Urinary Urgency & Frequency – Overactive Bladder

Do you:

  • Often have an urgent need to wee?
  • Feel like you are busting and need to go often but then only wee small amounts?
  • Need to get up and urinate regularly overnight?
  • Worry about making it to the toilet in time?
  • Limit your drinks and fluid intake?
  • Feel embarrassed about the urgency and feel like your bladder has taken over your life?
  • Know where every toilet is on all of your planned journeys?
  • Find it nerve racking to go to new places where you don’t know how far you will be from a toilet?

 

 

These can be symptoms of an Overactive Bladder (OAB). Overactive bladder  is characterised by urinary urgency often accompanied by frequency and night time urination (nocturia) if present without any urinary tract infection or other pathology (Haylen 2010).

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Overactive bladder occurs when the muscle of the bladder (the detrusor) involuntarily contracts regularly causing a sensation of an urgent need to wee. This can be associated with urge incontinence if the pelvic floor muscles aren’t strong or responsive enough to close the urethra off and withstand the pressure the bladder contraction. If urinary incontinence is also present, it is known as OAB-wet, while if not, it is termed OAB-dry.

Overactive bladder can be worsened by stress and anxiety, spicy foods, fizzy drinks or caffeinated or alcoholic drinks and excess intra-abdominal pressure. Constipation can also increase symptoms. Overactive bladder can have a serious impact on quality of life.

It is estimated that 12–17% of women and men in Australia are affected by overactive bladder (Altman 2013). Whilst rates of overactive bladder increase with age,  it is NOT considered a normal part of ageing and is indicative of bladder disturbance.  I regularly see bladder issues  in women in the 25-45 age group after pregnancy and childbirth, and again when there are hormonal shifts with menopause.

 

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Urgency, frequency and regular night time urination are symptoms of a bladder that isn’t communicating or working well.

Living with an overactive bladder can have a massive impact on day to day activities and freedom. Navigating symptoms can be exhausting and many find it depressing especially as time goes on. People with overactive bladder often report:

  • Significantly less work productivity
  • Less sexual satisfaction and sexual dysfunction
  • Higher rates of low mood and depressive symptoms
  • Significantly poorer mental health
  • Poorer quality of sleep

Why does an overactive bladder develop?

We don’t always know why people develop an overactive bladder. It can be common after illness, pregnancy and birth, abdominal surgery or be associated with the development of bad habits early in life (for example “just in case” toileting at school or before going out) and hormonal changes (for example during menopause).

Overactive bladder can also be associated with other conditions that impact how the bladder is working and how the nerves communicate – for example urinary infection and bladder stones, mutliple sclerosis, Parkinson’s disease, diabetes, malignancy, or other forms of neurological disease. These causes are less common than overactive bladder with no known cause and your GP may be involved in providing a differential diagnosis regarding overactive bladder symptoms.

Do you want to get your freedom and quality of life back? 

 

Physiotherapy Assessment and Treatment

Fortunately for most people there are simple and effective treatments that can help and alleviate symptoms. First line management includes Physiotherapy assessment with a specialised women’s health and continence Physio.

Significant life changing results can often be seen in only a few sessions and by making simple lifestyle changes which may include:

  • Reduce caffeine intake
  • Reduce alcohol intake
  • Reduce fizzy drinks
  • Keep your bowels regular
  • Stop smoking
  • Reduce weight

Physiotherapy assessment will usually include:

  • Urine testing
  • Frequency/volume chart and bladder diary for at least 3 days
  • Pelvic organ and pelvic floor assessment
  • Analysis of your movement patterns
  • Asessment of your speech and breathing habits
  • Assessment of  how you exert pressure through your core
  • Discussion regarding your general health, gynae and birth history, lifestyle and emotional and physical stressors

Physiotherapy treatment often includes

  • Dietary advice to reducing bladder and bowel irritants
  • Advice regarding toileting, pelvic floor relaxation and how to avoid straining
  • Modifying fluid intake (specific to your usual habits)
  • Bladder retraining
  • Core retraining including pelvic floor strengthening and pelvic floor relaxation
  • Suggestions regarding general relaxation and ways of calming the body
  • Options like vaginal oestrogen cream may be applicable for women who are breast feeding or menopausal and have developed vaginal thinning and dryness

Some Physiotherapists will also use acupuncture or electrotherapy stimulation to influence the activity and reduce reactivity of the bladder.

