Updated: Feb 9
Urgency - that dreadful feeling that you need to get to the toilet RIGHT NOW, or your bladder is going to let go, whether you like it or not. It sends you rushing for a loo far more often than you should need to go, only to produce a miserable amount of urine because your bladder was sending signals well before it was full.
This over-activity of the bladder can occur at any age. It happens because the bladder becomes too excited about sending messages to the brain, and starts cramping to push urine out even when it isn’t full and hasn’t been given permission by its owner.
This is not the same as a leak caused by a cough or by other activities like jumping or weightlifting. That kind of leaking is known as ‘stress incontinence’, and doesn’t involve a strong urge. It can get confusing though, because one person can have both stress and urge problems at the same time!
Usually urgency starts out mild, and sneakily increases in how often it strikes and how strong and urgent the feeling is. If you had no previous problems but suddenly start having obvious urgency, it may be due to an infection or inflammation. In that case you should see a professional - probably a GP but in some places nursing staff will be the first option.
A urine dipstick is often the first test done regardless of who you see, and a doctor is not required for the ordering of, or reading the results of a urine dipstick test.
If the urgency has not arrived suddenly, but has been sneaking up slowly, try the techniques shared below. If you don’t get a satisfying result, consider seeing a specialist Women’s Health Physio for a plan targeted to you. They deal with this issue a lot, and know what questions to ask to figure out what tricky thing is getting in the way of your recovery.
Keep in mind that there are other treatments available for those people who have more complicated problems that don’t respond to these lifestyle strategies and exercises. Physios can offer some of these options, including electrical stimulation using a TENS machine. ‘Electrical’ sounds scary but really it isn’t. It’s just stick-on patch electrodes, and one of the most likely places the physio will put them is on your ankle! That sounds crazy but the placement is very carefully designed to stimulate a particular nerve.
There are also medications that can be helpful, and may be ideal in the right circumstances. They shouldn’t be seen as an easy answer though, because medications always come with side effects and a financial cost. Surgery (such as implanting an electrical nerve stimulator) is generally only considered if all the simpler methods don’t work for you.
What You Can Do
Physios love you to spend a day or two keeping a diary of how often you go to the toilet, and how much you pass - so you can tell if you are making a difference, and also to help spot triggers that might be changeable. If you don’t want to take the time for that, perhaps you could think back over today and possibly yesterday and note down what you remember about when you got the urge, how strong it was, when you went to the loo and whether you passed a small, medium or large amount of urine.
Sometimes change happens slowly and unless we have a record of how things used to be, we don’t realise we’re actually having a win.
Some of the following tips might seem obvious, but don’t skip out early as some are more interesting than others. The first four tips are about planning ahead to reduce the urge; the second group of four are about dealing with the urge when it strikes.
Planning to reduce Urge striking:
1. Stay hydrated: Drinking less just makes your urine more concentrated, which basically stings the bladder from the inside and makes it want to empty out the strong urine as soon as possible. Drinking more may put more into your bladder, but your bladder will be more willing to stretch and hold. Increasing your fluids slowly by having small drinks regularly suits most people.
2. Avoid irritants: avoid or reduce things that irritate the bladder. Here is a list of things known to increase the ‘empty me now!’ messages the bladder is sending to the brain:
As an example, try replacing your breakfast orange juice with apple juice, and see if that helps you.
3. Stop going ‘just in case’. People dealing with urgency start going to the toilet more often in an effort to prevent the urge happening while they’re out or busy. Unfortunately that doesn’t work. It actually makes it worse, because the bladder is being trained to empty more often and hold less.
If you have had urgency for a long time, it may take time to train your bladder to hold more again, and you may want to get some professional advice to plan a timing strategy. (A women’s health physio, of course… oh okay, I’ll give Continence Nurses a plug too!)
