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What is Urge Urinary Incontinence?

When you get the urge to go and you can’t find, or get to, the bathroom in time, you might notice you have a little bladder or urine leak. These unintended leaks are the main symptom of Urge Urinary Incontinence. Urge Urinary Incontinence (also known as UUI, urge incontinence, overactive bladder, and OAB) is a dysfunction of your pelvic floor, which simply means that the muscles of your pelvic floor are not as strong as they could be (didn’t know you had muscles in your pelvic floor, you might want to check this out: Pelvic Floor Anatomy, Or “Forget Leg Day, Don’t Skip Pelvic Floor Day”).

The other common symptoms of urge urinary incontinence and OAB is having to urinate too frequently. You should be able to hold your urine for 2-3 hours during the day (make sure you are staying hydrated) and you should be able to go all night without having to wake up to urinate. If you cannot do these things, it is a good indication that you have pelvic floor dysfunction, which might include urge urinary incontinence. If you are 55 years old, or older, or pregnant then you get a pass on waking up once per night to urinate, but if you are younger, you shouldn’t have to wake at all during the night.

What is Urge Urinary Incontinence (AKA Overactive Bladder)?

Urge urinary incontinence or “urge incontinence” is that sudden feeling you get of needing to go to the bathroom, right now. You might be saying to yourself, “I have to go to the bathroom, again?!” The bladder leaks that follow the feeling of urgency, are the component we formally call urge urinary incontinence. When you are urinating too frequently, we call this component overactive bladder syndrome (OAB). Because the outcome of needing to go and ultimately bladder leaks are so similar, they are often grouped for both the discussion and treatment of overactive bladder syndrome and urge urinary incontinence.  

A normal frequency of urination is going every two to three hours. When you are going more frequently than this, for example, every 15 or 30 minutes, that's not normal. It means your bladder isn't as strong as it needs to be, which is a symptom of overactive bladder. When you have urine leaks because you cannot make it to the bathroom when you have the urgency is "urge urinary incontinence". Both OAB and urge urinary incontinence can be treated with Pelvic Floor Physical Therapy.

What is Happening during Urge Urinary Incontinence?

The sensation you are having related to needing to go is due to two sets of muscles in your pelvic floor; your detrusor muscle and your levator ani. Your bladder is like a balloon that fills with urine, your detrusor muscle makes up the wall of your bladder, this is what you would think of as the wall of the balloon. Below the bladder, sitting like a sling or a hammock, are your levator ani muscles.

When you have the urge to urinate, the muscles around your bladder, the detrusor muscles in particular, are contracting. These muscle contractions are what cause the sensation of needing to go to the bathroom and their activation is what ultimately causes you to leak. What should happen when you have the urge to urinate is that the muscles below your bladder, that is the levator ani muscles, should prevent the leakage of urine. But bladder leaks occur when the muscles around your bladder overcome the strength of the muscles underneath your bladder.

When your levator ani muscles are not as strong as your detrusor muscles, it allows your detrusor muscles to overpower them and causes the bladder leaks that are symptomatic of overactive bladder and UUI.

Your bladder is like a balloon, your fingers pinching the end are like your Levator Ani muscles preventing the leakage while your bladder/balloon tries to contract. If you cannot pinch hard enough to hold your urine in, you are going to leak.

What Causes Urge Urinary Incontinence?

Urge urinary incontinence is caused by your detrusor muscle squeezing on your bladder too frequently. Did you know that there is a muscle around your bladder? It is called your Detrusor. When your bladder expands, your detrusor muscle should signal to your brain that “Hey, I have to go to the bathroom.” When this happens it is called urgency, the feeling of needing to go. When your bladder that then is telling you that too often that is overactive bladder syndrome.  When your detrusor muscle is squeezing around your bladder and your pelvic floor muscles, below the bladder, are not strong enough to overcome the urgency that you're feeling from the bladder being expanded then you leak.

