouldn’t, etc. However, this habit is one that can really be problematic to the pelvic floor and the pelvic organs. Instead, when on the toilet, use your breath to relax your pelvic floor muscles (as mentioned above – take a slow, deep belly breath) and let your urine flow out. Some people struggle with this more than others and that’s a great time to reach out to an expert therapist for help!
Take Your Time
Sit for an extra 10 seconds to make sure your bladder has completely emptied. Mom’s again are victims of having to rush off the toilet for various reasons. If you can convince yourself that the house won’t burn down and all humans are safe in the house, try taking a little extra time to ensure that you’ve fully emptied your bladder. A little extra emptying can ensure that you won’t be back to visit the white throne quite so soon. If your bladder still doesn’t feel empty, you can try pressing down just above your pubic bone, or lifting up on your lower abdomen and leaning forward. Occasionally, standing up and then sitting back down can reposition the bladder enough to help urine move down and out.
Sometimes our bathroom habits, like going “just in case,” can inadvertently train our brains to think our bladders need to empty more frequently than they really do. Imagine that the brain is registering the signals from the bladder as a four alarm fire (true emergency) rather than just a tap on the shoulder as it most often is. We have to retrain the brain to interpret the signals from the bladder correctly.
Here are some tips to help get the brain and the bladder on the same page again:
1. When you get hit with an urge, sit if possible and engage your pelvic floor by doing a Kegel. Hold for 3 seconds and repeat 5-10 times to suppress the urge.
2. Try pressing on your pubic bone or perineum to see if this helps decreases the urge. You can use the your hand or a rolled up towel to press against your vulva.
3. Distract yourself! This step is KEY!! Sing a song, recite a poem, write your grocery list, watch your favorite show, count backwards by 7’s! Think about it – the more you think about having to use the bathroom, the stronger your urge will tend to become.
4. Once the urge subsides, assess whether or not you really have a full bladder sensation in your lower abdomen or not. If you feel you truly need to empty your bladder, do a Kegel and hold while you stand up and move calmly to the restroom to empty your bladder. If you really don’t have to go, carry on with what you were doing.
Keeping track of how often you use the restroom can also provide some insight to potential problem areas or habits. In general, a person should use the restroom NO SOONER than 2 hours from the last void and NO LONGER than 4 hours between voids. If you’re getting urges to use the restroom less than 2 hours apart, assess how much water you’ve drank and work through the urge suppression steps above to try to delay a bit longer. If you’re going longer than 4 hours between voids – well, you most likely need to drink a bit more water! 🙂
A bladder log tracks what you drink, eat and when and how often you urinate or have leakage. It is a good way for you to get a clear picture of any patterns in your intake and outflow! These can be helpful to find any trends, habits or potential irritants in your diet that may be contributing to your symptoms.
Sometimes we may not be going to the bathroom often enough, and other times we may be going with too great a frequency. Being more mindful and working on being more consistent can help normalize things too. Eliminating “just in case” trips to the bathroom and/or decreasing the number of times you urinate during the night in order to make your bathroom trips equidistant. Gradually increase the time between trips until there is regularly 2-3 hours in between. Anchoring them to other regular activities such as wake up, bedtime, and meal times can help with this.
Addressing urinary incontinence and urgency is not a one size fits all situation, but we hope that some of the above strategies might help you get your healing journey started.
If you feel you’ve tried many different approaches, have seen other therapists without resolution of symptoms or need more specific guidance, we would be happy to work with you individually at TVPH to help you understand what is contributing to your particular symptoms, address any underlying factors, and tailor treatment that will help you regain freedom from your bladder once and for all! Give us a call if you have any questions or check out our online booking to start your healing journey today.