The #5C Strategy for Bladder Overactivity: An excerpt from ‘The Happy Healthy Bladder Workbook’ (coming soon!)
© Michelle Lyons 2018 all rights reserved Do Not Reproduce Without Author’s Permission
In pelvic health, we love abbreviations, especially when it comes to bladder function! We talk about the conditions that may cause lower urinary tract symptoms (LUTS), including overactive bladder (OAB), bladder outlet obstruction (BOO), bladder pain syndrome/interstitial cystitis (BPS/IC), urinary tract infection (UTI) and many more…in this blog we’re taking a closer look at OAB or Overactive Bladder (sometimes referred to as DI or Detrusor Instability) – essentially when you get the urge, sometimes overwhelmingly, to urinate, even though its only been a short while since your last trip to the bathroom
What’s normal for the bladder?
So, what’s normal when it comes to intervoid intervals? In other words, how long should you be able to wait between trips to urinate? Alfred Hitchcock said that movie length should be tailored to the endurance of the human bladder, so we’d like the bladder to be able to have at least 2 hours between trips to urinate. But what if you feel like you have to go every 20 minutes? Sometimes pain can be a driver, and we’ll be looking at IC/ BPS in upcoming blogs but what if you’re going every 20 minutes because you feel you’ll leak if you don’t? Or you’re feeling in full bladder control on your drive home but as you put your key in the door, you are overwhelmed by an urge to urinate? (and maybe even leak a little?)
The average adult human bladder should be able to hold approximately 400 mls. Some people may limit fluid intake as a way to cope with LUTS, including urgency, frequency and incontinence. However, fluid restriction may increase urine concentration, leading to irritation of the bladder lining and increased incidence of urinary symptoms and urinary tract infections. The US Food Science Board recommends that fluid intake volume is 30 ml/kg per day or half an ounce per pound per 24 h.
What can we do about Overactive Bladders?
There are a couple of evidence based strategies that can help – which we’ll call ‘The 5 C’s’
But first: an anatomy review – the bladder is a hollow organ that has a muscular layer called the Detrusor – this is what empties the bladder (urination should always be a ‘letting go’ – you should never strain to urinate. Around the opening of the bladder, we have fascia, connective tissue and a muscular layer – the famous pelvic floor muscles! – which also play a part in supporting the bladder in the pelvis and contribute to our ability to control opening and closing of the bladder neck.
Connections of the Bladder, the Brain and Bradley’s Loops
These are a series of feedback loops between your brain and nervous system and your bladder and pelvic floor muscles. In order to maintain control over our bladders (and not have our bladders controlling us!) it is important that all of these loops are working well AND that we have the mobility to get to the bathroom AND the manual dexterity to open buttons, belts and zips! It’s a wonder we are continent at all!!
1. Awareness of desire to urinate
2. Detrusor contracts long enough and strong enough to empty almost completely
3. Coordinates pelvic floor muscles with detrusor activity
4. Keeps sphincters closed during bladder filling
So, some strategies for controlling urgency or increased frequency: The 5 C’s I mentioned earlier!
