Mythbusting the bladder: Strategies for overcoming Urgency, Frequency, and Little Bladders
Do you find yourself telling friends ‘I have a small bladder’ every time you have to use the bathroom? Feel like a broken record since you are going ALL THE TIME? Maybe you have an URGENT need to use the restroom as soon as you pull into the garage or some other similar triggering situation.
If this sounds like you, you may be experiencing what is commonly referred to as an Overactive Bladder (OAB). You might even be cueing up the catchy tune “Gotta Go” from the Detrol LA commercial from a few years back. Other terms you may hear to describe these symptoms are Urgency and Frequency. These symptoms may or may not be associated with urinary leakage. Bowels can be overactive too, but we will focus on bladders for this post!
Some hallmark characteristics of an urgent or overactive bladder include a sudden need to use the restroom with or without any warning. Sometimes the urge can be triggered by the sound or sight of water running. Other triggers might be behavioral like what PT’s refer to as the ‘key in the door syndrome.’ This is when you need to go as soon as you pull into the driveway, open the door to your home, get to the office, etc. Your triggers may sound similar or they may be completely unique to you. Triggers may be dietary, too! You may have noticed that after that morning coffee or evening glass of wine you need to use the restroom a little more frequently. While there is a whole list of potential dietary triggers, most people will only notice a few things that aggravate their bladder.
Another tell-tell sign of Overactive Bladder is when a patient tells me they go to the restroom ‘just in case.’ They may also know where all the bathrooms can be found from home to their destination and they NEVER get in the car without first taking a pit stop even if they don’t feel like they need to go.
The average human only needs to use the restroom 5-8 times during waking hours. That is about every 2-3 hours if you are doing the math. Unless you are over 70, you can ideally make it through the night without needing a bathroom break. If you have experienced or are experiencing Overactive Bladder, this might sound completely crazy to you! Our bladder can hold a little over 2 cups of urine and we will get our first sensation that we need to pee around a few ounces. Once the bladder fills a little more, we get a slightly louder sensation. When we get nearly full we get a pretty clear ‘get to the restroom soon’ message from our bladder.
Here’s how I describe this to patients. Imagine patient Jane having a convo with her healthy bladder.
Bladder (B): in a whisper tone- Jane, keeping you in the loop. We’ve got a few ounces over here
Jane (J): Busy with her workout doesn’t respond or notice
B: in a normal talking voice- Jane, we are about half full here. Maybe start thinking about taking a break
J: Ok B. Thanks for letting me know. Then goes back to her day and forgets again
B: in a slightly louder voice now- Hey J. We are nearing full. Time to take a break in the next 5-10 and hit the restroom.
J: Ok B. I’m on it. Gets lost on instagram and forgets again.
B: Shouting now. J. It's now or never.
J: Gets off the phone and walks to the restroom and empties.
This whole scenario takes a little over 3 hours.
Now. Let's say you have an Overactive or ‘small’ bladder it sounds more like this:
B: Shouts. HEY J! I feel something. You should probably empty.
J: Ok. I will go just in case. Empties and only has a few drops
B: Shouts again. HEY J! I know we just went like 30 minutes ago but like I really think you need to empty me again. I’m feeling something.
J: OK. Runs to the bathroom and barely gets her pants off in time to pee..
B: Rudely shouting yet again. HEY J! That coffee we drank just ran right through me. I don’t like how it feels. I know you just went like 20 minutes ago but I think we need to empty again.
J: Stops her conversation with a coworker and hurries off to the bathroom yet again.
And it continues like this ALL DAY LONG.
I like to make the analogy between bladders and toddlers. Toddlers don’t understand that you can’t drop everything on a moment's notice to answer every question. If we don’t pay attention to the toddler, they get louder. Bladders do exactly the same thing. They get louder and more insistent the more we ignore them. Overtime, we learn it's just easier to give in and go then listen to all the noise. The good news (at least for Bladders) is that we can train them. We can teach them good habits so that we can regain control and get back to our lives without constant interruption.
So how did our bladder become urgent in the first place? The simple answer is we trained it to be that way. The complex answer is that our society is set up in many ways to teach us not to listen to our nuanced bodily sensations. For example, when we are young children in school we often don’t have the ability to use the restroom when we really need to. We learn to go at certain times of day or when it is convenient for the teacher/ schedule. Or a loving parent who doesn’t want to experience another accident on the road encourages us to go ‘just in case’ and empty our bladder every time we get into the car. Professionally- many of us don’t have the luxury or the ability to interrupt what we are doing to use the bathroom when we really need to. Nurses and PT’s come to mind. It's not unusual to go HOURS between bathroom breaks if you are busy with patients. Your bladder is so used to having to shout loudly to get your attention, it learns to just start there vs. wait for hours.
