Three Steps for Stopping Urgency in its Tracks
I had the pleasure of going to a fabulous meet and greet with new moms recently. The audience was moms that had babies 12 months and under. My youngest is nearly 18 months, so although I’m not too far removed from that age group, it feels like a lifetime ago that my boys and I were navigating those tricky post-partum and newborn stages together.
While thinking about what I could offer to these ladies as a pelvic floor therapist, it suddenly struck me. They may not yet know what they need most, but I do. Every day I see (and treat) the aftermath of habits forged in those first few months — habits that can cause a lifetime of dysfunction.
So, rather than pitching my services and going through every single thing I could help them with, I decided to be the pelvic floor physical therapist they needed, if not the one they wanted.
We spent our time discussing urinary urgency and its partner in crime: frequency.
What is Urinary Urgency?
Urinary urgency is a sudden, strong, and often overwhelming need to empty your bladder. This can happen due to a trigger (unlocking your front door, getting in the shower, hearing water running), or it can happen without any noticeable cause.
Urgency goes hand in hand with urinary frequency. I’m about to lay a stat on you that blows minds in every workshop I do. Frequency, or voiding your bladder more times “than usual” is defined as going more than 7 times per day. As a rule, you should be able to sleep through the night without waking to void (although exceptions do exist in the tremendously well-hydrated).
The bladder has a triangular-shaped muscle called the detrusor that helps your brain sense when it’s time to empty. As it fills, stretch receptors send signals to your brain with updates on its requirement to void.
In folks without dysfunction, the first signal to void occurs when the bladder is about half-full (or half-empty, depending on how you look at life - ha!).
When functioning normally, we are able to redirect those signals and wait until an appropriate time to void within an acceptable time period (nurses, teachers, PTs — I’m looking at you!) whether that’s 15 minutes or another hour.
So, what could go wrong?
Now that we understand how things should work in a perfect world, let’s turn that on its head. You’re a few weeks postpartum. You might still be in a diaper or recovering from stitches. Your baby hasn’t quite figured out which is day and which is night, and you can’t put him or her down long enough to eat a snack yet, let alone take a shower. Your pelvic floor is recovering not just from childbirth, but from months of stretching and weakness caused by a progressive increase in the weight of your baby.
This is when post-partum habits start to cause issues. You feel the slightest urge to go to the bathroom and you suspect your pelvic floor may not support you if you wait longer, so you just go. Or perhaps you know that you can go now, but if you wait even 15 minutes you may be nap-trapped so you just run to the bathroom — just in case.
When you start using the bathroom before your bladder is full, those muscle sensors start to recalibrate what the signals really mean. If you empty at that 50% full signal every time, your bladder starts to perceive that as a sign that your bladder was actually more full than it realized, and it decides to send those signals even earlier the next time.
Over time, the urge to go becomes stronger and stronger, even if the amount you actually void stays the same. Your body and your brain are adaptable and honed to streamline to improve your efficiency.
Many moms ask me how to determine whether they have urgency or if they just really had to go. This is a totally fair question — if you’re staying really well-hydrated, this could be confusing.
I have my patients time their voids. Count how long they are actively releasing urine (not dripping, but a steady stream). A normal void should be at least 8 seconds. If you find that you go every hour but for just 5-6 seconds each time, it is likely that you have urinary urgency and frequency.
So how can you fix it? Glad you asked, that’s why we’re here!
Stop with the “Just in Case” Peeing
I get it. It’s beaten into us from infancy that if we’re going anywhere, we should go to the bathroom first, just in case. Unfortunately, this reinforces those signals going to your brain that your bladder is full when it’s not.
If you know you’re going somewhere within 20 minutes that has a bathroom, I’d challenge you to just wait. It’s going to take some thinking and planning on your part, but your brain will adjust quickly and rise to the challenge. Oftentimes you’ll find that you won’t need to go when you get to where you’re going, and may even be able to wait until you get back home again — but you’ll never know unless you try.
Distract your Brain
Your brain interprets all the signals from your body and nervous system and is, therefore, the referee turning your thoughts and feelings into behavior. Just because you may feel a sensation to punch someone who’s being rude to you doesn’t mean you follow through with it, right? Similarly, just because you feel an urge to use the bathroom doesn’t mean you have to do that either.
Think — how long has it been since you went last? Have you had a ton to drink? If it' hasn’t been 2 hours or you haven’t had a lot to drink, your brain is likely misinterpreting just how much you need to go.
There are a few different methods to distracting yourself. You can practice diaphragmatic (or belly) breathing to calm and regulate your nervous system. You can take up another activity that requires your focus and attention, You can wiggle your toes (which have neurological receptors right next to your bladder’s receptors on the brain). Or, you can keep your bladder guessing by changing up the order in which you do things. I often have patients wash their hands or brush their hair before voids to start chipping away at the urgency they feel the moment they walk into the bathroom to pee.
Manage Bladder Irritants
This is both a challenging and very sensitive subject for most of my patients, but it is arguably the most important step to getting rid of urgency and frequency.
The delicate walls and detrusor muscle of the bladder are very sensitive to what is stored within. With that said, the beverages we drink and even the foods we eat can cause irritation and inflammation that send a strong urge to empty and can even worsen leaks and incontinence!
It’s difficult to determine what food or drink is bothersome to each individual; everyone is different. I like to compare it to seasonal allergies. Although the potential list for what may cause allergies to worsen is long, each person has an individual and fairly unique response to allergens.
The most common offenders I see with my patients are: alcohol, caffeine, coffee, spicy foods, carbonated beverages, chocolate, sweeteners (especially artificial), citrus fruits, tomatoes, apples, grapes, strawberries, vinegar, and dairy. As you can see, you can eat a clean and healthy diet and still take in irritants.
Perhaps most counterintuitively, if you avoid taking in fluids because you know that this is an issue for you, your urine will become more concentrated and condensed and can itself become an irritant!
Nobody wants to give up their coffee or seltzer water. The good news is, nobody is asking you to do that. I usually have people steer clear of suspected triggers for a few days to confirm that they are causing issues. Once you’ve figured out your triggers, you have a few options.
You can time the intake of your triggers — perhaps if you enjoy fruit and yogurt with your coffee but finding all 3 irritants together are too much for your bladder you can do coffee in the morning with a fruit and yogurt snack later in the day. If you find that you only have urgency or leaks at the gym, you can wait until after your workout to take in any items you’re sensitive to.
There are also a few preventative supplements on the market that can help neutralize the acidity caused by bladder irritants. One is called prelief and another is called coffee tamer. Both are over the counter and allow you to enjoy your favorite foods and beverages that your bladder may not like.
Where do we go from here?
If what was described here sounds familiar to you, I know it can be overwhelming and feel like you’re completely out of control. I hope the tips included help you feel like you can take some control back.
If you’re a new mom, try to follow these tips now because the longer this goes on, the harder it will be to change your habits!
Many of my patients benefit from a step-by-step approach where we address each aspect of urgency in turn. It may be that you have a hyperactive or tight pelvic floor that is causing your bladder to feel more full than it truly is. Your issue could truly be weakness, or it may be some combination of everything mentioned here today. If these tips do not help you to get in control, reach out to a pelvic floor therapist today who can help you address the problem and feel like yourself again!
