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Physiotherapy Management of the Overactive Bladder (OAB)

26 October, 2014

Urinary incontinence is completely acceptable if you are under 3 years of age. So for all the rest of the 4.8 million Aussies over the age of 15 (1) that are suffering urinary and faecal incontinence – and yes they are suffering!- its literally a bummer. The Deloitte Access Economics report into Incontinence (2010) predicts that this figure will rise to 6.4 million by 2030.

Well not on my watch, I say!

And so do all my #pelvicmafia colleagues here in Australia and for that matter all of us world-wide are on a mission.

elaine miller

 Elaine Miller, Comedienne/Continence Physio

My great ‘never-met-face-to-face’ Twitter/Facebook friend Elaine Miller, (pictured above) who is a wonderful Comedienne/Continence and Women’s Health Physio in Scotland would probably call it a ‘Pishing Mission’!

And that mission is to spread the word about how damn easy it actually IS to minimize and prevent urinary incontinence.

Last week I was lecturing to a group of GP’s about the physiotherapy management of the overactive bladder and so I have decided I would share some of the info that I passed onto those doctors via this blog. GPs are at the coalface of incontinence. What better way to track down those women, men and children who are having incontinence problems EARLY ON- before the habits and rituals have become entrenched?

In fact, I wrote a blog about how I would love to see my little acronym PIPES included in the medical education on PAP smears, so it would become a routine for the doctor to ask questions about Prolapse, Incontinence, Pain, Exercise and Sex at that regular 2 yearly contact.

So the overactive bladder syndrome (OAB) is defined as urinary urgency, usually with urinary frequency and nocturia, with or without urgency urinary incontinence (ICS definition). This condition is particularly anxiety producing because of the uncertainty it produces- what if I get a sudden urge?; where is the next toilet?; what if I leak here in this Coles queue?; is there an odour associated with those pads I’ve taken to wearing?

Of course there are two predominate types of incontinence: Stress urinary incontinence where you leak with increases in intra-abdominal pressure such as coughing, sneezing, bending etc and urge incontinence where you leak on the way to the toilet and can often be in response to things like putting a key in the door or hearing running water (which is a part of the overactive bladder picture).

At my lecture to the GPs last week, one of the first messages I wanted to pass on was to dispel two myths.

  1. That pelvic floor physiotherapists only teach Kegals (pelvic floor exercises)
  2. That its critical to have a strong core (which equates to doing lots of sit ups)

Everybody, including many doctors, believe that pelvic floor exercises are pretty much all we physios teach. But if you’ve read my books you’ll know one of my favourite quotes comes from Michael Aronsen in 1994:

“As we learn about the natural function and causes of dysfunction of the female pelvis we are beginning to see that the parts can no longer be regarded in isolation. Rather the components must be thought of in relation to the whole pelvis and therefore the whole patient” (Current Opinion in Obs and Gynae 1994 n6: 305-307)

And what this means is that the bowel, the abdominal muscles, the bladder function itself, the position of the pelvic organs and even the brain of the patient all play a role in affecting function in this area and Continence and Women’s Health Physios are very well suited to educating about all of these important things.


The second message is a vital one. Lots of younger women are being more proactive about their health and may be seeking different forms of exercise- Pilates, Yoga, Crossfit, gyms, running……..And with anything that is good there is sometimes a downside. If the exercise you choose is NOT ‘pelvic floor safe’ then you can in fact make any condition in the pelvic floor region much worse. Having a very strong set of abdominal muscles (like those pictured above) can cause issues such as increasing the risk of pelvic pain; not allowing the bladder and bowel to empty properly; and increased incidence of pelvic organ prolapse amongst others. So many times we are encouraging women to learn how to RELAX their pelvic floor rather than only focusing on tightening it.


With physiotherapy management of the OAB we must look at: the pelvic floor muscles– are they overly tight from furiously holding on all the time and therefore affecting their ability to inhibit the detrusor contractions (spasms); the effect of any prolapse – again on effective contraction of the muscles; poor urethral closing pressure – if one drop enters the urethra, the urethra can funnel and open and therefore cause another contraction of the detrusor muscle and give you another silly urge to go; bowel dysfunction – if you have a loaded rectum or colon that can cause pressure on the bladder and make it more difficult to hold on; the brain– if you have stress and anxiety events, your bladder overactivity can be made worse.

So your physio treatment will incorporate management of all of these different problems.

But the mainstay of managing OAB is bladder retraining– this means that you will learn how to defer the first message using urge control techniques and allow the bladder to fill more and hopefully it will get closer to storing the 350-500 mls (which is the normal capacity of the adult bladder). Some of these urge control techniques include crossing your legs, squeezing your buttocks, curling your toes, a gentle pelvic floor muscle contraction and a gentle low abdominal draw in. Taking bladder irritants such as caffeine and alcohol out of your diet and replacing them with decaf tea and coffee and lower alcohol or no alcohol drinks will also significantly help.

I hope some of these ideas will have helped you if you are suffering with an urgent bladder and I suggest you also check out the Continence Foundation of Australia website for more information or ring their Helpline 1800 33 00 66

  1. Thanks for this great post. I’m glad that you are taking steps to educate other health care professionals about what pelvic floor physiotherapists actually do and how they help people who have urinary incontinence is ways that go far beyond the “kegal” exercise.

    I think it’s also important to note that pelvic floor physiotherapists investigate and look for the true cause of the muscle imbalances in the pelvic floor. Sometimes the region that is causing this imbalance is not the pelvis (it can come from the hip, the thorax the low back to name a few).

    Ultrasound imagining can also be an effective tool for pelvic floor physiotherapists. As you probably already know, this tool can serve as bio-feedback for patients so that they learn how to activate the right muscles in their abdomen and pelvic floor. Patients who have a pelvic floor dysfunction usually have no idea how to use the muscle properly because they haven’t done so in so long. If they try to do a pelvic floor activation, they might be doing it incorrectly or with co-activation of the wrong muscles. Re-training motor control is also key.

    I hope that pelvic floor physiotherapists follow your steps and take action to educate physicians and other health care practitioners about the good work we do.

  2. mark permalink

    I’m not sure that I can entirely agree with you, regarding “bladder retraining”.
    I am a male specialist medical practitioner, 56years old and I have had this damn irritable bladder for about over 5 years now.

    I have tried and continue to practice (because it seems physiologically a good idea) “bladder retraining”

    You know what it just does not seem to help.
    The problem is I think in a person’s brain. One can do bladder training until you are ‘blue in the face’ but it will not cure OAB! It does not make it more manageable. It does not increase a person’s bladder volume.

    Can you imagine asking a person to physically hold onto an extremely hot object, so hot as to cause constant pain and burning- and then tell them not to let go? This is what happens with so called bladder retaining!
    Then must hold off going to urinate while having painful bladder spasms!

    It just gets very depressing!

Trackbacks & Pingbacks

  1. International Women’s Day Lead up: Pelvic floor physiotherapists/physical therapists | sue croft physiotherapist blog
  2. How Physiotherapy for OAB Can Help -

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