What is Bladder Urgency?
Do you ever experience a sudden and strong urge to wee that you feel as though you cannot defer?
Do you experience a strong urge to wee that is often not related to the bladder being very full?
If you answered yes, you would be considered to have bladder urgency. This is dysfunction of the bladder and something that can be treated by a Women’s Health Physiotherapist.
What is the normal function of the bladder?
The feeling of needing to go to the toilet to wee/void is a common sensation we are familiar with.
Ideally, this feeling of the urge to urinate should come on gradually as the bladder fills with urine. The strength of the urge to go should be related to how much urine is in the bladder. The bladder can comfortably hold around 300-400ml in adults.
As the bladder fills with urine it stretches, just like a balloon if you were to fill it with water. As the bladder walls expand while filling, they stimulate receptors that sit within the muscular walls of the bladder. These receptors then send signals to the brain that the bladder is stretching and how much it is filling. The more the bladder fills the more of these signals that are sent to the brain.
Because we lead busy lives and need to focus on many different things it's not very helpful for our bladder to be constantly distracting us with messages of how full of urine it is. So our very clever brain filters the information from the bladder. When the brain starts receiving signals that the bladder is getting moderately full (<300ml of urine) we experience an urge to urinate and we will make a conscious thought about whether it is an appropriate time to go and wee. If it's not an appropriate time, this thought and associated sensation will be suppressed until either an appropriate time to go to the toilet arises or the bladder becomes more full.
When the bladder is quite full (500-600ml of urine) it will send a strong signal to the brain and then we experience a strong urge to go to the toilet to wee.
What causes urinary urgency?
When you experience urinary urgency the urge to wee is strong and sudden and often not related to the bladder being full. Urge that is normally associated with a very full bladder is now accompanied to a small volume. ~150ml is considered a small volume and that you may have gone to the toilet too soon.
There is a number of causes that lead to urinary urgency;
Bladder habits that encourage frequent voiding of low volumes of urine. Examples of these are; “just in case wee’s”, being triggered to wee by hearing running water, putting the keys in the door, etc.
Irritation of the bladder wall. As mentioned the bladder wall is a sensitive structure to enable it to have the ability to sense change in order to send signals to the brain. If this sensitive structure is being irritated it can trigger signals to be sent to the brain that it needs to be emptied. Some common things that irritate the bladder are; infection, concentrated urine, caffeine, carbonated drinks, alcohol.
The bladder doesn’t empty fully when you urinate, leaving urine behind and making your bladder feel full again quickly. When you empty the bladder it should be easy to start the flow of urine and it should come out in one continuous strong stream. It is normal for <50ml to remain in the bladder post voiding but >100ml can be problematic.
Pressure in the pelvic cavity. This refers to external pressure being applied to the bladder such as the weight of the uterus when pregnant, constipation or straining.
What is the effect of urinary urgency?
When every urge to urinate is sudden and strong it results in having to urinate frequently, discomfort in the bladder, or urinary incontinence (leakage of urine). These effects can be bothersome and impact quality of life.
How is Urinary Urgency treated?
In order to effectively treat urinary urgency we must first conduct a thorough assessment to identify factors contributing to your symptoms. The assessment will look at how often you are urinating, measure how much urine you excrete each void, identify any triggers that give you a strong urge to urinate or result in leakage, identify any food or drinks that irritate your bladder.
The gold standard for collecting this data is to perform a bladder diary study.
Once we have completed the assessment we then create a treatment plan to address the factors identified.
Generally speaking key components of bladder training are;
Avoiding bladder irritants
Ensuring adequate fluid intake
Eliminate bad bladder habits; just in case wee’s, large fluid intakes before bed, continuing to allow triggers to stimulate the bladder, etc.
Scheduled voiding to prevent going too frequently or holding on too long.
Ensuring healthy bowel function
In some cases we will need to work with your medical team (e.g. GP, urologist, urogynecologist etc) to ensure the best possible outcomes are achieved.