Happy, healthy bladders are a wonderful thing. We don’t often realize just how wonderful it is to have a purpose-built organ to store urine and give us helpful status updates on how long we have until we truly need to empty. A healthy bladder will comfortably hold about 2 cups (500ml) of urine and will send occasional signals to our brain to let us know how close we are to reaching max capacity. We’ll get a nonchalant “you’ll want to go at some point in the future when it’s convenient” signal, followed by a “start making plans to find the bathroom” signal, and only later when the bladder is truly full will we get the “GO NOW!” demand from our lovely bladders.
While we don’t often realize how wonderful our bladders are when they are working as designed, we certainly realize how terrible it is when their signaling seems to go haywire. For those with Overactive Bladder (OAB) or Urinary Urgency, the only signal the bladder seems to send is the “GO NOW!” one. This already frustrating symptom is often paired with urinating far too frequently. Normal frequency for urination is every 2-3 hours, but for those with OAB or urinary urgency, it can feel as if they need to go every 20 minutes, even if very little urine is actually produced. For others, a third symptom adds insult to injury: urinary leakage that occurs with the sudden urgency.
So how do we stop these urgency symptoms and get back into a normal bladder routine?
The first thing to discuss is what NOT to do. While it may make sense to cut back on hydration, this actually tends to exacerbate the problem. There are many factors that go into determining how much fluid you need, but for the vast majority of people, cutting fluid is not the answer. Speak with your healthcare provider to determine your own fluid goals and keep in mind that your environment and activity level will change how much is needed, but a good rule of thumb for most people is 4-8 ounces of water per hour.
The reason cutting fluid tends to worsen the problem is that it disrupts the way the bladder senses urine volume in the first place. Bladder walls are full of tiny little stretch receptors that act as sensors to tell us how full the bladder is at any particular moment. If we continuously dehydrate ourselves and go too frequently, the bladder never gets the chance to fully fill. As a result, the bladder walls begin to get stiff and have a harder time stretching to hold urine. The sensors in these newly rigid bladder walls start being triggered with even very small increases in urine. Other triggers like stress, movement, or changes in pressure are also more likely to send the bladder into a tailspin of “GO TO THE BATHROOM” signals when this is the case.
On the other hand, it is important to note that we should avoid routinely holding our bladder for too long so as not to develop urinary urgency and frequency issues in the first place. When we frequently hold full bladders for more than 2-3 hours, the walls of the bladder can become overstretched and have a harder time emptying fully. Frustratingly, this can create similar issues to those of going too frequently. Occasionally deviating from a 2-3 hour bathroom routine poses no problem, but when this becomes commonplace, bladder issues are likely to arise.
Ok, so let’s circle back to what we should do to combat unwanted urgency and frequency. There are three main strategies we should utilize:
- Address any underlying pelvic floor dysfunction.
The bladder is an introvert. It doesn’t like anything crowding its space. If you or a loved one has experienced pregnancy, you probably know how a baby sitting on your bladder will drastically increase the frequency of your trips to the bathroom. Things like constipation or tight pelvic floor muscles can push into the bladder in much the same way and can lead to urinary urgency symptoms. It’s important to address any of these potentially underlying conditions first.
- Minimize bladder irritants.
Even the healthiest of bladders has things it simply doesn’t like. In the pelvic health world, we call these “bladder irritants”. Common bladder irritants include carbonation, caffeine, alcohol, citrus, and artificial sweeteners. Sensitivity to bladder irritants will vary from person to person, but keeping bladder irritants low, typically 3 or fewer, is an important step, particularly if your bladder is already struggling with processing signals appropriately. (There is far more nuance in the bladder irritant conversation, and we’ll be covering this further in a future post – stay tuned!)
- Begin a bladder retraining program.
There are specific, gradual retraining programs we can follow to help reteach our bladders how to signal appropriately. These programs target not only the bladder, but the ways our brains process the signals the bladder sends. This is an important last step in making sure we get back into a good routine. Our bladders are supposed to be a helpful tool in letting us live our lives. If you feel that your bladder is suddenly your mortal enemy, you can list every bathroom on your common commutes, or couldn’t possibly make it through your book club without excusing yourself repeatedly, it may be time to discuss starting a retraining program with your provider. Stay tuned for bladder retraining program options in future posts!