You might think that solution to bladder leaks is going more often, but you would be wrong. The bad thing about emptying your bladder too frequently is that your bladder is itself a muscle and it's a pouch, when you start emptying it too frequently it's not used to being as expanded. This makes you have urgency quicker than you should because your bladder is actually starting to shrink. So, you don't want to get into the habit of emptying your bladder too frequently because you actually shrink the size of your bladder, and you cause yourself overactive bladder symptoms and can also contribute to leaking urine with urgency or “urge urinary incontinence.”

What Makes Urge Urinary Incontinence Worse?

The number one thing that makes urge urinary incontinence and overactive bladder syndrome worse is peeing more frequently. The more frequently you pee throughout the day, the small your bladder is getting and you are worsening your overactive bladder.

Most likely if you're going to the bathroom more than every two to three hours your bladder is lying to you and you don't really have to go that frequently. There are a couple of caveats, alcohol and caffeine will make you go a little bit quicker; they are bladder irritants. But if you are not drinking caffeine or alcohol and you're peeing more than every 2-3 hours it's too much. Another thing you may be doing that will make your urge urinary incontinence worse is when you are doing your Kegels, but you are not relaxing your pelvic floor muscles, you are not letting go of your Kegel. You can actually be making your pelvic floor muscles too tight, which will lead to a worsening of your urge urinary incontinence and overactive bladder symptoms.

What is the Treatment for Urge Urinary Incontinence?

The latest research into the treatment of urge urinary incontinence indicates that when your Kegel muscles become stronger, you can actually decrease the spasm or contraction of the detrusor muscle and helps overcome urge urinary incontinence. Pelvic Floor Physical Therapy will do a few things that to support your Kegel Muscles.

Emptying Schedules and Voiding Schedules – How often are you actually emptying your bladder?

A Pelvic Floor Physical Therapist may have you fill out a bowel and bladder schedule (sometimes called a void schedule) to track how often you are going to the restroom. Remember that going to the bathroom too often is one common symptom of urge urinary incontinence, so knowing how often you are going to the restroom (and sometimes how much you are going when you use the restroom) can be a really helpful measure of whether treatment is working or if you need to be placed on a voiding schedule.

Because when your bladder is contracting, it is a signal to the brain that makes you think you need to go to the bathroom, a pelvic floor physical therapist may also want to know how often you are having urges to go to the bathroom even if you do not go and do not have any bladder leaks. If you are going to the bathroom frequently because your bladder is contracting, the reality is that the signal to your brain is occurring prematurely and your bladder needs to fill more. It should be noted that you may still be able to push a little urine out even if it has been less than 2 hours since you last visited the bathroom. This is because your bladder retains a little urine (about 200mL, or a little less than a cup) even when you think you have fully emptied it.

As a component of your voiding schedule, your pelvic floor physical therapist may also ask about  your bowel movements. We also want to know about your bowel movements because your bowels can have an impact on your need to urinate. If your bowels are full, there is going to be less room for your bladder to expand, which means fullness of your bowels can irritate your bladder and may contribute to your detrusor muscle contracting.

How to Treat Urge Urinary Incontinence?

When a pelvic floor physical therapist is going to treat you for urge urinary incontinence, we want to make sure you can contract and relax the pelvic floor muscles. That is, we want you to be able to Kegel and de-Kegel. Your pelvic floor muscles are what you sit on, and these muscles have to both contract and relax. When your bladder muscles are stronger than your pelvic floor muscles that is going to cause you to have bladder leaking with urgency. So, we want to make sure that your pelvic floor muscles are healthy, which means your muscles are both strong and flexible. Over tightening of your pelvic floor muscles can also contribute to your urge urinary incontinence; we have to make sure that you can both contract your pelvic floor muscles and relax them. Research hasn’t quite given us as to why over tightening of the pelvic floor contributes to urge urinary incontinence. But I believe that when your pelvic floor muscles are strong enough to get better control it helps to decrease the spasming of your bladder muscles, and the spasming of your bladder muscles is a lot of times what is causing the urge urinary incontinence. And all of this bears out in my own treatment of people with urge urinary incontinence that when their pelvic floor muscles are strong they can overcome the urgency and they don’t leak.

