Tackle your bladder problems
Bladder problems tend to become more and more problematic over time, frequently not settling down on their own. Physiotherapist Maeve Whelan has tips on how to tackle the problem.
Are you going to the toilet more and more often? Needing to know where every toilet is when going out? Only being able to hold on to small volumes? Worst of all, not making it in time?
This type of pelvic floor weakness can be linked in with an overactive bladder and is treated differently to weakness linked with childbirth.
The causes are varied
The causes of this type of bladder overactivity are varied. It could be linked with a medical condition or with taking certain medication. If the cause is a urinary tract infection then the symptoms will settle with associated treatment. The problem can develop over time without any known cause. Some people report having had problems with bed wetting late in their childhood and problems into their teens. Frequently there are associated postural changes and tension around the torso, abdomen and pelvis.
What does the pelvic floor do to help the overactivity of the bladder muscle?
The pelvic floor muscles are situated below the neck of the bladder and when contracted they lift up and forwards into the neck of the bladder. If the bladder starts to contract at low volumes, for example at 150 mls, we need to try and suppress this contraction to encourage filling of the bladder to say 350mls, before going to the toilet.
The pelvic floor muscle works on the reflexes at the neck of the bladder. In sustaining the squeeze of these muscles, it may allow the bladder muscle to relax and enable further filling. This can be learned over time even if difficult and ineffective at first.
How exactly do I squeeze?
- Lie down or sit down
- Make sure the stomach is soft and relax and the spine is in the non-flexed / non- extended but rather – neutral position
- Breathe in and then all the way out
- Then slowly and gently draw in the back passage all the way up and forwards towards the front to the bladder – squeezing
- Don’t brace the stomach, don’t lift the chest and don’t squeeze the buttocks
- Hold this for 5 seconds without changing your breathing
- Then let it go completely
- Think of a lift: you started on the ground floor, lift all the way to the 6th floor and now drop all the way to the basement. Make sure it is the basement.
- Do this 10 times, 3 times per day.
When you can do this this, then try and hold the squeeze and breathe for 10 seconds. Repeat 10 times.
How do I know I am doing it correctly? 50% of women squeeze their pelvic floor muscles incorrectly. You can always have a look with a mirror and see if you can see any inwards drawing. Try using your fingers the next time in a bath or after going to the toilet and see if you can feel anything when you squeeze. Make sure you are not pushing out! If you are not sure visit a Chartered Physiotherapist in Women’s Health & Continence by contacting www.iscp.ie.
Once you can successfully squeeze your pelvic floor muscles you can use these holding on techniques when the strong urge comes on
- Sit down and lean forwards with some pressure on the perineum (the outside of the vagina). Squeeze the pelvic floor muscles as described but do not brace your stomach. Breathe and wait for the urge to pass.
- If you cannot sit down then stand up on your toes and at the same time squeeze the pelvic floor muscles as described and breathe and wait for the urge to pass.
Only go to the toilet when the strong urge has passed and you are in control. You will get better at this with practice.
If symptoms are severe and if these steps are not successful then your doctor may prescribe medication to help. You should always practice the techniques above as well. There are some muscle and nerve stimulation machines available to rent and patients report varying degrees of success using these also in parallel to these techniques. Overactive bladder is not a condition that responds to surgery.
OAB Outlook is a new Irish web resource for people living with OAB. It includes information on the condition and its treatments, as well as a self-assessment tool, patient stories, downloadable bladder diary, and some helpful videos with physiotherapy exercise tips to strengthen the pelvic floor.