Connie Continence – “Hey, I’ve got an idea! Wanna go for a ride and check out the scenery?”
Overactive Odette – “Oh, I’d love to, it’s so pretty out, but I can’t. We’d be too far away from a bathroom.”
C – “Oh,OK. How about we go to the beach?”
O – “Seriously? You know I can’t do that. The bathrooms are way back by the parking lot, too far from the beach. I’d never make it. Plus, the sound of the waves? Forget about it!”
C – “Huh, bummer. Well how about the mall? There are bathrooms there.”
O – “If we can go online and pull up a map of the mall showing the bathrooms I guess we could do that.”

Connie Continence is fortunate to have normal bladder control, while her good friend, Overactive Odette, suffers from overactive bladder (OAB), or urge incontinence (UI).  Urge incontinence is the strong, sudden need to urinate due to bladder spasms or contractions.  The symptoms of urge incontinence, or OAB, can be triggered by things such as turning a key in the door, washing dishes (Remember the old trick of  putting someone’s hand in a bucket of warm water?), or hearing running water.  As compared to stress incontinence where small leaks occur, urge incontinence leaks are usually of a larger scale emptying almost all of the contents of the bladder.  One in five adults over the age of 40 are affected by OAB or recurrent symptoms of urgency and frequency, a portion of whom don’t reach the toilet before losing urine. (http://www.nafc.org/media/statistics/urge-incontinence-and-oab/)  There are many different potential causes of urge incontinence, and in many cases the cause cannot be identified.  If you experience overactive bladder or urge incontinence you should discuss this with your healthcare provider to rule out any potential medical causes for the problem.

Mixed incontinence is when an individual suffers both from stress incontinence and the urge of the stress incontinence.  Typically it starts with stress incontinence.  As a result of the stress incontinence the individual may decide to use the facilities before they feel the urge, “just in case.”  As a result they rarely allow the bladder to completely fill.  Over time the nervous system becomes “reset” and sends a message to the brain that the bladder is full and must empty before it is anywhere near being full.  The lesson here is that you should be cautious about forming a habit of regularly urinating before you feel the urge.

So, what is one to do about urge incontinence?  Once medical problems are discussed and addressed with your healthcare provider you may consider behavioral treatments, medications, electrical stimulation, and/or surgery.

Behavioral treatments that I frequently recommend as a Physical Therapist and Yoga Therapist are:

1) Lifestyle changes (See my blog, “Control Issues”.)

2) Urge suppression techniques that help calm the nervous system include belly breathing, sequential muscle relaxation, and visualization of being in a relaxed soothing environment.  These techniques can be practiced on a daily basis.  Other possibilities include meditation techniques and yogic breath techniques that help calm the nervous system.

3) Bladder training – With bladder training you determine when you are going to urinate rather than responding to the bladder anytime that it sends a message that it “has to go really bad.”  The goal is to gradually increase the time between trips to the bathroom up to anywhere between 2-5 hours during the day, and 1-2 trips to the bathroom at night – which are normal frequencies.  Here is a guideline for retraining your bladder.

• Figure out how often you typically experience the urge to urinate.
  • every __________  hours
• For the 1st week, during the day, go to the bathroom at this same interval or a little less, whether you feel the urge or not.  (For example, if you usually have to go every 60 minutes, go every 45 minutes whether you have to or not.)
  • Week 1 every _________  hours
• Each week increase the interval between trips to the bathroom by about 15 minutes
  • Week 2 every _________ hours
  • Week 3 every _________ hours
  • Week 4 every __________ hours
  • And so on until you are able to comfortably spread trips to bathroom out to every 2-5 hours.
• If you feel the urge to urinate before the scheduled time:
  • Stand or sit quietly until the strong urge passes.
  • To help quiet the urge practice the urge suppression technique (above) that works best for you
  • You can also practice 3 quick contractions or lifts of the pelvic floor as mentioned in my blog “I laughed so hard tears ran down my legs” )
  • If at all possible, once the urge has passed, wait until the next scheduled time to void.
  • If you cannot wait until the next scheduled time be sure to walk SLOWLY to the bathroom.  Rushing stimulates the nervous system and bladder, and can increase the risk of an accidental leak.

If you suffer from urge incontinence consider taking steps to control your bladder, rather than letting your bladder control your life.  Studies have shown success rates up to 75% for improvements in bladder control with bladder re-training, and 12% for complete resolution of the problem.  Consider discussing these symptoms with your healthcare provider, making lifestyle changes, and consulting with an individual trained in Yoga Therapy or Meditation techniques to help you master approaches to quiet your nervous system, and/or a Physical Therapist who is knowledgeable in pelvic floor dysfunction if you have mixed incontinence.

“We are not creatures of circumstance; we are creators of circumstance.” ~ Benjamin Disraeli

Katey Hawes, owner and founder of Posabilities, Inc.., is a physical therapist, registered yoga teacher, and yoga therapist.

You may find her at Facebook.com/posabilities4u, Twitter @Posabilities4u, and Google+.