There are many different types of urinary incontinence. The causes of urinary incontinence can vary from muscle weakness, bladder and pelvic floor muscle coordination, poor diet and habits, or a combination of them all. Physical changes can occur from pregnancy, childbirth, hormones (including menopause) and lead to urinary incontinence. Other causes of urinary incontinence include constipation, medications, caffeine and alcohol, infection, nerve damage or excess weight.
Urge incontinence is when leakage occurs after a strong, sudden urge to urinate. This may occur when you don’t expect it, such as after drinking water, when you hear or touch running water, or when placing your key in the door or pulling into garage. With urge incontinence, it is common to leak urine on the way to the toilet.
Unlike stress incontinence, urge incontinence is not due to a muscle weakness but rather poor coordination of the pelvic floor muscles and bladder and is usually caused by poor diet and habits. Kegel exercises will be beneficial but Kegels alone will not usually resolve urge incontinence. Bladder Retraining, including diet and behavior modifications in conjunction with Kegels (as long as pelvic pain is not present) should all be applied to resolve urge incontinence.
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.
OTHER TECHNIQUES INCLUDE:
- Mental distraction techniques including visualization of your favorite relaxing vacation, counting slowly, deep breathing, and positive self-talk such as “I am in control of my bladder”.
- Apply pressure to your perineum (at the crotch of your underwear) with a towel or sitting on your heal to reduce urge.
- If all of the above techniques fail and you still have to an overwhelming urge to go, you may use the toilet.
In my experience of treating hundreds of patients with urge incontinence, bladder retraining is more effective than medication and most especially surgery. If you suffer from urge incontinence, physical therapy should be your first line of treatment. The important fact to remember is that urinary incontinence is common but that does not mean it’s ‘normal’ and it does not need to be accepted as a way of life. I also do not recommend urinating in the shower or with running water because ultimately you are training your bladder to associate emptying with water which can lead to urge incontinence—if your bladder is trained to empty when it hears running water it’s going to be confused when you are just trying to wash the dishes!