Yes, there are answers!

Bladder leakage, frequency and urgency are prevalent problems affecting people of any age and gender. While it is a common problem for many, it is not normal and conservative management is most often a first line of treatment.

Bladder leakage, also known as urinary incontinence (UI), can take several forms. Stress UI is leakage that occurs with coughing, sneezing, jumping, running, lifting or laughing. Urgency UI is leakage that occurs on the way to the bathroom when someone has the urge to empty their bladder. Mixed UI combines stress and urgency incontinence, but one type is typically more bothersome. Functional UI may also occur if someone has difficulty with hand mobility and cannot remove their clothing or has difficulty getting to the toilet in time. Overactive bladder syndrome is a combination of urinary urgency with or without incontinence, increased urinary frequency, and nocturia (increased nighttime voids).

These conditions can all negatively impact an individual’s quality of life. Urinary urgency and frequency can create bother and disruption during the day, causing stress and worry. Leakage of any type can cause a person to decrease their physical activity, leading to decreased cardiovascular conditioning and reduced strength. Decreasing social engagements, interactions with family and friends, limiting fluids and limiting exercise due to fear of leakage can lead to isolation and reduced mobility. The combination of getting up to go to the bathroom at night with urgency UI has been associated with increased fall risk.

Pelvic floor physical therapy is a conservative treatment option that focuses on improving pelvic floor muscle function, bladder habits and overall conditioning of the lumbopelvic muscles. Pelvic floor muscles, when well-coordinated, work to help stop the flow of urine and can also help with decreasing the urge to go to the bathroom. With a pelvic floor muscle examination, a physical therapist can determine if these muscles are weak and, if so, design a program to work on strength and endurance. If these muscles show overactivity and need to be able to relax, a program to assist with proper muscle activation can be developed.

A bladder diary is another helpful tool that physical therapists use to determine how often someone goes to the bathroom and what they are drinking. This provides valuable information to the patient and the therapist and helps with eventual bladder re-training. The patient may also do a bowel diary, as constipation can also

impact bladder health. Screening of lower body strength and flexibility is another consideration that can also be evaluated, as they can also contribute to improving bladder function.

Considering what is normal when thinking of bladder control can be helpful. The number of times someone should go to the bathroom should be six to eight times per day, depending on fluid intake. The first void of the day should typically be the largest. Going to the bathroom more than one time per night is known as nocturia, which is not normal, barring a few exceptions such as late-term pregnancy or advancing age.

Fluid intake is essential for general health but can also influence bladder control. Limiting fluid intake because of UI can make the urine more concentrated and cause burning with urination. The type of fluids matters as well. Caffeine, carbonation and artificial sweeteners can be irritating to the bladder lining and can worsen urinary urgency, frequency and/or incontinence. “Just in case” voiding can train the bladder to need to go to the bathroom more frequently and can create bad habits.

Also, toileting posture is important.

Hovering over a toilet makes it difficult for a person to fully relax their muscles to allow their bladder to empty.

With stress incontinence, individuals can be trained in a technique to contract the pelvic floor muscles before coughing and sneezing. Practicing coughing with a contraction while not actively sick is helpful. Working with individuals to regain bladder control with different sports often requires a multi-faceted treatment based on their examination. With conditions like overactive bladder syndrome and urgency UI, treatment typically starts with the completion of a bladder diary to determine how often the person goes to the restroom, what they are drinking and what triggers their leaking. From there, individuals are taught to use urge deference strategies and timed voiding.

Other conservative treatments, like surface electrical stimulation over the ankle or the lower back, can help change how the nerves in the bladder respond to the urge to go to the bathroom. This can be done in the office or at home. In more severe cases, this can be done with a needle in the urologist’s office or with an implanted device in the lower back or around the ankle.

There is a research study currently enrolling women over the age of 60 who experience symptoms of urinary urgency with or without incontinence, urinary frequency and/or nocturia. If you are interested in determining eligibility for this study, please get in touch with the author at Amanda.mahoney@lsuhs.edu or by calling (318)813-2970.

Amanda Mahoney, PT, DPT, is a board-certified specialist in orthopaedic physical therapy and assistant professor of physical therapy at the School of Allied Health Professions, LSU Health Shreveport.