So, in Pelvic Floor Physical Therapy, we work a lot on getting your pelvic floor muscles stronger, getting your core muscles stronger, and getting your hip muscles stronger but also more flexible because truly healthy muscles are strong and flexible unhealthy muscles are tight and weak. So, we have to work on both strength and flexibility of your pelvic floor, hips, and abdomen to make sure everything is healthy.

Proper Pelvic PFM Contraction

  1. Doing a proper kegel

    1. When you kegel, one visualization technique your pelvic floor physical therapist might employ is lifting the elevator. This is because you are contracting the levator ani muscles by lifting them. Teaching you how to control your levator ani muscles, the muscles underneath your bladder, is a key component of strengthening your pelvic floor muscles. By strengthening the levator ani muscles, they can overpower your detrusor muscle, thus prevent the leaking and help reduce the urgency.
    2. We are not exactly sure why, but the most up-to-date research says that stronger your pelvic floor muscles, the less your urge will be.
    3. When your pelvic floor muscles are strong, the better control you have of them, and the less you experience the urge to urinate. You can overpower the urge by inhibiting overactivity of the detrusor muscle and you don’t have your OAB anymore.
  2. Supporting your hips, low back, and buttocks

    1. When you use any muscle, there are other muscles that can help support that contraction and relaxation of that muscle. Your pelvic floor muscles are no different. In the case of your pelvic floor muscles, your hips, low back, and buttocks are supportive, but that does not mean they co-contract. You have to differentiate your pelvic floor muscles to be able to coordinate a proper contraction.
  3. Coordinating Your Breathing

    1. Breathing is a key component in all major body processes, but it is especially important in coordination of your pelvic floor. Proper coordination of your breathing allows you to fully empty your bladder and fully strengthen your pelvic floor muscles. Improper or paradoxical breathing can lead to both urine retention and urine leaks.

How Urge Urinary Incontinence & Overactive Bladder Impact Quality of Life?

Going to the bathroom all the time because of urge urinary incontinence or overactive bladder is no fun. Having to find a bathroom every 30 minutes or 15 minutes or having to know every stop along the way from your house to your work is really inconvenient. It takes up too much time; I've got too many things to do to worry about having to find a bathroom all the time.  It’s a real drag on people's quality of life. It keeps you from traveling, from doing the things you love to do, and it's just not not fun. The leaking portion, if every time you have urgency you are scared you are going to leak urine or pee your pants, you are probably using pads or incontinence products. There is a huge cost of urinary incontinence products all of those those pads and those depends cost money (over $900/year on average, that’s easily a nice weekend trip). Medications cost money too (as much as $400/month here in Oklahoma City), so it can really just not be fun for people. Have a Leak Free Life! Be able to hold it until it's convenient for you to find a bathroom

Seek out help from a physical therapist or come see us at FYZICAL Oklahoma City.

Who Suffers from Urge Urinary Incontinence?

While stress urinary incontinence is far more common in women than men, both men and women suffer from urge urinary incontinence. However, as is the case for all pelvic floor dysfunction, women suffer from overactive bladder or UUI more often than men. Men do suffer from urge urinary incontinence more often than they suffer from stress urinary incontinence, though. Additionally, while anyone can suffer from urge urinary incontinence, it is more common in middle aged to the later decades of men and women.

Women who are pregnant or have already had babies are at a greater risk for developing urge urinary incontinence. And anyone who has trained their bladder to urinate too many times throughout the day.

When it comes to pelvic floor dysfunction, urge incontinence is pretty much an equal opportunity offender.

Urge Urinary Incontinence is a pelvic floor dysfunction affecting both men and women. Urge urinary incontinence is characterized by a strong sudden feeling of need to urinate, this is the “urge” to go. But it is not something you have to suffer with. A pelvic floor physical therapist can help reduce the urge and help you love your life.