Urinary Urgency

bladder dysfunction diagram

What is urgency?

Urgency is described as the feeling of a strong, sudden need to urinate. Sometimes this is accompanied by urge incontinence, where you leak some urine before you have time to reach the toilet. If you experience urgency, you may also find that you frequently go to the toilet during the day and several times during the night.In a properly functioning bladder, the bladder muscle remains relaxed as the bladder gradually fills up. When the bladder is about a third full, we get a feeling of wanting to pass urine. In most people, this initial urge passes, and we can hold on until the bladder nears fullness and it is convenient for us to go to the toilet. However, if you are experiencing urgency, the bladder may feel fuller than it actually is. This means that the bladder muscle contracts too early when it is not very full, and not when you want it to.

Why do I get it?

The cause of urgency is not fully understood, however it seems to become more common as we age. Symptoms may get worse at times of stress and may also be made worse by alcohol or caffeine in tea, coffee and fizzy drinks.

Urgency can be linked to stroke, Parkinson’s disease, multiple sclerosis and other health conditions which interfere with the brain’s ability to send messages to the ladder. These conditions can affect a person’s ability to hold and store urine.

Urgency may also occur as a result of constipation (not being able to empty the bowel or having difficulty doing so), an enlarged prostate gland or simply the result of a long history of poor bladder habits. In some cases, the cause is unknown.

How do I fix it?

A bladder training program designed for you by a Pelvic Health Physiotherapist can assist in reducing your urgency and any leakage you may experience. Such a program will help you regain control over your bladder – gradually increasing its storage capacity and reducing the amount of times you need to go to the toilet at night and during the day.

The program will involve implementing Bladder Calming Techniques (see below) when you feel your urgency come on. You will use these techniques for a specified time period until the urge passes. You will then slowly walk to the toilet to empty. With time and practice you will learn how to defer your urge and hold on up to half an hour or more.

Bladder Calming

In addition to your bladder training program, your Women’s Health Physiotherapist will teach you Bladder Calming Techniques that help ‘distract’ you whilst your bladder is filling up. These techniques block some of the messages that tell your bladder you need to go to the toilet, reducing discomfort and urgency.

They include:

  • Deep breathing – focus on slowing down your breathing, taking big breaths in and out
  • Perineal/Vaginal pressure – sit on the edge of a chair or on a rolled up towel
  • Toe Curling – repeatedly curl up your toes and relax
  • Calf stretching – stretch against a wall
  • Pelvic Floor exercises – squeeze and lift your pelvic floor muscles
  • Trigger points – apply firm pressure to your top lip, on the inside of your ankle, or above your pubic bone
  • Controlled walking – walk slowly, focus on the heel-toe action
  • Distraction – think about something else. Try counting back from 100 in 7’s.

What else can I do?

Lifestyle factors that help to improve urgency include:

  • Decreasing the amount of caffeine (tea/coffee/fizzy drinks), alcohol & sugar in your diet
  • Avoiding constipation
  • Only going to the toilet when you really need to
  • Maintaining a healthy weight range
  • Exercising your pelvic floor
  • Drinking 1.5 – 2L of water per day

But it’s not getting any better?

You may not notice an improvement immediately, but gradually you will become aware of not having to go to the toilet as often, being able to stop yourself going, passing more urine each time you go, having less urgency, and not getting up to the toilet at night time.

Bladder training takes time. You may have good and bad days. Persevere and you will eventually be the boss of your bladder.

Despite best efforts, in a few cases, the bladder will not respond to the program. In these cases, some medications, prescribed by the doctor, may assist. If you decide to take medications it is still important to continue your bladder training strategies.