Urinary urgency is the strong sensation that your bladder needs to be emptied. This is caused by fasciculations or wiggling/spasming of the bladder. This is completely normal if the bladder is full and ready to be emptied. Our bladder has mechanoreceptors which are pressure sensors. As it fills with urine, it stretches and eventually lets you know it’s time to empty.

However urgency can become a problem and start impacting our day. Sometimes we see increased urgency with urinary tract infections or if we consume bladder irritants. This can be short lived and resolve on its own (if suspecting of a urinary tract infection that requires medical attention from your primary care provider). Some urgency becomes a learned habit. If we continually empty our bladder before it really fills up, we create a new behavior. The bladder will only fill a little bit and think it must empty sooner and sooner. Entering frequency, which is going to the bathroom more than 7-8 times per day.

Some examples of learned bladder habits that contribute to urgency are “just in case” peeing and “key in door” syndrome.

“Just in case” peeing is exactly what it sounds like. As kids, our parents often reminded us to go to the bathroom, just in case, before we left the house. Which makes sense, because kids are not always as in tune with their bodies as adults are, and their ability to hold a fuller bladder is less. In order to avoid a frantic search for the bathroom as soon as we arrived, a trip to the bathroom before we left “just in case” was the tactic.

While in theory this sounds like a good idea, it can form some bad bladder habits (mostly for adults). We keep telling the bladder it must empty when it's not full, and it thinks it always needs to empty at that point over time. Typically, most places we visit in public have access to a bathroom if you need one. The one exception to the rule is when you are going to be in the car for a long time and/or generally not have access to a bathroom. Then, its acceptable to go to the bathroom “just in case”.

“Key in door” syndrome sounds funny as well but is a real situation many find themselves in! Picture this, you are driving home from a quick errand out, feeling very relaxed and not remotely in need of a bathroom. Suddenly, you pass by a landmark that alerts you to being about 5 minutes from home and then the closer you get to home the more you start to feel that urgency to urinate. As you get your car parked and keys out to unlock the door, wow that urgency is really strong and you start to feel like you might not make it to the bathroom. But you were fine 5ish minutes ago right? “Key in door” syndrome is strong urgency as you get closer to home/access to the bathroom.

How do we treat urgency and therefore frequency?

It’s a multi-pronged approach! We need to make sure the pelvic floor itself is in a balanced state. Meaning not tight, not weak. Then we address bladder habits that contribute to the negative feedback loop of an empty bladder needing emptying. Additionally, learning identifying bladder irritants that are individual to that person.

Urge deference techniques are a great way to retrain the bladder! The bladder and the pelvic floor have an opposite relationship with one another. When the bladder contracts to urinate, the pelvic floor muscles must relax to let the urine out. We can use this relationship to our advantage by contracting the pelvic floor muscles to relax the bladder. This will buy you a little bit of time, about 10-15 minutes initially (or possibly even less if you have very strong urgency) and then the urgency will return.

Calmly heading to the bathroom when that urgency returns tells the bladder you are in charge and will make it on time to the bathroom. Over time that will lengthen time between trips to the bathroom to a more reasonable window (approximately every 3 hours in a perfect scenario).

Do you feel like you spend your whole day in the bathroom or thinking about going to the bathroom? We can work on this together! Reach out to my office today!

Emily@wildherpt.com 410-305-90532