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 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.

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.

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.

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.

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.



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