Kemper Pelvic Physiotherapy

Why do I pee all the time? Why does almost nothing come out when I go?

Urgency, frequency and hesitancy – these are some of the biggest issues that may be separate from or in addition to leakage. Although they may seem to be contradictory, 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 muscle walls may become less compliant. That compliance, or flexibility within the bladder walls, helps define when the body senses urgency. Basically, the bladder is a small muscular sack that stretches as it fills with urine. It needs to be stretched to a certain point to trigger urgency (correlating with bladder contraction). If the bladder is emptied too often (or not enough), then the ability of the bladder to register that “critical point” is changed. The body will send signals that it is “time to go” by starting bladder contractions at inappropriate times, either before necessary or way too late. The result may become frequent urinary urges.

Regarding hesitancy: Just as the bladder can contract when it shouldn’t, it can also relax inappropriately. Then the bladder will fill past that critical point, leading to urinary hesitancy and retention. With hesitancy, the bladder starts to release the urine, but then the urethra closes and/or the bladder stops contracting to push the urine out. Included in this scenario may be contractions within the urethra itself, at the bladder neck or ineffective bladder contractions – all preventing full release of urine. One danger of retention is that some urine may remain in the bladder which can cause an increased risk of bladder infections.

The good news? Notice that nerves and muscles are involved in much of this process. Even though most of these are smooth muscles (ie, not under voluntary control), they can still be retrained! That’s where physical therapy can help. A trained pelvic PT will consider how everything in the trunk, hips and pelvis may be contributing to this altered bladder-urethra-pelvic floor pattern and give you the tools to regain control over voiding again.

Physical therapy can help to reduce urinary urgency, frequency and leakage.

What should you expect at your initial PT evaluation? It will include a thorough history followed by an orthopedic and pelvic examination that determine what factors may be driving your particular issue.

In treating urinary incontinence, physical therapy interventions can be directed toward the pelvic floor muscles, but should also include a full-body assessment and treatment program. Appropriate coordination of the pelvic muscles with everything around and attached to them is required to reduce bladder symptoms, regardless of the cause.

Subsequent physical therapy treatments will likely include some combination of the following:

• Instruction in urgency control techniques. There are simple, effective methods for getting those sudden, strong urges under control (often without surgery)!
• Pressure regulation, including breath work, postural / positional training, and core work.
• More local training of pelvic floor muscles (those muscles that surround the urethral/vaginal openings). This may include manual training, biofeedback, vaginal weights, and modalities to increase coordination and strength.
• Instruction in bladder health, dietary considerations, and lifestyle modifications to reduce urinary frequency. It is impossible to treat a condition by only addressing the muscles – dietary influences and years of habitual training may need to be addressed for full success in bladder retraining.
• Training in body mechanics to reduce strain on the pelvic muscles and organs. Increased strain on the pelvic organs and pelvic muscles due to inappropriate body positioning or movements may reduce the body’s ability to maintain continence and increase prolapse.
• Instruction in techniques to reduce nighttime frequency, urgency and leakage. Decreased leakage at night is often one of the first areas of improvement noted with conservative measures.

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.

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.