Bladder Health

Dr. Tanvi Maharaja, PT, DPT, OCS, Pelvic PT, Signature Healthcare

Urinary urgency and frequency are common symptoms that affect millions of people worldwide. These symptoms can be very disruptive to a person’s daily life and can have a significant impact on their quality of life. 

Urinary urgency is the sudden, intense urge to urinate. It can be difficult to ignore, a common example being latchkey syndrome. Latchkey incontinence is the sudden strong urinary urge as soon as you open the door to your home, resulting in the need to rush to the bathroom. This can also happen when pulling into the driveway. It can be very distressing, especially when it results in urinary leakage, which is known as urge incontinence. 

Urinary frequency is the need to urinate more than 7-8 times a day, on a consistent basis. This can include waking up multiple times at night to use the bathroom and is particularly concerning for the elderly as it can result in falls. Given age-associated bone health issues, falls can result in fractures and trigger a domino effect of devastating consequences.

These bladder symptoms can be caused by certain medical conditions such as overactive bladder syndrome, urinary tract infections, peri- or post-menopause (lack of the hormone estrogen in the female body), interstitial cystitis, and prostate problems. Other causes may include lifestyle factors, such as consuming too much caffeine or alcohol, taking certain medications, or not drinking enough water.

To manage urinary urgency and frequency, it is important to identify the underlying cause of the symptoms. If it is caused by a medical condition, treatment will focus on addressing that condition. For example, antibiotics may be prescribed to treat a urinary tract infection, or medication may be prescribed to manage an overactive bladder.

Physical therapy can be an effective treatment for urinary urgency and frequency, particularly if these symptoms are related to weak or overactive pelvic floor muscles. Pelvic floor physical therapy is a specialized type of therapy that focuses on treating pelvic health conditions including overactive bladder. 

During pelvic floor physical therapy, a trained therapist will work with the patient to perform exercises that target the pelvic floor muscles. These exercises may include coordination exercises for the pelvic floor muscles and relaxing the muscles that control urination. The therapist may also use biofeedback techniques to help the patient learn to control these muscles more effectively. Management of constipation can be an important factor as it can further magnify bladder issues. Manual therapy techniques such as mobilization of any abdominal scars including C-section scars are included in pelvic PT and a therapist trained in visceral mobilization can work along the abdominal tissue to affect changes to manage bladder symptoms

Pelvic PT will also include behavioral tools such as urge suppression strategies to help manage urinary urgency. These techniques are designed to help individuals suppress the urge to urinate and delay the need to use the bathroom until an appropriate time.

Here are some urge suppression strategies that can be effective for managing urinary urgency:

Deep breathing: Taking slow, deep breaths can help to relax the body and reduce the urge to urinate. When experiencing an urge to urinate, try taking slow, deep breaths while focusing on relaxing the pelvic floor muscles.

Distraction: Distracting oneself with a mentally engaging activity can help to reduce the focus on the urge to urinate. For example, try reading a book or engaging in a conversation to take the mind off the urge.

Visualization: Imagining a peaceful or calming scene in the mind can help to reduce the sense of urgency. For example, try imagining a tranquil beach or a serene forest to help reduce the urge.

Pelvic floor exercises: Coordination, relaxation, and breathing exercises can help regulate the pelvic floor muscles to improve bladder control and reduce urinary urgency.

Foot exercises: Toe scrunches or heel raises performed 10-20 times in a row can ease urinary urgency through their effect on the common nerve roots shared by the bladder and the leg muscles.

Fluid management: Managing fluid intake by avoiding or minimizing bladder irritants like caffeine, alcohol, citrus fruits and juices, and soda, and drinking enough water to stay hydrated, can help to reduce the frequency and intensity of urinary urgency.

Other treatments in pelvic floor PT can include Trans Tibial Nerve Stimulation (TTNS). This is a non-invasive treatment option that can be effective in managing overactive bladder syndrome (OAB). TTNS works by stimulating the tibial nerve in the ankle, which is connected to the nerves that control the bladder.

It is important to work with a qualified physical therapist who specializes in pelvic floor therapy when undergoing this type of treatment. The therapist can help to design a personalized treatment plan that is tailored to the patient’s specific needs and goals. In addition, the therapist can monitor progress and adjust the treatment plan as needed to ensure the best possible outcomes and work with the entire medical team to optimize patient care.

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