Have you ever noticed that you have to go to the bathroom at the same time each day? For example, as soon as you arrive home from work or errands, suddenly an urge hits you that wasn't there before?
We train our bladders when we are potty-training as young toddlers, teaching our pelvic floor to assist us in holding back until we reach the toilet. In the cases of urinary incontinence, especially over-active bladder, this isn't always the case. What once was us controlling our bladder has become our bladder controlling us.
The good news is that we can retrain our bladder overtime to help reduce or completely eliminate our experience of urge incontinence.
The American College of Obstetricians and Gynecologists (2014) state treatment for UI (urinary incontinence, both stress and urge) should begin with conservative treatment first. Conservative treatment includes behavioral modifications and pelvic floor physical therapy.
The aim of this blog post is to cover behavioral modifications associated with improving urinary incontinence, however it does not take the place of actual medical care. When you go to pelvic floor physical therapy, your PT should work with you to develop a plan of care that is fit to your needs and goals.
Tip #1: Stop going to the bathroom "just in case".
One of the most common pieces of age-old advice is to go to the bathroom before you leave the house, just in case. The problem with this behavior is that by going to the bathroom when you do not actually need to teaches your brain and bladder that it is okay to give you the signal to urinate before your bladder is actually full. Our brain should only signal us to urinate when the bladder is reaching full capacity. So by going to the bathroom when our bladder is only 20% full, for example, teaches our brain that it should tell us to head to the toilet at 20%.
This is similar to new behaviors developed in the work-from-home era of the pandemic. Suddenly it's easier to get up and go to the bathroom more frequently. Clients have expressed that they increased their voiding habits just because the bathroom was right there, and it was a good excuse to get up once per hour. Fast forward to your brain taking the hint, and now telling you each hour you HAVE TO GO, when really you don't.
The Fix: If you've developed urinary frequency, feeling like you have to go a lot more often than you once did, try this:
Determine the average length of time between when you are getting the signal to urinate. Let's say, for example, it's 45 minutes.
Gradually increase the time you wait to go to the bathroom from 5-15 minutes at a time. Instead of 45 minutes, aim for every 60. Once you've tackled that, and can now comfortably wait 60 minutes, aim for 75 minutes etc. The average length of time for an adult without urge incontinence is 2-5 hours, so that's the range you're aiming for.
*If you experience moderate to severe urgency: As you gradually increase the time, stick to that voiding schedule. Every 60 minutes (as per the example) go to the bathroom and urinate whether you need to or not. *Do not do this in the middle of the night.
If you feel a strong urge to go between your scheduled times, do this urge suppression technique:
Stop what you're doing, sit down, and squeeze. Also known as the "freeze and squeeze" method where you squeeze your legs together or put pressure on the pelvic floor to help counteract the need to go.
Relax and take deep breaths. Try to distract yourself. Rushing to the bathroom is the worst thing you can do. Distractions: get on Facebook or Instagram, play a quick game on your phone, count backwards from 100 by 7, pretend you're driving and you cannot stop somewhere.
Do small kegel contractions. Doing hard, intense contractions may make you leak. Your pelvic floor physical therapist will teach and guide you on how to correctly perform a kegel, as doing it wrong is counterproductive.
Tip #2: Drink an adequate amount of water; and sip on water throughout the day versus chugging it.
Most individuals that experience over-active bladder / urge incontinence tend to limit their fluid intake, assuming that by drinking more will make them have to go more frequently. However, severely limiting fluid intake, especially of water, can make the urine more concentrated which is irritating on the bladder.
When our bladder is irritated, it can make us experience even more of an urge to urinate.
The recommended water intake is 1/2 oz of fluid per body weight in pounds, or 6-8 glasses of an 8 ounce cup.
Tip #3: If you experience moderate to severe urgency, consider the role of your dietary habits with your symptoms. Certain foods and beverages, especially acidic and caffeinated, can increase the urge to go as they irritate the bladder.
Here is a list of the most common irritants, as listed by Johns Hopkins.
To determine whether or not certain foods or beverages bother you, take note of when your symptoms worsen and what foods / drinks you had shortly beforehand. Try cutting out that particular item for one week and re-evaluate your symptoms. Consider if having that food in your diet is worth the symptoms you experience, or if you feel you can do without.
Sometimes it's really hard to cut out the foods though, and that's completely understandable! If you really want that piece of chocolate, try sandwiching it with water. Drink a glass of water before the chocolate and afterwards to reduce the irritation impact on the bladder.
Tip #4: Increase your daily exercise, even if it's just walking for 15-20 minutes. Mild to moderate exercise has been shown to decrease urinary incontinence (Bo 2019). If you're experiencing incontinence when working out, however, such as leaking at the bottom of a squat or during a run, this is especially the time to enlist the help of a pelvic floor physical therapist.
TLDR:
Over-active bladder / urge incontinence is a learned behavior. You can retrain your bladder to improve your symptoms and quality of life.
Tip #1: Stop going to the bathroom "just in case".
Tip #2: Drink enough water, but sip it throughout the day vs chugging it. Limiting water intake makes urine more concentrated and therefore irritating to the bladder. This can make the feeling of urgency worse.
Tip #3: If your urgency is moderate to severe, consider the role of your diet in your symptoms. Foods and beverages that are more acidic and caffeinated tend to be culprits of urgency and irritation.
Tip #4: Exercise! Mild to moderate exercise has been shown to decrease urinary incontinence.
About the Author:
Caroline Gamwell, DPT is a Doctor of Physical Therapy, specializing in Pelvic Floor and Women's Health. She is the founder of Worth It PT based in Denver, Colorado, a clinic whose focus is to help others achieve their health and wellness goals through a higher quality of healthcare.