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An Overactive Bladder: Urinary frequency, urgency and urge incontinence

17 May, 2020

   

Knowing where the next toilet is hiding is the bane of your life if you have an overactive bladder. Especially in our new #Coronvirus life where many public toilets are locked off to the general public – women and men must be really struggling.

I was reminded of this when we went for a giant walk yesterday in my home town, Brisbane, from Somerville House, across the Goodwill Bridge, along a brand new walkway called The Mangrove Walkway, under the freeway where there’s a new exercise area, past Parliament House, through the Botanical Gardens, along another new walkway over the river in front of Riverfront Place, then back through the Botanical Gardens, back over the Goodwill Bridge and to the car.

     

It was a 10,000 stepper walk that took a couple of hours. And what was interesting that in that whole time we were out walking we only walked past one set of toilets.

In the good old days (pre-COVID19), when we were travelling overseas, we often ended up buying a coffee or a spritzer/beer at a cafe just so we could use their toilet, because toilets are as rare as hen’s teeth in Europe and the UK.

You may remember another blog regaling my struggle to maintain continence after a train trip to Brighton where there was no toilet on the train and when we arrived at Brighton, all but two of the toliets were blocked off and the queue to the remaining two was resembling the opening of ticket sales to the Rolling Stones concert. Needless to say I survived and my dignity remained intact – but I remember I was conducting a messenger conversation with some friends back in Australia to keep myself distracted and not thinking about the toilet.

Distraction is just one of the methods that can work well when you have an urgent bladder urge and there is no toilet available. Other ‘urge control’ strategies are toe curling, squeezing your glutes (your butt cheeks), crossing your legs, pulling in your low tummy or strangely relaxing your tummy (try each and see which works better for you), gently engaging your pelvic floor muscles and finally belly breathing.

Toe curling to help turn off the urge (yes I got to go to have a pedicure yesterday for the first time in 3 months)     

These strategies are useful to help you build up your bladder capacity by deferring, but when you are as full as you can tolerate and you sense: “If I take a step I am going to lose it all”, then defer the urge once more and use the time to walk slowly to the toilet, breathing and perhaps counting your steps as you go along.

Doing a bladder diary to check your bladder capacities across two days is helpful in determining how much work you need to do to build up your bladder holding ability.

Other strategies such as pelvic floor exercises (they may help to calm down the smooth muscle pump of the bladder but also sometimes doing too strong a pelvic floor contraction this may make your urgency worse); and even having local oestrogen up the vagina can help overactive bladder symptoms – discuss this with your doctor.

Managing your bowels well is also an important strategy for an overactive bladder. A loaded rectum or even lots of gas and bloating can make it harder to hold onto a decent capacity, so things like sitting with correct postures to empty your bowels and the correct dynamics of defaecation and avoiding foods that give you excessive bloating will be helpful.

Another helpful strategy is using TENS (stands for TransCutaneous Electrical Stimulation) over the tibial nerve (see the application of the electrodes below) to provide some neuromodulation. Your pelvic health physiotherapist will teach you how to use the TENS unit.

It is always important to have a bladder ultrasound before and after you void to make sure you are emptying your bladder completely. If you have a largish residual and you are not aware of this, you may try to wrongly build up your voided capacity when in fact your bladder emptying needs addressing.

An ultrasound can check whether the bladder is emptying properly. Use this position to try to empty completely

Anyway, what is the moral of this blog?

  • The Brisbane City Council needs to install more public toilets around the city.
  • An overactive bladder can be significantly improved by a Pelvic Health Physiotherapist – make sure you get some help.
  • Medications can help also – but discuss with your GP, gynaecologist, urogynaecologist or urologist about the best drug of choice as there is increasing, emerging evidence that long-term use of many of the drugs used to help the urgent bladder are implicated with dementia. (The drugs that cross the blood-brain barrier are the ones to watch out for.)

And finally walking everywhere allows us to stop and ponder life. On our regular walks, we’ve discovered new things that have been built, new outdoor art which is refreshing and beautiful, found things we never knew existed and just observed things.

I wanted to be this bird. He’d had a swim and there he was just sitting on a log in the Brisbane River, drying his wings, oblivious to the pandemic. If you can believe the theories, we should all be doing this to get our daily dose of Vitamen D – which appears to be useful with this damn COVID!

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