This is actually one of the hardest habits to change. We’ve spent our whole lives going to the toilet before we need to, often just so we won’t inconvenience anyone by wanting to stop for a toilet break later. And of course no-one wants to get ‘caught’ with no loo available! But if you put some thought into it, there are times when you can skip the ‘go before I leave the house’ because there will be toilets at your destination. And the future of your bladder is more important than possibly making someone wait a few minutes. I bet you’d be happy to wait for someone else!
4. Eat well: Be aware that your bladder is part of your whole body, so eating well and being physically active helps – particularly by helping you avoid constipation, which directly effects bladder function.
A healthy gut has a broad influence on the rest of our body, particularly with regard to inflammation and healing. Supporting yourself with good nutrients and fibre will influence all of your health. To paraphrase some fairly famous health advice: eat simple foods, not too much, mostly plants. (The origin of that saying seems to be Michael Pollan, his rules are the amusing kind of true. There’s a couple more of them mentioned in this book review.)
Things to Try When Urgency Strikes
This is a retraining process so the idea is to defer the urge so your bladder is taught to wait longer and allow proper filling. If you know your bladder can’t be full yet, and you can reduce the urge with one of these techniques, then don’t go to the loo until after the next urge, or the one after that. If you think your bladder might be full, you should still use the techniques to lessen the urge so you can take your time to get to a toilet. (This is especially important because lots of falls happen when people are rushing to the toilet.)
As time passes, you should need these techniques less and less. But they can still be handy when you’re out on the highway miles from a toilet, and that coffee catches up with you!
1. Pelvic Floor contractions: Activity in the pelvic floor has a direct calming effect on the bladder because of signals a nerve sends automatically. Squeezing with a healthy strong pelvic floor will give a better effect on the bladder than squeezing with a weaker pelvic floor, so strengthening your pelvic floor with regular pelvic floor exercises will make this work better.
Whether it’s a long hold or quick squeezes actually varies between people so just try it out and see what works.
What’s more, if you know when your urge is likely to be triggered (eg when you get out of the car, or when you turn on a tap), then do some pelvic floor exercises just before you do the triggering activity.
2. Perineal pressure: it’s what little girls do instinctively, pressing their crotch with their hand while they try to hurry mum up to get them to a toilet. Society thinks it isn’t polite in public so we all stop doing it - and I’ll grant it’s not the best option while walking through the grocery store! But there are situations where you could do it, especially if you’re at home.
Keep in mind that this is a retraining process and you’re trying to teach your bladder to hold more and wait longer. These techniques are not just for when you are out and not near a toilet - they are also for when you’re at home, very near a toilet, and choosing not to go anyway. Because bladders, like kids and dogs, get trained by the message they get consistently.
3. Mental distraction: think about your happy place, or do maths in your head. Think of a song and see if you know all the words. Our brains really like to focus on one thing at a time - multitasking is a myth according to neuroscience. (Neuroscientists have lots of brains, so they should know.) So although it sounds foolishly simple, you actually can distract yourself and thereby calm to urgent message your bladder is trying to send to your brain.
4. Neural distraction: sounds similar, but is not the same as mental distraction! Instead it means adding input to your nerves so the messages from your bladder are diluted by the time they reach your brain. So you want to do things that send sensations along the same path as the nerves from the bladder. Luckily, those pathways are used for other body parts, especially sensation and movement of the lower legs.
Try any of these - you can do one or more, even in public, with no-one noticing:
Scrunch up your toes – use the muscles under your feet to dig your toes into the floor so you can feel them pressing down.
Use one foot to scratch the back of the other calf.
Reach back with your hand and rub or tap on your sacrum (at the base of your spine).
If you’re standing, lean your weight forward onto your toes and clench the muscles of your bottom.
Although it sounds completely different to the rest of the suggestions: try pressing firmly on your top lip. It interferes with a different part of the nerve pathway, but it can work.
The bottom line is, fight back. Don’t let your bossy bladder push you ever further into the corner. Every time you make it wait, even for a short time, you are teaching it that waiting is okay and urgency is not needed. Expect progress to take time, but if you aren't getting progress then ask for professional support. Don't just put up with bladder problems.
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