By: Melinda Fontaine, DPT, PHRC Walnut Creek
You know that feeling when you just drank the equivalent to a big gulp and you haven’t had a bathroom break in over four hours. That sensation of your body telling you to get to the bathroom ASAP is called “urgency.” In case you wonder if urgency and the frequent need to urinate are common problems, look at the number of apps available for finding the nearest restroom. In the above scenario, it is natural and expected, but what if you felt that same sensation when you have not had a lot to drink and you have emptied your bladder recently? You may feel fine one moment, and then you suddenly have the urgent need to go. This is a red flag that something is out of sync in the body. Urinary urgency and frequency is a very common symptom that our patients report here at the Pelvic Health and Rehabilitation Center. Let’s go over some causes and solutions as this is a very common and treatable problem.
Possible Cause: Bladder irritants
It might be what you put in your body that is making your bladder act up. The inner lining of your bladder, the part that comes in contact with the urine, is sensitive to urine that is very acidic or very concentrated. When one of these irritants is present, then the bladder tries to get it out quickly by squeezing, and that creates the sensation of having to urinate. Common bladder irritants include citrus, caffeine, tomatoes, vinegar, carbonation, artificial sweeteners, alcohol, spices, and chocolate. Caffeine and other diuretics make the body create more urine, and they can lead to urgency because the bladder fills up quicker.
Being dehydrated means that the bladder may have a smaller amount of urine, but it is more concentrated and usually a darker color. This is also irritating to the bladder making it want to get rid of the contents quickly. Though it sounds counter intuitive, drinking a good amount of water throughout the day can actually help avoid going to the bathroom too often.
Some products help coat the lining of the bladder and protect it from reacting to common irritants. These products include aloe vera, marshmallow root, Prelief, and Azo.
An infection can also create urgency, and should be ruled out with a urine test because the symptoms of an infection and any of these other situations can be identical.
Possible Cause: Tight tissues
Typically, when the bladder fills up and gets heavy, it weighs down on the structures around it. The stretch receptors in the muscles get activated and send a message on a nerve to the brain telling you to find a bathroom. If the muscles and fascia around the bladder are already tight or restricted, then the stretch receptors can activate the messaging system to tell you to go even if the bladder is not full.
In some situations, especially when dysfunction has been present for a long time, the body may have made more nerve endings and more sensitive nerve endings around the bladder. When they each send a message to the brain, the brain gets a lot of signals. The brain interprets the large number of signals as meaning there is an urgent need to empty the bladder, so it creates an intense sensation of having to go. Luckily, the increased sensitivity of these nerve endings is reversible. Pelvic floor physical therapists know a number of ways to retrain the nervous system, which I will describe below.
Possible Cause: Urinary Retention
Sometimes, the body has an urgent need to urinate, but then not much urine comes out. This leaves us wondering, was the sensation of urgency an exaggeration of the nervous system, or did the bladder not fully empty? We just talked about the first possibility, but what about the second? Retention is when not all the urine comes out when you urinate, leaving a large volume still in the bladder. Not only is this uncomfortable, because it will make you have to pee more frequently, but it also puts you at a higher risk for a urinary tract infection. Retention can be caused by restricted muscles and fascia around the bladder and urethra that do not allow the bladder to empty completely, and can be treated well with physical therapy.
Possible Cause: Constipation
Did you know that constipation can lead to urinary symptoms, including urgency, frequency, and even incontinence? The rectum and bladder are so close together in the pelvis. A full rectum can squish a bladder and make the bladder want to empty. Treating the constipation can alleviate urinary urgency. For more information on constipation management check out this blog.
Possible Cause: Hormonal Deficiencies
Hormones can get out of balance from a number of situations including oral contraceptive use, perimenopause, or menopause. The bladder has specialized receptors for estrogen and rely the hormone for normal bladder function. When estrogen levels get low, these sensitive tissues become compromised and create urgency. Bringing this up to your doctor will help you find out if hormones are to blame for your urgency and what can be done about it.
Solution: Urge drill
In the same way that fire drills teach us what to do in case of a fire, it is handy to know the urge drill. When you feel a super strong urge to go to urinate, our tendency is to rush to the nearest bathroom. When the urge is strong, your body is employing the fight or flight system that makes your bladder contract to push urine out. I guess if your body thinks you are going to be running away from a mountain lion, then it might be useful to have an empty bladder. Running to the toilet reinforces this behavior and makes the bladder continue to squeeze. On the contrary, slowing down to breathe and calmly walking to the toilet makes the bladder less likely to squeeze and can decrease the urgency you feel and the likelihood of not making it to the toilet in time. Doing some quick pelvic floor contractions or relaxations or both can send a message to the bladder to stop squeezing as well. Also, distracting yourself can decrease the urge because your brain will prioritize something else over having to get to the toilet. Some ideas for distractions: curling and uncurling your toes, naming every green vegetable that you can, or singing a song in your head. Waiting until the urgency has somewhat or completely subsided before peeing can teach the nervous system not to overreact to a slight pressure on the bladder. Over time, this can lead to less urgency.
To review the urge drill, when you feel urgency:
Stop and breathe
Do a couple pelvic floor contractions and relaxations
Distract yourself
If needed, slowly and calmly walk to the bathroom
Solution: Pelvic Floor Physical Therapy
How do you retrain the nervous system? Is it like training a puppy? Pelvic physical therapists have many techniques, such as the urge drill, to adjust the way you think about using the bathroom. This teaches the brain how to have an appropriate response. For example, when you use the urge drill successfully, you wait to urinate until the urge has decreased, and this reinforces to the brain that it does not need to create so much urgency the next time.
Pelvic physical therapists can also use myofascial release on tight tissues around the pelvis. Manual therapy creates more length and flexibility in the tissues, so they are less likely to create a false sense of urgency. Therapists can also walk you through appropriate diet and lifestyle modifications and much more.
Check out our services see if a pelvic floor physical therapist can help you!
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.