Occasionally too, the bladder doesn’t empty fully and symptoms resemble overactive bladder can be mimicked by overflow incontinence. Your Physiotherapist has specialist assessment skills and will use methods to help determine what is going on.

 

At least 3 months of supervised pelvic floor muscle training is required to see benefits.

What are the options for Physiotherapy?

In many areas in Australia you will have private and public Physiotherapy options.

 

Private Women’s Health Physiotherapy

In Australia you do not require a referral to see a private Physiotherapist as a private payer and your session is likely to be eligible for health insurance rebates if you have private extras cover.

 

Chronic Disease Management Plan – Medicare (formerly EPC)

If you do not have private health insurance cover you can still see a private Physiotherapist and pay in full. If your issue has been present for longer than 3 months you are also eligible for a Medicare rebate under the Chronic Disease Management Plan. To access Medicare support you will require a GP referral to a specific private Physiotherapist and will receive part payment for sessions of approximately $45 over 5 sessions annually.

 

Public Women’s Health Physiotherapy

Many hospitals, especially those providing maternity services, have a Women’s Health Physiotherapy department. If you would like to access a public Women’s Health Physiotherapist in Australia you will need a GP referral faxed or sent to the relevant hospital and Physio department. Depending on your area and hospital you may be placed on a waiting list for your initial Physiotherapy assessment. Access and waiting times will vary from area to area.

 

To find a Physio who can help CLICK HERE 

 

Other physio and medical assessments may also include:

  • Urinary tract ultrasound and measurement of post urination ( post residual) volume
  • Urine testing
  • Urodynamic testing
  • Imaging of the bladder (cystoscopy)
  • Imaging of upper urinary tract or spine

Behavioural therapy including bladder training, bladder control strategies, pelvic floor muscle training and fluid management  is the first line of management, which includes specialised Physiotherapy assessment and treatment. Drug therapy is sometimes also appropriate and can include anti-muscarinic drugs. These however can have side effects like dry mouth and constipation.

Beta-3 adrenergic receptor agonists are another group of medicines recently trialled to treat overactive bladder. Botox injections  are also sometimes used for more severe cases where other treatments haven’t been beneficial.  Other treatment options are intermittent catheterisation, sacral neuromodulation and posterior tibial nerve stimulation (Gormley 2012).

Don’t simply put up with urgency and frequency thinking “nothing can be done to help”, “it will go away”, “it’s just a normal part of aging” because it isn’t normal and it can be helped!

Case Study

One of my clients “Katy” was running to the toilet 10, 12, 15 times a day and going several times a night. Often it was only a dribble or small wee but it always felt completely urgent. Some times she didn’t make it started leaking,  She felt embarrassed and that her my life revolved around her bladder. She reported always feeling like she was checking into her bladder, aware of the urges and going just in case. I am only 37. Katy felt that she was too young to be having these issues.

Katy had two children and the bladder issue had intensified after a chesty cold. and she started to feel depressed about this being a long term issue here to stay. A friend recommended women’s health Physiotherapy.

At the initial appointment we discussed all the issues she’d been having. I explained the neurophysiology and mechanics of the bladder, pelvic floor and core including the diaphragm. We looked at her posture, movements, breathing and alignment and it was obvious that she was a “chest gripper” and “pelvic floor gripper” pushing pressure into her pelvic floor and onto her bladder. She was also quite stressed, stretched and exhausted as a Mum looking after 2 children under 2.

