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Urge incontinence, also known as overactive bladder, is the sudden and intense urge to urinate due to an inability of the bladder to hold urine. This is typically a result of abnormal bladder contraction. Frequent trips to the bathroom, day and night, are often necessary for those experiencing this condition. In this blog, we will explore the urination process, how our lifestyle, habits, and nutrition impact our bladder control, and what an effective treatment for this condition should include but is grossly missing in the standard treatment.

How Does Urination Work?

The bladder is a smooth muscle that stretches and expands significantly. This muscle called the Detrusor, works in conjunction with the internal urethral sphincter. When the Detrusor contracts, it signals the urethral sphincter to relax, facilitating urination. The autonomic nervous system and the parasympathetic and sympathetic nervous systems, control this process.

What Happens In Urge Incontinence?

In urge incontinence, the bladder muscles contract excessively, overpowering the sphincter muscles of the urethra. This condition can arise from nerve damage due to diseases like MS, Parkinson’s, stroke, diabetes, spinal cord injuries, or bladder irritation but not everyone experiencing urge incontinence suffers from those conditions. Trigger points in the hip joint adductor muscles, causing pain in the groin, knee, shin, and thigh, can also lead to urge incontinence.

This is the part of care that is overlooked but think about it, if the pelvis stability is absent or weak, then the function of the bladder and how it supports urination changes too. Read to see what I mean!

Can Musculoskeletal Conditions Affect Urge Incontinence?

In my practice, many patients report improvement in urge incontinence symptoms while being treated for musculoskeletal conditions. Addressing the adductor muscles and obturator externus muscles, alongside posture and movement correction, has yielded significant results.

Your pelvis is the ‘house’ that the pelvic floor is the ‘floor’ of. It only makes sense to attend the house first before looking into providing balance in muscle function and tone of the floor of the pelvis, right?

What Are Healthy Habits For Healthy Bladder Control?

  • 3-4 hours between voids
  • 5-7 voids per day
  • Avoid ‘just in case’ visits, including at night
  • No sitting and waiting on the toilet
  • No straining during urination
  • Avoid foods and behaviors that cause constipation
  • Drink sufficient water with dinner
  • Avoid bladder irritants (listed below)
  • Void before and after intercourse
  • Perform Biological breathing as Kegel’s alternative
  • Perform Trunk stabilization exercises
  • Have functional mobility of the spine and the lower extremities

What Are Common Treatments For Urge Incontinence?

While medications, electrical stimulation, and surgery are common treatments, behavioral modifications can also be effective. Keeping a bladder diary helps patients adjust their bathroom habits to prevent accidents which then allows the pelvic floor therapist to approach the solution better.

A pelvic floor therapist can be a physical therapist, chiropractor, occupational therapist, nurse, or medical doctor who is trained in the field of pelvic floor therapy. Most of the training involves internal pelvic work with some breathing techniques; IMO that is not sufficient as we should chase the ‘why’ behind the reason for tightness, weakness, or dyssynergy of the muscles inside the pelvis leading to some of the symptoms associated with this area.

In my practice, while I have had the training for pelvic floor therapy, I focus on pelvis stability which involves the pelvis and what is attached to it. What I see is that by addressing the stability, almost all other associated symptoms go away; of course, in some cases, this is not sufficient, and other interventions need to parallel the pelvis stability treatment.

Does Nutrition Impact Urge Incontinence?

Yes. Nutrition plays a crucial role in managing urge incontinence. Patients should avoid caffeinated drinks, soda, chocolate, citrus, artificial sweeteners, spicy foods, carbonated drinks, tomatoes, and alcohol to reduce urinary urgency.

Does Lifestyle Affect Urge Incontinence?

Yes. A sedentary lifestyle, especially prolonged sitting, can lead to fluid buildup in the legs, which moves to the bladder when lying down. Evaluating and adjusting lifestyle habits is essential in managing urge incontinence.

Are Pelvic Floor Exercises Effective?

Pelvic floor exercises are vital and must be performed correctly with a focus on functional mobility and postural stability. I have seen fantastic results with Developmental exercises which are what we all did as babies; think about it, we all start as helpless infants and become running toddlers and have a strong pelvis stability so the structure above, the trunk, can be built on. We don’t need to reinvent the wheel but follow the same patterns and become experts in recognizing the wrong patterns of movement. In other words, follow the ‘human manual of movement’!

What Works Best For My Patient

Here is what I incorporate in my treatments with the focus on stabilizing the ‘house’ that the pelvic floor is the ‘floor’ of.

  • Postural Neurology

Postural Neurology is often overlooked in treating pelvic floor dysfunction, including urge incontinence. We resume our posture and movement as a result of the map of movement that is called Homunculus. This map gets altered as a result of our injuries, lifestyle, and habits and so if the map is off, so is the posture and movement. I have explained this in detail and encourage you to look into it.

  • Developmental Kinesiology

I follow the exercise protocol that is as a result of studying human babies and is called Dynamic Neuromuscular Stabilization (DNS); it involves the entire body in movement, ensuring the pelvic floor muscles function correctly within the body’s overall movement system.

  • Biological Breathing

Proper breathing techniques significantly influence pelvic floor health. Most patients are incorrectly instructed on breathing and they think ‘belly breathing’ is the right type of breathing! While I am always unclear when patients tell me they do belly breathing and when I ask them to show me, I see that they are mistaken, you have to understand that correct biological breathing is what babies do. It involves breathing in, sending the abdominal diaphragm downward toward the pelvis as the side of our body pushes out not the abdomen and certainly not the chest bone! The correct method involves expanding the rib cage outward with each breath. Here is how it is done!

If you have pelvic floor dysfunction, it is important to make sure your pelvis is stable and the proven method to stabilize is what we all did as babies. Clearly, we all stood up, walked, and did amazingly until we started sitting too much (schools), played one-sided sports, and ended up with injuries and modifications our bodies had to take on in order for us to move on with life.

If you have pelvic floor dysfunction and are ready to take on the comprehensive holistic treatment contact us.

Dr. Shakib

Recommended Reading:

What Is The Most Effective Treatment For The Pelvic Floor?

How Do I Perform Kegel Exercises Correctly?