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Urgency, Frequency & Hesitancy in Urination

In addition to leaking, why do I have to go to the bathroom more often (urgency and frequency)? Why does almost nothing come out when I get there (hesitancy)?

There are many causes for urinary frequency, hesitancy and urgency. Although they may seem to be opposing symptoms, frequent voiding and urinary hesitancy may actually drive each other.

Regarding urgency/frequency: When the bladder is emptied too often (or not enough), the bladder itself may become less compliant.

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What if physical therapy doesn’t completely stop the leakage?

Urge, stress and mixed UI all respond very well to physical therapy interventions, usually with a high percentage of improvement noted – if not complete resolution of symptoms. Should further interventions be necessary, they will only be helped by good pelvic floor training. Just as someone having knee surgery is encouraged (or even required) to get physical therapy for a few weeks prior to surgery, the pelvic region also benefits from a little “advance training.” And keep in mind training could mean learning to relax the pelvic muscles as much (or more) than strengthening them!

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What are some conservative ways I can attempt to reduce urgency, frequency and leakage?

Your doctor will discuss various medical interventions appropriate to your condition that may include medication, surgery, or uroplasty.

Should she prescribe physical therapy for UI, your initial PT evaluation visit will include a thorough history followed by an orthopedic and pelvic examination that determines pelvic floor strength and coordination.

In treating urinary incontinence, physical therapy interventions are directed toward the pelvic floor muscles first. Appropriate use of the pelvic muscles is required to reduce leakage regardless of the cause.

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What is the difference between stress, urge and mixed urinary incontinence?

The most common types of UI are “stress,” which involves increased abdominal pressure (sneeze, cough, laugh, etc) and “urge,” which is accompanied by urgency and/or bladder contractions. Mixed incontinence has both stress and urge components. This is the most common form of UI, and people will exhibit a higher percentage of one component over the other. For example, you may have frequent, sudden strong urges with leakage most of the time but occasionally also leak with a strong cough. That would be considered mixed UI with urge dominance.

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Do I Have Incontinence? (UI)

Urinary Leakage, Urgency and Frequency – A Physical Therapy Perspective

Some feel that if urinary leakage is infrequent or only happens a few drops at a time, then it’s not considered incontinence. In fact, urinary incontinence (UI) is defined as experiencing involuntary loss of any amount of urine, at any frequency. Leakage does not result from “just getting older” and should not be regarded as inevitable. It is a physical condition that is treatable. If you find that you are going to the bathroom all the time just to avoid leakage/urgency then you likely fall in the UI category as well.

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Physical Therapy Internet Resources

The list of websites below is not meant to be exhaustive, but they are each reliable sources of information and support.


  • PopUp Lifting is an amazing online exercise program designed for women with prolapse. It’s run by Haley Shevener and Annemarie Everett, PT. It’s an amazing, informative program – lots of options!
  • Intimate Rose is a company that helps all-things-pelvic. It includes resources for education, supplies, and many other pelvc-related.

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