C#1: Constipation – there’s evidence to suggest that when you are constipated, you are more likely to have an irritable bladder. The criteria for normal bowel function, (according to the Rome IV Criteria) is having up to three bm’s a day or 3 bm’s a week…but I think it would be great to aspire to at least one good bm a day (#lifegoals!) However, if you’ve been having a bm every other day for your whole life, then that’s your norm and that’s ok! Your bowel and your bladder do love to talk to each other so when one of them is unhappy, they like to show solidarity – especially when it comes to constipation. It’s easy of course to say – don’t get constipated but not always so easy to fix. Your bowel is a creature of habit – it loves to empty in the same bathroom in the same house at roughly the same time every day (ever notice how things become a little ‘sluggish’ when you travel? That’s your bowel’s way of saying it DOESN’T LIKE CHANGE!! The good news is, you can tap into your bowel’s love of habit and routine to your advantage – whether that’s a nightly shot glass of prune juice (not if you’re diabetic) or an abdominal massage in the morning or a consistent position on the toilet (you can find more constipation tips in the free resource HERE) If you’re struggling with constipation, check out The Constipation Cures, a free resource you can find here
C#2: Clockwatching: So, if we should be aiming for a two hour pause in between trips to the bathroom, but you’re currently going every 20 minutes…how do we get from A to B? Bladder diaries (either paper or apps) can be really helpful to monitor your intake and output (Are you drinking enough water? Are you consuming bladder irritants like carbonated drinks, lots of caffeine, spicy food or for some, citrus/ tomatoes?) If you’re going every 20 minutes, it isn’t reasonable to expect to be able to immediately stretch that to every two hours, but you can start by increasing the time between trips by five then ten then 20 minute intervals. When you feel the urge to urinate, when it has only been twenty minutes since your last trip, what can you do to stretch the time between trips? There’s a couple of different strategies – for some people it can be taking some slow deep breaths, followed by some quick flick contractions of the pf muscles (squeeze, relax, squeeze, relax, squeeze, relax…for five reps) Others find doing heel raises (going up and down on your tiptoes x 5) or crossing your legs, and other people use distraction strategies like counting backwards from 100…in sevens…to be helpful (everyone can go 100, 93…its after that it gets trcky, which distracts your brain from listening to your bladder!) So if you have been going every 20 minutes, your week 1 goals might be to stretch it to every 25 minutes, week 2 to go every 30 minutes and so on…until you can stretch it out to 2 hours between trips to the loo.
When you get the urge to go…even though it has only been a short while since your last trip…but you feel your bladder contracting and your brain is saying ‘go now…GO NOW!!!’ How can we calm down both our brain and our bladder? If you have ever seen the film ‘Up’, you may remember Doug, the goofy dog who is talking away until…he gets distracted by a….SQUIRREL! That’s the effect we want to have on our brain and bladder conversation! We want to steer their attention away from the bladder sensation and the growing sense of panic – and the good news is, there’s a number of ways we can do that. Some do better with calming breaths, others do better with physical distraction or mental arithmetic – here are some different strategies – for some people it might be taking some slow deep breaths, followed by some quick flick contractions of the pf muscles (squeeze, relax, squeeze, relax, squeeze, relax…for five reps) Others find doing heel raises (going up and down on your tiptoes x 5) or crossing your legs, and other people use distraction strategies like counting backwards from 100…in sevens…to be helpful (everyone can go 100, 93…its after that it gets tricky, which distracts your brain from listening to your bladder!)
If you remember from above, when we were talking about the physiology of healthy bladders, you’ll remember Bradley’s Loop 3, which is all about the relationship between the pelvic floor muscles and the detrusor muscle in the bladder. Essentially, when the pelvic floor contracts, the detrusor relaxes and stops messaging the brain about wanting to empty the bladder. The opposite also occurs – when the pelvic floor muscles relax, for example when you are fully seated on the toilet, that signals your detrusor that it is time to empty the bladder so it squeezes and contracts and empties the bladder (this is why it is NOT a good idea to do ‘kegels’ while you’re urinating – it confuses the bladder so it stops emptying and you may end up retaining more urine than you should) So when you get the urge to go, some quick pelvic floor muscle contractions (close and lift) may help calm down that overactive bladder (you can download a free pelvic floor muscle activation guide HERE)
Although the exact mechanisms linking obesity and overactive bladder have not been completely determined, results of the Program to Reduce Incontinence by Diet and Exercise (PRIDE) study indicate an association between BMI and abdominal circumference with intra-abdominal and intravesical pressure – in other words, if you are carrying a lot of weight around the centre of your body, it increases the downward pressure on your bladder, making it harder for the supporting connective tissue and muscles to support and close the bladder neck. Simple (but evidence based!) strategies to help decrease waist circumference include the obvious – for example avoiding food with added sugar, but also the perhaps less obvious tactics of stress management (stress hormones like cortisol may contribute to belly fat) and getting enough quality sleep (poor sleep quality is linked to both weight gain and chronic pain. Not to mention early morning grumpiness…)
So there you have it – the #5C strategy to manage and hopefully reverse Overactive Bladder. Stay tuned for upcoming posts on other aspects of bladder health and don’t forget, you can get these posts sent directly to your email inbox by signing up for a free resource HERE
If you’d like to learn more about pelvic health…why not have a look at the Pelvic Floor and Core Foundations course…
or if you’d like a deeper dive into menopausal health, our 3rd Age online global certification?!
Until next time
Onwards and Upwards!