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What is an overactive bladder and why is my pelvic floor important?

Updated: Oct 11, 2023

Important Note: This article is intended for educational and informative purposes only and should not be used to make decisions regarding any health-related issues. For diagnosing, treating, or making decisions about your health, it is essential to consult with an appropriate health professional.

When the bladder fills with urine, the bladder wall (detrusor muscle) remains relaxed, while the pelvic floor muscles (PFMs) contract, allowing the bladder to fill without leakage. Once the bladder is full, a signal is sent to the brain to decide whether it is time to urinate.

During urination, as we sit on the toilet, the bladder wall starts contracting, and simultaneously, the PFM automatically relaxes to allow urine to flow. This system works well when both the bladder and PFMs function correctly. However, individuals with Overactive Bladder (OAB) often experience dysfunctional bladder-PFM relationships. In OAB, the detrusor muscle contracts inappropriately, leading to a sudden and overwhelming urge to urinate, even when the bladder isn't full.

Symptoms of Overactive Bladder include:

1. Urgency: A sudden strong urge to urinate, often triggered by events like hearing running water or approaching a bathroom.

2. Frequency: The need to urinate more frequently, passing small amounts of urine each time.

3. Urge Incontinence: Difficulty reaching the toilet in time, resulting in urine leakage, ranging from a few drops to a full bladder.

4. Nocturia: Waking at night more frequently to urinate than what is considered normal.

Lifestyle modifications can help reduce OAB symptoms:

1. Regulate fluid intake: Balancing fluid intake is essential; excessive fluid can overfill the bladder, while insufficient fluid can lead to concentrated urine, irritating the bladder.

2. Limit bladder irritants: Reduce consumption of alcohol, caffeine-based drinks, artificial sweeteners, spicy foods, and carbonated drinks, which can irritate the bladder and worsen OAB symptoms.

3. Avoid constipation: Constipation can strain the pelvic floor, triggering or worsening OAB symptoms. Maintaining regular bowel movements is crucial.

4. Maintain a healthy weight: Weight loss has been shown to decrease the severity and frequency of OAB symptoms.

5. Quit smoking: Smoking cessation can lead to reduced urinary frequency.

Bladder training can be helpful:

Step 1: Increase bladder fill volume by visiting the toilet less frequently. Try to ignore the urge to go when it is strong and defer going until the next urge. Gradually increase the time between urinations.

Step 2: Use deferral strategies to suppress the urge to urinate. Strategies include pelvic floor muscle contractions, perineal or clitoral pressure, sitting on a rolled towel, or employing distraction techniques.

Step 3: Decrease sensitivity to triggers. Identify triggers (e.g., running water, turning a key) and approach them with an empty bladder. Slowly increase the time between voiding and encountering triggers.

Osteopathy can assist with OAB and urgency by addressing the person as a whole. Osteopaths assess alignment, movement patterns, breathing, pelvic floor function, and deep core engagement. Treatment plans may include osteopathic treatment, a specific bladder training program, lifestyle modifications, pelvic floor muscle rehabilitation (strengthening or relaxation), and mindfulness. Real-time ultrasound can be used to check bladder emptying.

For individuals with tight pelvic floor muscles, which can increase sensations of urinary urgency, addressing pelvic floor tension may be necessary before strength training.

Always consult a qualified health professional to address specific health concerns.


ICS terminology report, 2010

Evaluation and management of overactive bladder: strategies for optimizing care. Marcella G Willis-Gray, Alexis A Dieter, and Elizabeth J Geller

Dietary caffeine intake and the risk for detrusor instability: a case-control study.Arya LA1, Myers DL, Jackson ND.

Caffeine and urinary incontinence in US women.Gleason JL1, Richter HE, Redden DT, Goode PS, Burgio KL, Markland AD.

The prevalence and risk factors of overactive bladder symptoms and its relation to pelvic organ prolapse symptoms in a general female population. de Boer TA1, Slieker-ten Hove MC, Burger CW, Vierhout ME.

EFFECT OF SMOKING CESSATION ON OVERACTIVE BLADDER SYMPTOMS IN ADULTS: A PILOT STUDY. Wyman J1 , Allen A2 , Hertsgaard L2 , Overson E2 , Allen S2 , Hatsukami D2 1. School of Nursing, University of Minnesota, 2. School of Medicine, University of Minnesota

Bladder training for urinary incontinence in adults. Wallace SA1, Roe B, Williams K, Palmer M.


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