We might also limit our fluids to prevent needing to go to the restroom during our workday. This effectively concentrates our urine making it more irritable to the bladder lining. Sometimes it is as simple as going to RR at that first urge (remember the whisper?) because we think ‘what's the harm.’ We may hurry up and pee as fast as possible over-riding our bodies natural rhythm and relaxation mechanism. I hear this from a lot of moms with little ones at home- bathroom privacy is non existent. We may also eat or drink foods that irritate our bladder lining and make us FEEL like we need to go sooner than why actually need to pee.
The bottom line is IT IS NOT YOUR FAULT. The great news is these symptoms are completely reversible. Bladders are fantastic learners and we can reset the system so that you are back in the driver's seat. I LOVE working with people who have Overactive Bladders. Sometimes it is as simple as a few modifications in a daily routine to experience a big turnaround in symptoms. Other times it is a bit of practice and problem solving to tease out the triggers and reprogram the bladder. Either way, it gets better. And it usually gets better without medication or other intervention.
In fact, the American Urological Association lists behavioral therapies like bladder training, bladder control strategies, pelvic floor muscle training, and fluid management as the first line of treatment with level B evidence for Overactive Bladder. If you are already working with a Urologist or other provider and have not received a referral for Pelvic Floor Physical Therapy now might be the time to ask. Self advocacy is often an important step in getting exactly what you need to get better. It can also be really helpful to rule out a Urinary Tract Infection or Bladder Infection which can mimic the symptoms of Overactive Bladder.
Below I’ve listed some strategies for a healthy bladder you can try on your own at home. Some of them are so simple they are almost unbelievable, but when they work it feels like something magic has happened! I’ve literally had patients shocked that such simple routine changes made such a big difference so quickly in their symptoms.
Strategy #1 for Overactive Bladders: Walk slowly to the bathroom
When you experience that strong urge to go, take a couple of breaths and try to walk slowly to the bathroom. Think about the toddler scenario, how you respond to a toddler when they fall and scrape their knee sets the tone for how they respond. If we tell the bladder that this isn’t an urgent matter, it will learn that it doesn’t need to respond quite so enthusiastically. Conversely, if we run as fast as we can and rip our undies and pants off, the bladder learns that this is indeed an emergency situation and will respond as such.
Strategy #2 for Overactive Bladders: Distract yourself
Seriously! If you have the urge to pee see if you can distract yourself with a conversation, checking an email, or any other task on your list, etc. When the strong urge subsides, re-evaluate if you actually need to use the restroom. If you do, walk calmly to the restroom and eliminate (see strategy #1).
Strategy #3 for Overactive Bladders: Take your time
You deserve 2-3 minutes for your potty time! Once you arrive at the bathroom, calmly and slowly remove your clothes. Take a couple of breaths and let your pelvic floor relax naturally. Try to avoid pushing your pee out. Once you have finished voiding, calmly clean up and thoroughly wash your hands in a nice, non rushed manner (see strategy #1).
Strategy #4 for Overactive Bladders: Sit your A$$ down
This is probably the most important thing you can do for your overall pelvic health. Sit down. All the way. On the toilet. Let your hip and pelvic floor muscles relax in order to void. Bonus points if your toilet is at a height where your knees can be at or slightly above hip level. Did you know that you are more likely to pick up germs from your own iphone than from a public toilet seat? If you are still worried about hygiene, use a toilet seat cover. You can even purchase disposable ones to carry with you in the event they aren’t available when you need to go!
Strategy #5 for Overactive Bladders: No more ‘Just in case’ pees
Lets begin to challenge the thought that shows up saying ‘Maybe I should go just in case.’ When was the last time you went to the bathroom? If it hasn’t been at least a couple of hours, see if you can distract and delay (See Strategy #2). If you really need to go or you have anxiety about not going, see strategy #1 and use the restroom without a lot of excitement so your bladder learns it doesn’t need to panic.
These are some practical behavioral strategies. They are in no way meant as a substitute for medical care with a healthcare provider. They are general healthy habits for the bladder that anyone can benefit from. If you need support with specific symptoms, please reach out! If you are looking for in person therapy in your local area, refer to the clinician directory at www.PelvicGuru.com.
Wishing you a happy and healthy Pelvic Floor!
Dr. Megan Anderson (She/ Her)
Pelvic Floor Physical Therapist
Integrative Health Coach
Mindfulness and Yogi Therapist
Dr. Megan is available for in person therapy in Lewes, Delaware and virtually worldwide.