Urge incontinence, also known as overactive incontinence, is the sense of urgency to have to urinate because the bladder simply cannot hold the urine. The solution for most people with urge incontinence is frequent visits to the bathroom and this goes throughout day and night.
Urge incontinence is not a disease but a sign of abnormal bladder contractions, but to appreciate what happens with urge incontinence let’s review the physiology behind bladder control and contraction.
What Happens with Urination?
Your bladder is a smooth muscle that allows it to stretch and expand quite a bit (the same type of muscle as the uterus and intestine). This muscle, called Detrusor, is connected to the internal urethral sphincter and with it contracting, it stimulates the urethral sphincter to relax so you urinate. The contraction/relaxation of the detrusor and sphincter is controlled by the autonomic nervous system (parasympathetic and sympathetic nervous systems).
With urge incontinence, the bladder muscles contract so much that they override the sphincter muscles of the urethra. This can happen when the nerves to the bladder are damaged by a disease (MS, Parkinson’s, stroke, or diabetes), the spinal cord is damaged or the bladder is irritated. The least acknowledged, though well-known cause of urge incontinence is the presence of trigger points in the adductor muscles of the hip joint which also cause pain in the groin, knee, shin, and front/inside part of the thigh.
Interestingly enough, in my practice I see many patients that come in as a result of their musculoskeletal condition and the urge incontinence is mentioned in history taking or are referred by patients whose urge incontinence were resolved as their course of treatment of their musculoskeletal condition. Addressing the adductor muscles, obturator internus muscles as their posture and movement conditions have shown great results among my patient base.
Healthy Bathroom Visit Checklist
- 3-4 hours in between voids
- 5-7 voids per day
- No ‘just in case’ bathroom visits including at night
- No sitting on the toilet to just wait
- No straining
- Avoid eating food and resuming behavior that causes constipation
- Drink enough water with dinner
- Avoid bladder irritants (see below)
- Void before and after intercourse
- Do Kegel/PFM exercise
- Orgasm is great for healthy pelvic floor
Common Treatments for Urge Incontinence
While medications, electrical stimulation, and surgery are commonly used, behavioral treatments are also helpful. Keeping a bladder diary allows patients to work on adjusting their habit of going to the bathroom to avoid those accidents.
Nutrition plays a big role in urge incontinence though it is hardly ever discussed with patients. It is important to avoid, caffeinated drinks and soda, chocolate, citrus, artificial sweeteners, spicy foods, carbonated drinks, tomatoes, and alcohol by those with urinary urgency.
A Lifestyle of prolong sitting leads to a high incidence of fluid back-up in the legs which will work its way up to the bladder when laying down. It is so important to look into the lifestyle when addressing all health conditions and urge incontinence is no exception.
Pelvic floor exercises are huge and not all of them done routinely will do the job! It seems that there are too many recommended exercises that are just mechanically done vs correctly done and then there is my go-to exercises: Looking outside the box type of exercises and activities!
How about making each move an opportunity to practice proper movement that works out the body and pelvic floor? After all, the pelvic floor is the bottom of your torso with the torso being the stabilizing portion of your body. Here is a great example of how you can turn a simple daily activity into a pelvic floor exercise.
Postural Neurology is what is being missed when treating all pelvic floor dysfunction including urge Incontinence. We are too busy working on strengthening the pelvic floor muscles when our failed posture and dysfunctional movement will undo the hard work. Postural Neurology is the way to find out the blueprint of posture and balance.
Developmental Kinesiology in the form of Dynamic Neuromuscular Stabilization (DNS) is how the whole body is involved in movement and the pelvic floor muscles (not just the floor but the connecting parts such as the lower back, sacroiliac joints, and hips) get to ‘play’ along.
You see, if movement was a concert, the brain would be the conductor, the blue print of movement (Homunculus) would be the notes in front of the conductor and the body parts would be the musicians. With any dysfunction, this map gets modified based on what is available and accessible to movement by the brain and the body parts play based on that.
Now when we work on the pelvic floor strengthening, removing the nerve irritation to the brain, or clearing the trigger points at the locations I mentioned above, through DNS exercises, the new and improved part has to play with the rest of the body in movement or it will be misused or not used at all (old blue print).
Breathing is a huge influencer of the pelvic floor but what I see being instructed to patients in almost all cases is wrong! When you breathe in and out, your chest does not rise and fall. Put your hands on the lower part of your rib cage and with every breath in, feel the rib cage expand outward and into your hands. THAT is not being instructed to patients and no one talks about the pelvic diaphragm which is different from the pelvic floor. Here is the video that explains it:
…so what is the right way to breathe? Common sense tells us that the way babies breathe is the right way. After all, all babies despite their many differences do certain things the same way and breathing is one of them. In fact, the way they breathe is the reason why their abdomen is big; it is not because they are fat but because their breathing apparatus is correctly being used. This is explained here:
When it comes to pelvic floor dysfunction, urge incontinence or not, it seems that the commonly used modalities are either a simple bandaid or a partial treatment at best. The proper treatment has to include a careful and comprehensive history and consultation, followed by the appropriate examination of the region, posture, and breathing. We cannot delegate each piece to one specialist who is only the expert in that piece of the puzzle or a lot gets missed.
If you suffer from pelvic floor dysfunction or not sure about your urge incontinence and the treatments you have received so far, contact me.
