Leaking urine and other bladder dysfunctions

Our bladders can be sensitive little creatures. Not enough liquid and the concentrated urine can be irritating. Too much liquid and we are running to the bathroom. What gives?

Here is an overview of some common bladder dysfunctions you or someone you know may experience. This affects all genders!

Bladder storage issues

Our bladders are like little balloons. They expand up to the top of our pubic bone when full and shrink back down after emptying.

The muscle around the bladder, the detrusor muscle, contracts to push the bladder out when the pelvic floor muscles are relaxed.  If your pelvic floor muscles are not relaxing due to pain (interstitial cystitis, vulvodynia, endometriosis, coccyx pain, etc.) that your bladder might be affected.

Here are a few examples of bladder storage dysfunction:

Urinary urgency

Sudden, intense urge desire urinate which can cause emotional upset and fear of not making it to the toilet.

I’ve seen some patients have sympathetic nervous system responses with urgency (sweating, increased heart rate, etc). This may be associated with urinary frequency.

Some people find urge deferral techniques to be helpful strategies.

Urinary frequency

Normal voids per day is 5–7 times. This may be different according to your water intake and activity level (needing more water for breastfeeding, singing, sports, etc).

Patients who suffer from urinary frequency might go every hour, twice and hour, or even 3–4 times per hours. This may or may not be associated with pain or discomfort at the bladder and/or urethra.

Nocturia

Nocturia, or “nighttime voids,” is when you have to get up one or more times at night to go to the bathroom. This may not seem like a dysfunction—it happens to so many people it seems normal—but nighttime voids can disrupt sleep, become a fall risk, and cause anxiety around falling back asleep.

Nighttime voids occur for many reasons. A few include:

• drinking liquids late
• waking up to breastfeed and going “just in case”
• timing of medications
• swollen legs, ankles, and feet*

*It’s true! When people accumulate swelling in the lower legs and lay down at the end of the day, the fluid is pushed back up into the center of the body and processed out as urine in the middle of the night. In this case, elevating your feet in a recliner or on a coffee table before going to bed will help.

For people taking diuretics at night (e.g. high blood pressure pills), they may want to talk to their doctor about switching to morning dosing.

Overactive bladder (OAB) syndrome

Urinary urgency, (with or without leakage) usually accompanied by frequency and nocturia. As with all bladder storage and leakage diagnosis, UTI and other pathologies must be ruled out.

Hydrating with overactive bladder can be tricky, but it’s critical to make sure you figure out a way to nourish your tissues, kidneys, and whole body.

Bladder irritants, such as coffee, black tea, soda, seltzer, citrus, red and blue food dyes, and alcohol may increase urgency and bladder pain. Pay attention, perhaps track using a bladder diary for a few days, to what foods and beverages might irritate your bladder lining.

When bladder storage issues are accompanied by overactive pelvic floor muscles, calming yoga programs can help. Check out the urgency track on Optimizing Bladder Control, or Yoga for Interstitial Cystitis or Yoga for Vulvodynia for another downtraining strategy you can try at home.

Urinary incontinence

Urinary incontinence is a frustrating condition that affects millions of people of all genders. It can be caused by surgery, pregnancy, delivery, weakness, connective tissue changes, poor posture, decreased core strength, constipation, and non-optimal breathing patterns.

A few types of leakage (not an exhaustive list):

Urge urinary incontinence

Involuntary loss of urine associated with urgency. Urge incontinence is often associated with weakness or tightness of the pelvic floor muscles. Urgency, frequency, and urge incontinence can get worse with stress, hormonal fluctuation, and bladder irritants.

Stress urinary incontinence

Involuntary loss of urine with an activity such as coughing, sneezing, laughing, or picking up an object (a kiddo, groceries, etc). Stress urinary incontinence is often associated with weakness and poor recruitment of the pelvic floor muscles and other core musculature (transverse abdominals, multifidi, diaphragm, and hips).

Mixed urinary incontinence

Leakage with both the urgency and activity components

How is urinary incontinence treated?

The most effective treatment for urinary incontinence is a multidisciplinary approach. An evaluation from an appropriate medical provider is critical to rule out infection or other pathological causes.

After the provider establishes a plan of care, which may include medications, pelvic health physical and occupational therapy is helpful.

Physical and occupational therapists with a specialization in pelvic floor dysfunction help decrease pain and increase function by restoring optimal length to the muscles and tissues, enhancing muscular coordination, and creating home programs for the client to use during treatment and after discharge to prevent flare-ups.

Can yoga help urinary urgency, pain and incontinence?

There can be different underlying causes of urge urinary incontinence and stress urinary incontinence. After you are evaluated by your provider to determine if you need to strengthen the pelvic floor and core, or lengthen first, you will be able to determine which program is best for you.

If you need to lengthen first (urge, urge urinary incontinence, pain from interstitial cystitis, etc.) then check out the urgency track on Optimizing Bladder Control, or Yoga for Interstitial Cystitis or Yoga for Vulvodynia.

If you need to strengthen your pelvic floor and core, check out Optimizing Bladder Control, which has three segments that will be helpful: seated awareness, gravity eliminated, and standing flows.

I designed these pelvic yoga programs to augment the medical treatment provided in the clinic. The goals of the videos are the same as the goals in a physical therapy home program: to increase flexibility, core strength, and offering a tool for self-healing. I hope you find them helpful!