We tested her urine and there was no indication of any infection. I assessed her pelvic floor and found that she had difficulty fully relaxing. There was also considerable tension around her c-section scar and increased tone in the pelvis around her bladder. Her breathing patterns were upper chest dominant with minimal expansion into her lower rib cage. During inspiration, there was minimal movement of her abdominal wall. She also had a history of constipation and slow bowels. 

After the first session she completed a 3 day bladder chart and started making some simple changes with her diet, drinking habits and bowel habits and overall relaxation. She also started a pelvic strengthening programme including pelvic floor relaxation or “down training” and did gentle manual therapy around her scar line to increase awareness, proprioceptive input and enhance self relaxation  and connection to the area.  

These simple measures saw symptoms significantly reduce within two sessions with both urgency and frequency reducing. Not long into her sessions she became LEAK FREE which was a break through. She started to feel comfortable going out more. One of her comments was “My bladder is no longer ruling my life and  I can now comfortably hold on which is a major break through. My bladder doesn’t shout at me to GO GO GO all day long”.  Katy also reported that her sexual arousal and orgasms had massively improved – a positive side effect she hadn’t been expecting. 

Every case is different but overactive bladder issues can be extremely respopnsive to Physiotherapy management.

Seek help now. Treatment is often simple and effective and Women’s Health, Men’s health and paediatric continence Physiotherapy can help.

*This article is for information only and is not meant to replace medical consultation, diagnose, treat, or act as medical advice. Please consult your health care provider and seek individualised advice for any concerns**

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Written by Wendy Langshaw   (c) Nurtured Mumma

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Wendy Langhaw is an innovative and talented Physiotherapist with 20 years of experience combining musculoskeletal, women’s health, respiratory, lymphatic, neurological physiotherapy and pain management to help people address simple, complex and persistent issues using a top to toe approach.  Wendy works in partnership with clients combining Physiotherapy, yoga therapy, pilates, acupuncture and functional approach to to movement, fitness, health & wellbeing. Wendy graduated from the University of South Australia in 1996 and gained wide public hospital experience before moving privately. Wendy has a particular passion for working with pregnant and postnatal women through classes and individually and  has substantial experience supporting people through a wide range of complex issues including chronic persistent pain.

Wendy has worked in both Adelaide and London where she gained her acupuncture certification in musculoskeletal and women’s health acupuncture. Wendy has been involved in setting up innovative new initiatives including a hospital Falls & Balance Clinic, and new public and private Women’s Health Clinics in the UK. Wendy has been at the forefront of pregnancy and postnatal physiotherapy care for many years, running Bellies, backs & babies since 2000.  More recently Wendy set up Energy & Motion Integrated Health in the beautiful Adelaide Hills providing general, preganancy and postnatal classes and individual consults. She regularly runs Birth Preparation workshops for Mums and couples.

Through her day to day clinic work and Nurtured Mumma, Wendy is dedicated to inspiring, empowering and educating Mums and Mums to be, health professionals, midwives, doulas, yoga teachers, therapists, students and people in pain about ways that integrated physiotherapy and movement therapies can effectively address a variety of health issues and improve quality of life, wellbeing and a deeper sense of connection to themselves, others and the world around.

 

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References

ALTMAN 2013

Altman D, Cartwright R, Lapitan MC, Nelson R, Sillen U, Tikkinen K. Epidemiology of Urinary Incontinence (UI) and other Lower Urinary Tract Symptoms (LUTS), Pelvic Organ Prolapse (POP) and Anal Incontinence (AI). In: Abrams P, Cardozo L,Khoury S, Wein A editor(s). 5th International Consultation on Incontinence. 5th Edition. International Continence Society, February 2012:17.

GORMLEY 2012

Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, et al. American Urological Association, Society of Urodynamics, Female Pelvic Medicine, Urogenital Reconstruction. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. Journal of Urology 2012;188(6 Suppl):245563.

HAYLEN 2010

Haylen BT, De Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction.Neurourology & Urodynamics 2010;29(1):420.