5 Tips to Tame Your Bladder

If you find yourself…

• Frequently interrupted by the urge to jet to the toilet
• The sense that you gotta get there right away, or you are going to leak!
• When you do go, it seems like there’s only a dribble
• Feeling like you spend half the day running to the toilet

…then these tips are for you!

Bladder urges are important to us! There is a pretty cool communication network happening between our brains, our bladder and our pelvic floor muscles. When our bladders and pelvic floor muscles are functioning optimally, the bladder fills with urine and when it reaches a certain threshold, the smooth muscle of the bladder wall give us a squeeze. This signal is sent up to our brains and we experience this as that urge sensation. Like an alarm, this system alerts us that it is time to find a toilet. Our pelvic floor muscles then activate, helping us to control our continence and telling our bladder to cool its jets. When we engage our pelvic floor muscles, this cues the muscles of the bladder to relax and that urge sensation subsides for abit so that we can find a toilet. If we get distracted along the way and don’t find that toilet, our full bladder will give us another little squeeze and the whole cycle will start again until we take care of business.

What are some things that can go wrong with this pretty incredible system?

We encounter challenges when the cross talk between our brain, our bladder, and our pelvic floor gets really noisy. The urge alarm can become hypersensitive and active even when the bladder isn’t necessarily at its capacity.

While this is not an exhaustive list, here are some pretty common ways that this system gets noisy…

Pressure on the bladder: Constipation, menstruation, and prolapse are some factors that can contribute to pressure and ramp up urge sensations

Nervous system arousal: When we are anxious or stressed, this communication pathway can become very noisy and very sensitive, sounding that “Urge Alarm” more readily. We also hold more tension in our muscles, which can contribute to pressure around the bladder

Connections develop & build over time: If the urge sensation strikes when under stress, anxiety about getting to a washroom or having a leak can feed the tension, stress, and urge sensation cycle even further

The “Just in Case” Pee: An unfortunate consequence of this habit is that the bladder gets accustomed to holding less and less urine. It starts to forget its true capacity and will start to give you that squeeze when it is less and less full, thus unintentionally training it to set off that urge alarm more readily

An irritated bladder: Limiting fluids is another common way that people try to cope with urgency and frequency. Dehydration can also cause the bladder muscles to become irritated. Beyond hydration, certain foods and beverages tend to irritate the bladder as well

My Top 5 Tips for Taming an Overactive Bladder

1. Manage the Pressure

It can be really helpful to first address any challenges with constipation. Work with a health care provider to tease out the factors that might be contributing to your constipation (diet, hydration, habits, pelvic floor muscle tension). If you are navigating Pelvic Organ Prolapse, it might also be helpful to address how best to support your POP with a pelvic floor therapist. Gaining more agency over these challenges can have a huge spill over effect to improving your bladder urgency!

2. Stay Hydrated

Staying hydrated is about more than just getting a certain amount of water into your system before the end of the day. Many people try to rely on the strategy of chugging a whole bunch of water a couple of times throughout the day. Turns out, our bladder is not a huge fan of this strategy. It becomes flooded, overwhelmed, and just wants to dump it right back out again. When we work on sipping water abit more regularly throughout the day, our whole bodies get to process and use much more of it to our advantage and our bladders feel more in control of the load we are providing.

3. Be Mindful of Bladder Irritants

Being mindful of and starting to limit or eliminate bladder irritants can also be a really effective step towards taming your bladder. 

Let me acknowledge that making these changes can be tough. I don’t know about you, but I am VERY attached to my morning cup of coffee and would have a really hard time cutting coffee out cold turkey. It can be really helpful to start with the ones that you don’t have a strong attachment to and then consider, with the others, what a reasonable goal for you is. Perhaps, for you, it is about cutting back just a little bit and curiously tuning in to see how your bladder responds to that. You might find that your body is more sensitive to some irritants and less sensitive to others.

Depending on the severity of your symptoms, and how big an impact it is having on your quality of life, it may not be necessary to cut out or cut back on all of these. Experiment! Ultimately, you get to decide what your body can manage and the changes that are worth making.

If you are interested in reading more about Building Healthy Habits to Support Your Pelvic Health.

4. Retrain the Bladder

First…reduce your use of the “Just in Case Pee”. It can be tough to cut this out cold turkey, especially if this is a strategy you’ve been relying on for a really long time. It can be helpful to start with small, accessible challenges and work your way up. You might start with cutting it out before short outings but still leaning on this approach for long road trips. Work your way up-challenging your bladder to hold more and more as your confidence and your bladder’s confidence in its capacity, builds back up!

Second…when the urge strikes and it has not been that long since your last void, try to hold off! Again start with small challenges (i.e. start when you are in the security of your own home) and work your way up to the scenarios that are tougher for you. You can use some of these tried and true urge delay tactics…

• Distraction: Notice the urge, but then bring your attention elsewhere. Return to the task at hand or try thinking about something else for a brief period. Every so often, bring your attention back to your bladder checking in to see if the urge is still there or if it has subsided
• Relax your body: Take a few deep breaths, notice where you might be holding tension in your body and see if you can allow it to melt away. You might even imagine yourself in your “happy place” seeing if you can bring about a sense of calm in your body
• Do a couple of quick pelvic floor muscle contractions: Recall that this cues the bladder to relax and can be a really powerful way to delay voiding
• Do a couple of quick calf raises: Fun fact-the nerve that controls the bladder also has a connection to the calf muscles. Calf raises can also cue the bladder to relax. This is a great strategy, especially if pelvic floor muscle contractions aren’t accessible to you just yet

5. Involve your Brain!

THIS IS OFTEN THE MISSING LINK! Sometimes folks are using ALL of the delay tactics but still report “it’s just not helping” or “the urge just keeps getting stronger the more I try to avoid it!”.

Remember that when our bladder has become overactive over time, connections start to build and strengthen between certain situations, cues or triggers (i.e. key in the lock, social settings, hopping in the car) and our body’s response to them (“URGE ALARM!”). These connections become very well practiced. The good news is that we can enlist the support of our incredibly adaptable brains to begin breaking these connections and building up a sense of agency when it comes to managing these cues and the urge sensations connected to them. This is where an approach called Cognitive Behavioural Therapy (CBT) comes in! A crucial component of CBT for managing bladder urgency is called “exposure”.

When we rely on trying to push away or avoid our uncomfortable body sensations, they tend to want to shout even louder to get our attention. When we gradually and intentionally pay attention to these sensations, we can build up a sense of agency in our capacity to manage them. You got this!

For support with using CBT & other gems to tame your bladder, get in touch!

*Disclaimer*

It is critical to talk to your primary care provider if you are struggling with significant bladder urgency that is disrupting your quality of life. Health concerns such as UTIs or conditions of the bladder can contribute to bladder urgency and should be ruled out or treated. Certain medications can also contribute to bladder urgency. As always it is important to discuss these options and whether or not they are appropriate for you with your primary care provider. This blog is meant for general education purposes only.

Lara Desrosiers is an Occupational Therapist that supports individuals struggling with pain and pelvic health challenges to get back to living life. She works with individuals from across Ontario, Canada. To learn more about Lara and her work, visit Pelvic Resilience.