Urge Defense Techniques
Overactive bladder syndrome (OAB) and interstitial cystitis (IC or painful bladder syndrome) cause bothersome urinary frequency and urgency. Each time we urinate, we should have a strong consistent stream for about 8 seconds, equivalent to about 8 ounces of fluid. We should urinate every 2-4 hours, and only 0-1 times overnight. With OAB and IC, we may urinate more frequently than this, and may only urinate a small amount when we sit down to pee.
Physiologically speaking, urinary urgency is equivalent to a muscle spasm of the bladder. The bladder is a muscle-bound balloon that expands as it gradually fills with urine. When we feel an urgent need to pee, it’s because we’ve reached the pressure threshold setting of our bladder, and it’s starting to contract so that we initiate bladder emptying. These urge defense techniques interrupt these reflexive bladder contractions, stopping the feeling of urinary urgency. By using urge defense techniques, over time we can reset the pressure threshold setting of the bladder. Then it tolerates filling to its normal capacity before telling us we need to pee. The bladder is like a sweet puppy–it easily gets out of control if we indulge it, but when we exert some gentle discipline over time, it is easy to train!
Step 1. When you get the urge to pee–stop!
We have to stop and get control before we move on. Otherwise, the urinary urgency will just keep going!
Step 2. Practice an urge defense technique.
Deep breathing: Take 5 deep breaths, expanding your front, back, and side ribs as you breathe.
Kegel: Perform a few sets of 5 quick kegels, contracting for 1 second and then releasing for 1 second each. (Note: You might try endurance holds, or different kinds of kegels, if the quick kegel isn’t yet in your repertoire. Do NOT try kegels if you hold a lot of tension in your pelvic floor.)
Distract yourself: Brainstorm your grocery list, or count backwards from 100 by 7’s.
Give yourself a pep talk: Say to yourself, out loud or silently in your head: “I am the boss of my bladder! I don’t let it boss me around! I am in control, and I don’t need to go pee.”
Try calf raises. Do 5-10 seated or standing calf raises. Your calf muscles are innervated by the same spinal cord segment as the bladder. When we feed the spinal cord input at this level, it gets confused and stops the bladder spasm!
Step 3: Check back in
Do you still have the urge to pee? If it’s gone, and you’re working on gradually expanding the amount of time between pee intervals–then move along about your day! Wait until your set voiding interval has passed (2 hours, or whatever goal you’re working on), and you get another urge, before you let yourself visit the toilet.
If the urge is gone, and you have a normal urinary frequency but are working to reduce urge urinary incontinence–then proceed calmly to the bathroom. If the urge strikes again when you grab the bathroom door handle or see the toilet–return to step 1 and repeat!
If the urge is not gone yet, repeat the same strategy you tried before a few more times. OR try a different strategy. Most of us find that one or two of the strategies are our body’s preference.
***A note for people with painful bladder syndrome/IC: We want to start deferring the urge when pain levels associated with bladder fullness are tolerable. Work with your PT, and your own sense of what’s best for your body and whole self, to determine when the time is right to begin using urge defense techniques. There may be days where using these strategies makes sense, and others where doing so increases pain.***
Pelvic Care Physical Therapy
3770 W. Robinson St. - Ste. 112 - Norman, OK - 73072
www.pelviccare.org - 405.240.9575 – info@pelviccare.org
