Do you need physical therapy for urinary urgency? Often have a sudden urge to urinate?! Do you cross your legs or run to the bathroom, trying to stop urine? Do you ask yourself, when’s the last time you went? How much have you drank? What did you drink? Wondering why might you be feeling this urge?
It’s a shame we aren’t taught the norms of how our urinary tract system works. This includes how our bladder fills and how fluids and foods affect it. If you never learned that, it’s hard to know if you should give in to an urge to urinate or not.
Some people may feel like they rarely get urges to go. Others may feel like they are always getting urges to go.
How do you know if you have an overactive bladder?
How do you know if you have incontinence?
What is urinary urgency?
Urinary urgency is when a person feels the sudden, intense need to urinate. This sensation can occur even when the bladder isn’t full. This often comes with an involuntary leakage of urine. Urinary urgency is often seen in people with certain types of incontinence. Yet, it can also happen to those without other urinary problems.
What causes urinary urgency?
The causes of urinary urgency can vary. Stress and urge incontinence are very common. Incontinence occurs when a person experiences sudden urges to urinate that are uncontrolled or can’t be stopped. These urges often happen without warning. This can cause the person to involuntarily leak urine before they have time to make it to the toilet.
Other types of urinary incontinence include overflow incontinence, mixed incontinence and functional incontinence.
- Overflow incontinence is when the bladder does not empty completely. Or, small amounts of urine are frequently released.
- Mixed incontinence is a combination of both stress and urge incontinence. This is where the person experiences leakage of urine due to both stress and urge.
- Functional incontinence is when a person may have normal bladder control. But, they cannot reach the bathroom in time due to physical disabilities or mental impairment.
Compare a hunger cue to a bathroom cue
I sometimes relate understanding bladder urges to getting in tune with hunger cues.
It’s hard to listen to our bodies (internal hunger cues) vs. external thinking. For example: “When’s the last time we ate/drank? What did we eat/drink? When will our next chance to eat/drink be? Why am I getting a hunger cue (is it real hunger vs. a trigger: taste/stress/emotional/etc.)?”
When we check internal and external cues we can better decide if we want to give into it or ignore it.
Internal urinary urge cues:
- How full your bladder is
- How concentrated the urine in your bladder is. Is it irritating the bladder and causing an urge sooner than full?
- Pressure on your bladder. Think from a baby growing, pushing, kicking or external from tight clothing like belts.
External thinking related to bladder awareness:
- Volume: Most bladders (not pregnant) can hold up to 1.5-2 cups during the day and up to 4 cups at night
- Urge sensation: Most urges begin to start when your bladder is about 60-70% full
- Frequency: Take into consideration bladder volume and quality hydration. Most people will void every 2-4 hours, or roughly 6-8x per day (more when you’re pregnant).
- Hydration: What did you drink and how much? Larger volumes of fluid (more than 2 cups between voids) or bladder irritants? Anything that isn’t water has the potential to irritate your bladder lining. This can make you feel an urge sooner (more concentrated urine). Think things like coffee, soda, tea, alcohol, carbonated beverages, spicy foods and more.
Consider urge triggers
Is there something external happening that might cause your urge to be sooner or more intense than the actual fullness of your bladder? Common urge triggers are:
- Running water
- Being in water
- Arriving home
- Key in the door
- Seeing the toilet/bathroom
- Leaving the house and a “just in case” urge
All this is to say we drink fluids and we pee. Sometimes we urinate when a bathroom or break is available and sometimes we do it because there’s an urge. But how often do we actually think about balancing between internal cues and the external thought processing? Doing so will help you decide if you should or shouldn’t go.
Should you urge suppressions?
What happens if you experience really strong urges and are running to the bathroom to make it in time? Consider trying some urge suppressions.
- Count backwards from 100 by 7s
- Wiggle your toes (toes and bladder are near each other in the brain)
- List off groceries, to-do list, trees, birds, countries
- Go through the ABCs with a theme/categories
The idea is to decrease the intensity of the urge or stop it completely. Then, decide if it feels like an appropriate time to go. Does it feel like “yes, this urge makes sense, my bladder is probably pretty full?” Then, once the urge intensity has decreased, go ahead and CALMLY head to the bathroom.
It could feel the opposite. This would feel like a trigger causing the urge and not actual fullness or irritation. If that’s the case then go ahead and suppress the urge and continue on with what you were doing. Trust that when the bladder fills more, you will once again get the urge. You can also reference the clock for a rough time frame of when you might want to go.
10 physical therapy tips to help urinary urgency
- Drink enough fluids. Drinking plenty of water helps to keep your bladder healthy. This can reduce the need to urinate a lot.
- Limit caffeine. Too much caffeine can be irritating to your bladder. This can increase urgency.
- Avoid alcohol. Alcohol irritates your bladder and cause more frequent or urgent urges.
- Go when you need to go. It is important not to ignore the urge when you feel it. Rather, go as soon as possible so that you don’t risk having an accident later on.
- Schedule regular bathroom trips. Try scheduling regular times throughout the day for bathroom breaks. This will help you maintain control of your bladder muscles and avoid accidents.
- Increase your fluid intake. Slowly increase the amount of fluids you drink throughout the day. This can help to prevent bladder problems like urgency.
- Practice pelvic floor exercises like kegel exercises. Strengthening your pelvic floor muscles through exercise can help to reduce bladder urgency.
- Avoid smoking. Smoking is harmful for many reasons. It also contributes to bladder irritation, so avoid it.
- Wear absorbent clothing. Wear absorbent clothing such as cotton underwear and breathable pants.
- Seek professional help. If at-home remedies are not helping, seek the advice of a medical professional. Pelvic floor physical therapy is one potential treatment option.
Additional treatment options
Another method for treating urinary urgency and other types of urinary incontinence is electrical stimulation.
Electrical stimulation involves applying electrical currents to the nerves in the bladder. This is done with a device placed on the skin near the pelvic area.
This helps strengthen urinary control by stimulating specific nerve pathways. It also improves coordination between the bladder and urethra muscles. The stimulation helps to reduce sudden muscle spasms that can cause leakage of urine. Electrical stimulation may treat a variety of urinary conditions, including stress and urge incontinence.
The takeaway on urinary urgency and physical therapy
Try to balance the timing of your voids (2-4 hours) with good hydration habits. That means a steady intake of water throughout your day and what your body is telling you (urge sensation). Drink about 6-8oz of water between voids.
You’re definitely going to pee more when you’re pregnant, keep that in mind! Postpartum, you may need to retrain your bladder’s awareness of filling and urges. Remember, it’s a balance between internal cues and thinking.
Physical therapy for urinary urgency
Sometimes intense or frequent urges may come with pain or leakage. Physical therapy for urinary urgency is a great option for treatment. If your urge comes with pain, you may want to work with a pelvic PT or a urologist or urogynecologist.
Providers can help rule out any underlying diagnoses or infections. If your urge comes with leakage a pelvic PT can help! A PT can determine if it relates to a tight pelvic floor that needs help relaxing or a weak pelvic floor that needs strengthening. It may also be a combination that needs help with coordination and timing.
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