Urinary Urgency: When you REALLY gotta go!

By Amy Price, PT

We have all experienced that feeling of intense urge to urinate…maybe you’re stuck on the TTC, or in a long meeting at work, or waiting at the end of a seemingly endless bathroom line at a sports game. Most of the time, these situations kind of make sense in terms of why we would be feeling like our bladders are going to burst. We can understand that when we’ve left it too long or had a lot to drink, our bladders are telling us that we need to empty! The signal is proportionate to the bodily need. The thing is, urgency can become more of a day to day issue for someone when it becomes disproportionate to the need. Some people experience urgency that can be sudden, very strong, and uncontrollable. At times, this extreme urgency only results in a small amount of bladder output. This is understandably confusing and frustrating for the person in question! In this blog, I’ll shed some light on the topic of urinary urgency by touching on what’s ‘normal’, what some underlying causes of increased urgency can be, and some tips for management.

So what is ‘normal’ anyway?

I often ask people, ‘how many times do you pee on an average day?’; a tough question to which a lot of people don’t have a specific answer. However, if you experience abnormal urinary urgency and frequency, you definitely have the sense that you’re spending a lot of time in the bathroom. One thing people commonly notice is ‘I pee a lot more than my friends or coworkers’. Generally speaking, it’s normal to empty the bladder 5-7 times per day, or about every 3 hours. Having increased urgency and frequency beyond this is categorized as having an ‘overactive bladder’. It’s estimated that about 1 in 5 Canadians suffer from overactive bladder.

What can cause urgency? (other than a full bladder)

There are a number of reasons that increased urinary urgency can arise. Here are some of the most common.

Health conditions: Medical conditions that can involve increased urinary urgency include urinary tract infections, interstitial cystitis, diabetes, and prostate problems, to name a few. These conditions may require medical intervention, so if you have increased urgency it’s important to see your doctor to decide if testing for any of them is indicated.

Pelvic floor muscle dysfunction: The pelvic floor muscles support the bladder and are thus closely related to bladder function. Having pelvic floor muscles that are weak or tense (or both!) can contribute to urinary urgency.

Stress and Anxiety: The mechanism is not fully understood, but there is evidence to show that increased levels of stress can contribute to increased urinary urgency. Some studies find that people who have higher levels of stress are more likely to have conditions like overactive bladder. One of the proposed reasons is that stress and anxiety cause increased muscle tension, which can lead to urgency as explained above.

Consuming bladder irritants: Certain foods and liquids can irritate the lining of the bladder, creating urgency. Different people can have different reactions and tolerances, but generally speaking things that are considered irritating to the bladder are: coffee, tea, alcohol, carbonated beverages, artificial sugars, and citrus.

Dehydration: It might seem reasonable to cut back on fluids to decrease bladder urgency, but this can actually make your symptoms worse! When dehydrated, our urine becomes concentrated, which can become irritating to the bladder lining, creating urgency.

Habit: Sometimes, we might find ourselves emptying the bladder out of convenience or ‘just in case’. Common examples are: before you leave for a long care ride, or if you’re in the bathroom anyways brushing your teeth. This might not seem like a big deal in the short term, but over time, frequent ‘just in case’ voiding can lead to a decreased sense of bladder capacity; feeling like you need to go at lower and lower bladder volumes.

Is there a way to help with excessive bladder urgency?!

Luckily, yes! There are many strategies that can be implemented to reduce frequency and urgency of urination, and a pelvic health physiotherapist can help to implement them properly. Usually it is helpful to record your daily habits in a ‘bladder diary’ to get a baseline, and then from there you can practise timed voiding to get on a more normal schedule over time. Learning strategies for urge suppression (eg. relaxation breathing, visualization and distraction techniques) can help you to increase the interval between your voids. Making sure you’re properly hydrated and avoiding irritants that affect you can also decrease urgency. Lastly, making sure you’re emptying the bladder fully with each void (don’t try and stop the pee mid stream!), addressing any underlying muscle tension, and finding strategies to manage stress can each be effective methods of treatment.

References:

1. Suppressing the Urge – Your Pace Yoga (https://yourpaceyoga.com/blog/suppressing-the-urge/)

2. Urology Care Foundation. What is a urinary tract infection in adults? (https://www.urologyhealth.org/urologic-conditions/urinary-tract-infections-in-adults#Diagnosis)

3. International Continence Society Fact Sheets (2016). (www.ics.org)

4. The Canadian Continence Foundation – About bladder health.(www.canadiancontinence.ca)

5. Lai, H. Rawal, A. Shen, B. & Vetter, J. The relationship between anxiety and overactive bladder/urinary incontinence symptoms in the clinical population. Urology. 2016; 98: 50-57.

6. CalmClinic – Anxiety urination: an inconvenient symptom. 2018. (https://www.calmclinic.com/anxiety/signs/urination-problems_