Overactive Bladder (OAB) or increased urinary frequency most often is associated with Pelvic Floor Dysfunction and the incoordination of the pelvic floor muscles and bladder. Diet and poor habits will lead to bladder irritation or inflammation resulting in increased urinary frequency or OAB.
When the bladder is irritated, emptying will not feel satisfying due to inflammation and incoordination. This is not to say that the bladder isn’t actually empty yet, it will give the feeling of not being empty resulting in feeling the need to urinate often to ’empty’ the bladder. Often times it is empty, however, due to poor bladder health (diet, voiding habits) and training of the bladder to empty frequently the brain, bladder, and pelvic floor are not getting the proper signals (incoordination) that the bladder has emptied resulting in the need to urinate often. Bladder Retraining including following a voiding schedule and water guidelines is the best treatment for this. Teaching your bladder to not empty until it is full (see What is Normal) will allow for the brain, bladder, and pelvic floor muscles to coordinate again and that urgency feeling will resolve.
It is important to remember that we always have urine in our bladder, so just because you CAN urinate, doesn’t mean you SHOULD urinate. We do not void 100% of our urine out with each void (normal residual urine is 10%) and our kidneys are constantly making urine, so as soon as you walk away from the toilet, the kidneys started making urine. Give the bladder time to fill up before your next void despite the feeling. Teaching your bladder to empty before it is full will lead to bladder dysfunctions including incontinence, urinary frequency, and feeling of incomplete emptying, as well as pelvic pain. See Urge Suppression Techniques.
URGE SUPPRESSION TECHNIQUES
- When you feel the urge, stop the activity and sit down if possible. Try to stay very still to maintain control. Avoid rushing to the toilet.
- Perform Kegels by contracting pelvic floor muscles quickly 5-10x. Pelvic floor contractions send a message to the bladder to relax and hold urine. Try to distract yourself by thinking of something other than going to the bathroom. If you are not a candidate for performing Kegels then take 5 big belly breaths instead of contracting the pelvic floor muscles.
- Relax. Do not rush to the toilet. Take a deep diaphragm breath and let it out slowly. Let the urge to urinate pass by using distraction techniques and positive thoughts.
- Repeat the above steps until you feel you have control over the urge. When you feel the urge subside, walk normally to the bathroom. You can urinate once the urge has subsided; unless you are on a voiding schedule then wait until your next scheduled time. Remember you are retraining your bladder, giving into the urges and urinated too early is letting the bladder have control of you.
Overactive bladder results in negative quality of life, from anxiety and fear of accident to constantly thinking about where the next bathroom is, leading to isolation and depression. The good news is this condition is successfully treated with physical therapy and bladder retraining without the need for medication. I have treated hundreds of patients with this condition with an end result of discontinuing use of medication or preventing medication at all.