It’s National Bladder Health Week and we want to dedicate this blog post to our favorite (and only) urine collecting organ! The bladder is a vessel that sits on the pelvic floor and its primary function is to collect and hold our urine. It is made out of a hollow muscle called the detrusor which stretches to allow urine to collect and contracts when it is time to urinate. Just like any other muscle in the body, it can become injured or dysfunctional when things go awry. So, in honor of National Bladder Health week, I want to highlight some of the most common bladder ailments that we encounter on a regular basis, as well as discuss how pelvic floor physical therapy can help.
Incontinence. An all too common issue that many of us deal with on a daily basis. Research has shown that anywhere from 8.5%-38% of the population experience urinary incontinence1 . However, incontinence tends to be more common among the female population; women experience urinary incontinence 75% more than men2 .
Stress urinary incontinence is the most common type of incontinence. It is characterized by urine leaks that occur with an increase in intra-abdominal pressure, such as a sneeze, laugh, cough, or vigorous activity like running or jumping. If the pelvic floor muscles are not able to contract strongly enough to resist this increase in pressure, then the result may be a leak.
How we can help:
It is important to make sure that the pelvic floor and pelvic girdle muscles have the proper strength, endurance, and control to ensure optimal muscle function. A pelvic floor physical therapist can work with you to prescribe a tailored program of strengthening exercises (beyond the ubiquitous kegel) and neuromuscular re-education of both the pelvic floor/girdle and core musculature to train these muscles how to contract appropriately and eliminate incontinence. Biofeedback is one of the many tools that a physical therapist may choose to employ to enhance a treatment program.
*As we have discussed in previous blog posts, not every person with incontinence needs to be doing pelvic floor up training/strengthening. So, check with a qualified physical therapist to determine the appropriate treatment plan for you. This post is a great example of someone who is experiencing stress incontinence, but would not be appropriate for a strengthening program.
**Pregnancy is a factor that creates many changes in a woman’s body, including increased intra abdominal pressure, increasing weight of the fetus, and hormonal changes. All of these changes put stress on the pelvic floor and increase the risk for incontinence. Over half of pregnant women have reported varying degrees of stress urinary incontinence. If you are experiencing any bladder symptoms, check with your OBGYN and a physical therapist to determine the best course of action.
Urge urinary incontinence occurs when we feel a strong urge to urinate and are unable to delay the urge long enough to get to a toilet in time. Such a strong urge to urinate can be created by tight tissues near the bladder or other various triggers. One example of a common trigger is when we get our key in the door, it has even been named it ‘key in the door syndrome’!
How we can help:
There is often both a behavioral and musculoskeletal issue happening for people dealing with this symptom. Tight pelvic floor muscles can irritate the urinary tract which can cause urinary urge that is disproportionate to the amount of urine that is actually in the bladder. Working with a PT to normalize the pelvic floor tone and make behavior modifications can be a huge factor in overcoming this issue.
Prolapse. The bladder is supported in the bony pelvis by connective tissue and the pelvic floor muscles. When one or both of these structures are unable to support the bladder, it becomes hypermobile, allowing itself to fall backwards, into the vaginal wall. When this happens, the angle where the urethra meets the bladder changes, and it becomes more difficult for the pelvic muscles to compress the urethra to stop the flow of urine. When this occurs, a person may be asymptomatic or may experience symptoms ranging from a heaviness in the pelvis to urinary incontinence.
How we can help:
A physical therapist can give instruction on a pelvic floor/pelvic girdle muscle strengthening/neuromuscular re-education program to increase support for the bladder, as well as how to use these muscles appropriately to avoid excess pressure on the pelvic floor and reduce symptoms. A person may also need to use a pessary or have surgery to correct for the degree of pelvic organ prolapse. Check out this blog post for more information.
Urgency/Frequency. Urgency is the sudden need to urinate that (as mentioned above) may cause urine to leak on the way to the bathroom. Frequency occurs when we are feeling the urge to urinate more than what is considered the norm. Normal is about 6-8 times per day or once every 2 to 5 hours. We want to strive for not waking up in the middle of the night to urinate; however, during pregnancy or menopause, one time in the middle of the night is considered “normal”. (Similar to urge urinary incontinence, urgency and frequency are often a combination of both pelvic floor muscle overactivity and behavioral factors).
How can we help:
The urge drill is one technique to retrain the bladder to reduce urgency, frequency, and urge urinary incontinence. When you feel a sudden, urgent need to go to the bathroom, do not run to the toilet. Rushing will activate your fight or flight system and increase the urge. To help control the urge, first stop and be still, as this quiets your nervous system. Then try doing 5 quick pelvic floor contractions or pelvic floor drops (relaxations). This sends a signal to your bladder to stop trying to get the urine out. When the urge is under control, slowly and purposefully walk to the bathroom to empty your bladder. Timed voiding schedules may also be necessary for those experiencing urgency and frequency.
Pain. Bladder pain (aka painful bladder syndrome (PBS) or interstitial cystitis (IC)) is a condition that can be caused by various mechanisms that presents with a range of symptoms. Different treatment plans will be successful for different people, however a very common finding in people with bladder pain is a tightening of the muscles and connective tissue in the surrounding area. Painful organs can cause painful muscles and tissues in the surrounding areas which then restrict blood flow and oxygen to that area. This further irritates the tissues and nerves causing further bladder discomfort (a perpetual cycle). Stay tuned for an upcoming post dedicated to PBS/IC.
How we can help:
A skilled pelvic floor physical therapist can help to decrease the tone of the involved muscles and tissues allowing improved mobility, blood and oxygen flow, and aid in the healing process. Here is a link for more information on PBS/IC support.
**This blog is intended to give a brief overview of some of the physical therapy treatment options for musculoskeletal factors contributing to bladder dysfunction. If any of these issues are affecting you, there is hope! Let’s seize the moment of National Bladder Health Week to get on the path of recovery! Contact your physician or physical therapist today to determine the right treatment plan for you!
Finally, check out this blog post for ideas on how to locate a pelvic floor specialist in your area!
1Ashton-Miller JA, Howard D, and DeLancey JOL. The functional anatomy of the female pelvic floor stress continence control system. Scand J Urol Nephrol Suppl 2001;207:1-7.
2Pages IH, Jahr S, Schaufele MK, et al. Comparative analysis of biofeedback and physical therapy for treatment of urinary stress incontinence in women. Am J Phys Med Rehabil 2001;80:494-502.
3Price N, Dawood R, and Jackson SR. Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas 2010;67:309-315.