Who’s the Boss? You or Your Bladder
Did you know that incontinence is not the only indication of bladder dysfunction? Did you know that voiding frequency can also indicate dysfunction? The good news is that pelvic health physical therapy can still be beneficial! While the treatment plan may vary, it remains an excellent conservative option to explore before considering medications or injections.
Let’s start by introducing the bladder and its function. The bladder, located in the lower abdomen behind the pubic bone, contains a muscle called the detrusor. This muscle is involuntary, meaning it is not under our conscious control—no need to add bladder workouts to your next fitness routine. As the bladder fills, the walls will expand and cause a stretch of the detrusor. The amount of stretch helps to give the brain feedback on bladder capacity. A small stretch gives a little whisper to tell you, “psst, we’re going to need a bathroom soon.” Eventually, if we haven’t emptied, the whisper will turn into a full shout, “we need to go, NOW.” Once we get to the toilet, the detrusor will contract, the urinary sphincters will relax and voiding occurs. This resets the system to start again.
What happens if we just ignore these urgency signals and continue on with our day? This may cause some issues if we consistently override our body’s well intentioned messages. The bladder relies on a feedback loop with the brain which means our actions can lead to retraining whether we intend to or not. If we regularly override the signals our brain gives us, our brain will stop giving us the signals it knows we won’t pay attention to. Rather than experience subtle urges which gradually increase, onset of urgency will be very strong and very sudden. For some this may cause them to experience leakage when trying to make it to the toilet. This is what we call urinary urge incontinence. It is common to see this in occupations where walking away for a bathroom break isn’t always easy or maybe bathrooms aren’t readily available. Typically healthcare workers, teachers, military service members and first responders will report these issues but it can happen to anyone.
In that case, should I just go to the bathroom whenever it’s available? Nope, it’s not that simple. Just like retraining to hold too long, we can retrain to go too often and not allow the bladder to get full. Again, it’s a feedback loop. If we always use the bathroom without an urge the brain will start to learn to send signals for urgency at lower thresholds. Now, instead of feeling that my bladder is full at 75% capacity it’ll feel that same fullness, for example, at 50% capacity. This is when people feel like they really have to go and then once they get to the toilet, there’s very little output. Our bladders don’t have a viewing window, so we have to rely on these feedback loops and ensure our habits support proper functioning.
Okay, so how long should I be able to hold? You should be able to go 3-4 hours between voids, consistently! If that sounds like a challenging timeframe, we can help! Spoiler alert: it may not have anything to do with your pelvic floor strength. Ready to be more confident leaving the house without needing to know where all the bathrooms are in a 10 mile radius? Ready to feel confident you’ll still make it to the bathroom when nature calls even if your talkative coworker stops you in the hall? Contact us to schedule your free discovery call today!
