Exploring & Explaining Urinary Urgency
We're talking about the sudden, unexpected, urge to urinate - which may also include leaking before you even make it to the toilet!
Have you ever experienced the feeling of a completely full bladder that makes you feel super busting to go to the toilet to wee? Like you’ve got 30s to get to the toilet before you pee your pants.
Have you ever experienced that feeling, but it just came out of nowhere? No warning. No sensation of your bladder filling gradually. Just BOOM. Busting to pee.
Has this feeling ever made you so panicked that you got up and raced to the toilet, only to start weeing a little before you even sat down? Or maybe even loosing your whole bladder on your way to the toilet.
Have you ever raced to the toilet because you thought your bladder would explode if you did not wee, only to have just a dribble of urine come out?
Does this happen to you more than you would like to admit?
The sudden unexpected urge to urinate, in the medical world, is called Urgency. There are a few conditions that can cause this feeling of urgency, some of which most women will have experienced at some point in their lives. Urinary tract infections, for example, can give us the sensation that we need to urinate, only to not actually need to urinate. Once we treat this infection, we go back to having a normal, healthy functioning bladder.
There is another condition called Overactive Bladder Syndrome (OAB), which unfortunately, is not treated by antibiotics, and does not go away with time. Today’s blog post is going to focus on Overactive Bladder syndrome.
To understand this condition, it is first important to understand how the bladder functions when it is happy and healthy.
Imagine your Bladder is a Water Balloon
Like a balloon, your bladder can fill and stretch to a certain capacity, before it then needs to be emptied. The volume of liquid inside your bladder plays a role in determining when the urge to empty is triggered!
If we first imagine the bladder is a water balloon, that can fill and stretch to a certain capacity, before it then needs to be emptied. This balloon is also covered in a muscle, so when the time is right, it contracts to squeeze all the water out of it. When we start to fill the balloon, we can put 50mls of water in it and it will not have stretched the balloon at all. Inside our bladder, this amount of liquid would not register, and therefore we would not feel the urge to go to the toilet.
Let’s then increase the volume of the balloon to 150-200mls. This would start to stretch the balloon, and likewise in the bladder, we would start to get a stretch on the bladder walls, that signals the brain that there is something in there. With this amount in the bladder, we would often describe our urge to urinate as mild to moderate. As if we were in the middle of grocery shopping and thought “I can wait till I get home”.
If we then fill the balloon to 250-350mls, we start to see a fair bit of stretch, and in our bladder, we would be receiving stretch signals to the brain that indicate a strong urge to void. “I’ll quickly finish up my shopping and find a toilet close by”. Maybe having under 15 minutes to find a toilet.
Finally, if we fill our balloon to 400-500mls, we start to hit our max tolerable capacity in the bladder. “I don’t care, I’m just going to leave my shopping trolley here and go find a toilet”. It’s the feeling that you have less than 5 minutes to get to the toilet.
This progression of filling and the urge that steadily grows would be considered “normal”. Feeling a gradual build of urge to void but being able to rationally decide to hold and make your way to the toilet when it feels right for you.
Overactive Bladder Syndrome (or OAB, which I will use for the rest of this blog post) does not follow this normal journey of bladder filling. People suffering from this condition often experience sudden, intense and often frequent desire to pass urine, even if their bladder hasn’t undergone a stretching that would tell the brain that it needs to empty.
If you imagine the muscle that surrounds the bladder has a little tick, and every once in a while, it just twitches, for no reason, causing a little squeeze on the bladder. This muscle twitch isn’t necessarily triggered by a stretch on the bladder walls, in fact the bladder could be practically empty when a twitch occurs. Which means you’d be feeling an intense desire to wee, causing a mad rush to the toilet, but by the time you got to the toilet and sat down, only a dribble of urine comes out. Making you think “weird, I thought I was busting to pee”. We call this scenario, OAB-Dry. Because you got that sudden, unexpected urge to urinate, and managed to hold on while you got to the toilet, or until the desire to void passed.
If instead, the bladder twitched, and you thought “AHH I HAVE TO PEE OH MY GOSH I’M GOING TO WET MYSELF” *insert running madly down the hall to the toilet* and whilst you were madly rushing to the toilet you started weeing a little which then made you go “AHHHHH IT’S COMING I’M NOT GOING TO MAKE IT”, so you get even more hyped up, and by the time you get to the toilet, you’ve leaked a little bit of urine (or a lot). In this scenario, we call this OAB-wet, because you experienced the same urgent, intense and unexpected feeling to go to the toilet, and you leaked a bit of urine on your way.
In both scenarios, we have a sudden, unexpected and intense desire to wee. Both scenarios are terribly inconvenient, especially if you’re suffering from this multiple times a day (or hour!).
Golden Rule: Take Deep Breaths & Reduce Stress
We know that all of the above is naturally stressful, not to mention awfully inconvenient – but stress heightens your bladder signals too!
We know that this mix up of bladder signals can be heightened when we stress out about the thought of weeing ourselves (and sometimes even just being stressed and anxious about general life stresses that have nothing to do with our bladder or desire to wee!), so the first thing we need to in this situation is B.R.E.A.T.H.E (I wrote that really big to emphasize my point 😉)
We also know that there are other things that can trigger these signals to be worse for someone with this condition. Both drinking too much, and too little fluid throughout the day can increase our symptoms. As can drinking too much water in one hit! And finally, you all knew I would say it, you just don’t want to hear it – caffeine, alcohol and artificial sweeteners. (“nooooo” I hear you all saying).
If you’re suffering from the symptoms of this condition, please do not feel that there is nothing we can do for you. There is actually a lot we can do for you! But the first place to start would be to reduce your intake of caffeine, alcohol and artificial sweeteners, and try and get a handle on some of those life stresses.
The next step is to book in to see your women’s health physiotherapist and be guided through different treatment techniques such as bladder retraining, electrical stimulation and pelvic floor and muscle therapies.
Don’t lose hope, and don’t put up with a twitchy bladder! Reach out for help today.