Bladder (1)

Understanding and management of an Overactive Bladder often starts with a crucial dialogue on symptoms, strategies, and effective interventions in a Women's Health Physio appointment.

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    What is an Overactive Bladder?

    'Overactive Bladder Syndrome' is a term used to describe a collection of symptoms - bladder urgency, frequency of urinating, and/or needing to get up more than once in the night to urinate (this is called 'nocturia').

    You can have 'Overactive Bladder Dry' which is urinary urgency with or without the daytime frequency and nocturia, but without leakage.

    Or you have have 'Overactive Bladder Wet' which is the same, but also with the added symptom of 'urge urinary incontinence', which is where you leak urine on the way to the toilet, because of an overwhelming urge to go.

    A 'normal' bladder should tell you that it needs to be emptied approximately 5-7 times each day, should be able to hold on overnight or only wake you up once, and should give you an appropriate increase in urge to go depending on how full it is. Urgency, where you feel like you really need to rush to the toilet for fear of leakage, can be due to spasms happening in the muscles in the wall of your bladder during filling - this isn't normal.

    This is all based on a 'normal' fluid intake of approximately 1.5-2.5L of fluid intake in a 24 hour period.

    What can you do if you experience an urgent need to wee, in order to get there with control?

    Let's talk about making it to the toilet in time with you feeling in control, and decreasing your chance of leaking on the way.

    During episodes of urgency, it is understandable that you might feel a strong urge to race to the toilet. However, doing this may cause the spasms in your bladder muscle to increase, which would create an even bigger pressure and may cause leakage to be more likely.

    If you find yourself in a situation where you have a sudden urgent need to go to the toilet, instead of rushing, try the following tips instead:

    Step 1

    Stop, take a couple of breaths and stay calm.

    Understand that urges like this come in 'waves', and if you can stay calm during the peak of the wave, it will be easier to get to the toilet with you in control when the wave subsides.

    Step 2

    Try one or more of the following 'calming strategies' to 'ride out the wave' of urgency. Most of these include doing something else that involves the same nerves that control bladder sensation - the thinking being that if you cause multiple inputs from the same spinal level, the brain can't 100% focus on them both at the same time, and the urgency can be dampened down.

    Different techniques will work for different people so give all of them a try to see which ones works best for you.

    • Curl your toes

    • Rise onto the balls of your feet

    • Apply pressure to your perineum, vulval or clitoral area - for example, using your hand to place an upward pressure against perineal/vulval area, sitting on the heel of your foot, or sitting on the corner of a table or arm of a chair

    • Contract your pelvic floor. You can either try holding on while you count 8 or 10 seconds, and do a few repetitions of this, or you can try a few 'quick flicks' on and off for 5-10 reps, and see which is best for you. Ensure that afterwards your pelvic floor completely relaxes again

    • Rub your sacrum with your fist (above your tailbone)

    • Apply pressure above your top lip with your finger

    • Apply gentle pressure to your lower tummy, just above your pubic bone

    • Distract your brain - Try to count backwards from 100, or distract yourself with another mental task

    Step 3

    Wait until the urge has subsided and slowly walk to the toilet.

    What steps might be involved in Physiotherapy Management of an Overactive Bladder?

    If you'd like help with managing Overactive Bladder symptoms, Women's Health Physiotherapists can help.

    After initial investigations such as completion of a 'bladder diary' and a pelvic floor assessment, the following is an example of what might be included in a management plan:

    1. Fluid intake modifications

    2. Bladder habit modifications

    3. Teaching Bladder Calming Strategies (see above!)

    4. Pelvic Floor Exercises

    5. TENS for calming an overactive bladder

    If you'd like to book an appointment with one of the Women's Health Physio's at FitRight HQ, click this link.

    What about medical management of these symptoms? Should you see a doctor?

    Sometimes the physiotherapy strategies above are just one piece of the puzzle - often Overactive Bladder Syndrome requires medical input as well.

    We are lucky enough to work alongside a team of Women's Health GP's at FitRight HQ.

    You can book a Women's Health GP appointment here.


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