Overactive bladder is a medical term used to describe a condition involving the sudden, strong urge to urinate, and often results in having to urinate more frequently.
You might think: “What does this have to do with my pelvic floor?” To answer this question, it is important to understand what normal bladder function looks like and why overactive bladder might occur.
Normal Bladder Filling and Emptying
The bladder is a storage unit for urine. The kidneys continuously send urine into the bladder to get rid of waste. The bladder is made up of a muscle called the “detrusor” which stretches as it fills, and contracts as it empties. It can hold about 13-20 ounces of urine.
Normally the bladder will need to empty every 2-4 hours during the day or 5-8 times total. It is not considered normal to wake up at night to urinate. We go less often overnight because our body produces an anti-diuretic hormone when we sleep. This hormone reduces how much urine the kidneys make, so that the bladder fills at a slower pace. However, during pregnancy or after the age of 65, it is acceptable to wake up once per night to urinate.
As the bladder fills with urine, it stretches and enlarges. If you have a uterus, the bladder stretches up and over the uterus filling to capacity. The stretching of the bladder muscle helps you know when you must go. When the bladder is about halfway full, the detrusor muscle contracts a little to let you know. At this point, the brain gets the signal and normally responds with: “No thanks, we’ll wait.” The sensation calms down, and you might forget about it. As the bladder stretches closer to capacity, the detrusor muscle is triggered to contract a little stronger. Again, this signal gets sent to the brain. The brain now responds with: “Okay, we will come up with a plan, don’t stress out,” and the sensation calms enough to allow you to get to the restroom without rushing. Finally, as you sit down to urinate your pelvic floor muscles relax, which allows the urethra to open, and your bladder contracts to squeeze the urine out.
Unfortunately, this system doesn’t always work perfectly.
What Happens When the Bladder is "Overactive"?
When the bladder is overactive, it is essentially throwing a tantrum. The first signal or urge of filling is much stronger than it should be and does not calm down easily. This is because the detrusor muscle is contracting too hard without stopping and ignoring the messages from your brain. This might cause you to rush to the bathroom even when your bladder is not full, and you may even leak along the way.
There are some habits that can increase your risk for “Overactive Bladder.”
- Urinating “just in case”
Also known as, “JIC-ing”, this means you are often urinating without the urge to, resulting in frequent emptying of your bladder below capacity. Your bladder can become attuned to this “new capacity,” essentially training your bladder to have a new, lower threshold.
- Bladder Irritants
Some foods and fluids are irritating to the lining of the bladder, making your bladder want them out faster. Some common bladder irritants include caffeine, alcohol, artificial sweeteners (e.g., Splenda, Sweet n’ Low, Equal), carbonation (e.g., sparkling water/seltzer) and not enough water. A common response to frequent urination is to try to drink less, but remember, your kidneys are always making urine to get rid of waste. This means if you don’t drink enough water, your urine will be more concentrated, resulting in bladder irritation and urinating more often.
Nicotine in cigarettes can also be irritating to the bladder, again making it more likely to send you running to get that waste out!
Not having enough bowel movements or not emptying your bowels completely can put pressure on the bladder. The rectum sits at the back of the pelvis and there isn’t much room between the rectum and the bladder. This means when the rectum is distended with stool, it can limit how much the bladder can stretch, resulting in reduced capacity or bladder irritation.
- Pelvic floor overactivity
The pelvic floor muscles surround the bladder and urethra. If the muscles are short, tense, not fully relaxing, or “overactive,” there can be more pressure placed on the bladder and urethra. Trigger points, or “knots,” in the pelvic floor muscles can also casue discomfort to the bladder or reproduce the sensation of urgency, making you feel like you must urinate even when the bladder is not full.
- Abdominal Surgery
Scar tissue or adhesions surrounding the bladder may limit its ability to stretch resulting in urgency at lower capacities, forcing you to urinate more frequently.
So, What Can I Do?
Reduce your risk factors:
- Limit bladder irritants and slowly increase your water intake if you have been limiting it. Aim for approximately 60-70 ounces of flat, non-sparkling water. You also want to think about having water before and/or after bladder irritants to dilute the irritating items.
- Speak to your doctor about smoking cessation.
- Get constipation under control. Consider speaking with your doctor about this. Constipation is also a condition that can often be improved with pelvic floor therapy
Scar Tissue Massage:
If you have abdominal scars, massage the scar for 5-15 minutes a day to improve mobility and elasticity.
Calm the bladder:
When the urge to urinate begins, resist the instinct to panic. Sit down if you can and take some deep breaths, allowing yourself to be distracted for a minute or two.
See a specialist for evaluation and guidance: This can include a pelvic floor therapist, a urogynecologist, and/or a urologist.
- A pelvic floor therapist can provide a detailed assessment of your spine, hips, feet, abdomen, and pelvic floor as well as discuss your medical history and other potentially related symptoms. This evaluation will help you and your provider identify impairments and risk factors that are contributing to your symptoms to create an individualized treatment plan to get your overactive bladder back on track.
- A urogynecologist is a physician and surgeon that specializes in conditions related to pelvic floor dysfunction including overactive bladder. They can perform testing, provide medications, and consider surgical options for your symptoms. They may also refer you to pelvic floor therapy as a conservative option.
- A urologist is a physician, sometimes a surgeon, that specializes in the urinary tract including the kidneys and bladder.
The Bottom Line
You don’t have to endure an overactive bladder. Talk with your primary care physician about testing and treatment. Consider seeing a pelvic floor therapist for an individualized treatment plan to help you regain confidence and control over your bladder.
How Can I See a Pelvic Physical Therapist?
Spaulding Outpatient Rehabilitation of Care New England is currently offering pelvic health services in multiple locations throughout the state of Rhode Island.
To be seen by a pelvic health therapist, you will need a physician referral. Please head to our Pelvic Health Rehabilitation website to learn more about the referral process and how to set up an evaluation.
• Interstitial Cystitis Association (https://www.ichelp.org)
• Holistic Pelvic Health (https://www.holisticpelvichealth.org)
• Haylen, B.T., de Ridder, D., Freeman, R.M., Swift, S.E., Berghmans, B., Lee, J., Monga, A., Petri, E., Rizk, D.E., Sand, P.K. & Schaer, G.N. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourology and Urodynamics 29, 4-20 (2010).
• American Urogynecological Association (firstname.lastname@example.org, www.voicesforpdf.org)