Pelvic Floor Physical Therapy for Overactive Bladder
Do you pee just in case? Or find yourself constantly feeling the urge to urinate even after you just went?
You may have an overactive bladder, OR it might be your pelvic floor. Lets take a look at how the bladder works and how these issues can be addressed with pelvic floor physical therapy and behavioral changes.
The bladder is a hollow, muscular organ that stores urine produced by the kidneys until it’s ready to be released from the body. As the bladder slowly fills, it stretches, and stretch receptors in the bladder wall send a message to the brain, creating the sensation of needing to urinate.
The bladder can hold up to 500 milliliters of urine in women. Most people begin to feel the first urge to urinate when the bladder holds around 150 to 200 milliliters of urine. This urge is typically mild and can be ignored for some time. As the bladder continues to fill up to about 400 to 500 milliliters, that urge intensifies into a more urgent "I need to go right now" feeling.
When it's time to urinate, the brain sends a signal to the bladder telling it to contract, which pushes the urine out. At the same time, the pelvic floor muscles, including the urethral sphincters, must relax to allow urine to flow. This coordinated effort between the bladder contracting and the pelvic floor relaxing is vital for a smooth, complete emptying.
Ideally, the bladder will empty completely, and you will not feel the urge to urinate for a few hours. However, some issues can cause urine retention (meaning your bladder did not fully empty) or give you that sense of urgency even though your bladder is empty.
Overactive Pelvic Floor and Bladder Issues
Tension in the pelvic floor can cause difficulty starting a urine stream and inability to fully empty the bladder. An overactive pelvic floor can also give you the sense that you need to urinate even if your bladder is empty. This is why pelvic floor muscle awareness and function are important not just for holding urine in, but also for healthy bladder emptying.
Another thing that can cause urinary urgency is peeing “just in case.” This means you don’t feel the need to urinate, but decide to go to the bathroom anyways. This sends a message to your brain that your bladder is full when it’s not, causing your brain to always think that your bladder is full.
Treatment for Overactive Bladder
At Cappuccino Physical Therapy, urinary frequency is something we see very commonly. Our treatment for urinary frequency includes:
Bladder Diary
Education on proper hydration and bladder irritants
Education on Proper Bladder Habits
Urge suppression techniques
Pelvic floor evaluation to assess for tension that may be triggering a sense of urgency (this one is most important!)
Bladder Diary
Our first line of treatment is keeping a bladder diary so you can see how frequently you are urinating and how long your urine streams are. We also ask about what you are eating and drinking, as certain food and drinks are bladder irritants and can cause urgency and discomfort.
Click here to request a copy of our Bladder Diary.
Staying Hydrated
While it might seem logical to drink less water to reduce urinary urgency and frequency, doing so can actually make things worse. When you're dehydrated, your urine becomes more concentrated, meaning it's more acidic and contains higher levels of waste products. This concentrated urine can irritate the bladder lining and urethra, leading to increased urgency, burning, or discomfort when urinating. Staying well-hydrated helps dilute the urine, thus decreasing irritation.
This is especially important for people with sensitive bladders, urinary tract infections, or pelvic floor dysfunction. Proper hydration supports bladder health and can actually reduce symptoms of urgency and frequency in many cases.
bladder irritants
Here is a list of common bladder irritants.
While we know how hard it can be to eliminate all of these foods and beverages, it is good to know if a particular food or drink is causing irritation to the bladder.
voiding habits
Healthy voiding habits are KEY to reducing frequent trips to the restroom. If you constantly feel the need to urinate and are taking frequent trips to the bathroom, there are simple changes you can make without needing medication:
Voiding should occur every 2-4 hours.
Your urine stream should be 10-30 seconds long
Urine release should not be forceful-don’t push your urine out.
Do NOT pee just in case-wait until you actually feel the need to go
Urge Suppression Techniques
If you are a frequent peer, you are constantly sending the message to your brain that your bladder is full when it is not. Urge suppression techniques are strategies used to help manage the urge to urinate. These techniques work by calming the bladder and giving your brain time to regain control, helping to gradually extend the time between bathroom visits. Our 3 favorite urge suppression techniques are:
We recommend using these urge suppression techniques to try to extend voiding intervals by 10-15 minutes at a time, until you are able to successfully wait 2 hours in between voids. This is something that takes time and will not be achieved overnight, but it’s VERY effective in treating overactive bladder.
Pelvic Floor Physical Therapy
Our most important treatment technique for overactive bladder is pelvic floor physical therapy. The pelvic floor muscles surround and support the bladder, urethra, and other pelvic organs. These muscles are meant to relax during urination and support the bladder and the urethra throughout the rest of the day.
Tension in the pelvic floor muscles, especially around the urethra, can create pressure or irritation in the bladder wall. This pressure can mimic the feeling of a full bladder, tricking the brain into thinking it’s time to void, even with an empty bladder. This false signal can lead to frequent or urgent trips to the bathroom.
The pelvic floor and bladder work in opposition: when the bladder contracts to empty, the pelvic floor should relax. If the pelvic floor is overactive (which is more common than a weak pelvic floor), it can send mixed signals to the bladder. This lack of coordination can cause the bladder to become irritated or confused, leading to premature urges or incomplete emptying.
Overactive pelvic floor muscles can develop myofascial trigger points which are tight, irritable spots in the muscle tissue. These trigger points can cause referred sensations that feel like urgency, fullness, or even pressure in the urethra or bladder. Someone might feel like they have to pee urgently, but it’s actually a neuromuscular referral from a tight pelvic floor muscle, not a bladder signal.
This is why it is imperative to see a pelvic floor physical therapist for a full evaluation of your pelvic floor muscles if you are experiencing overactive bladder.
Overactive bladder is something we see very commonly at Cappuccino Physical Therapy, and something we have GREAT success treating. We have been able to help our patients get off their OAB medications, reduce frequent trips to the bathroom, and eliminate the constant need to urinate.
If this is something you are dealing with, fill out this form and give us a call today!
References:
https://www.ncbi.nlm.nih.gov/books/NBK279384/
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1742-1241.2009.02078.x
