Hi and welcome the fourth installation of the Pelvic Empowerment overactive bladder
series! I’m Tori, and I am a doctor of physical therapy who specializes in pelvic dysfunction,
which means I treat things that can go wrong around the pelvis and this includes bladder
dysfunction.
If you haven’t please do check out the previous three videos in this series, as theses videos
are the most effective if you view them in order, and this video assumes that you’ve
kept a bladder diary, reviewed it with me, identified which bladder re-training strategies
are best for you, and are ready to learn some urge suppression techniques to better support
some of those re-training strategies.
So, in today’s video, we’ll first discuss my favorite four urge suppression techniques
and why they work, and then we’ll talk about how to use them as bladder retraining strategies
in isolation, and how to pair them with other bladder re-training strategies!
As always, timestamps and links to any studies or resources mentioned today can be found
in the description below, and, without further adieu, let’s get into it.
As you may recall from the first and second videos in this series, when you feel urgency,
what you’re actually feeling is the walls of your bladder contracting. So all urge suppression
techniques are aimed at relaxing your bladder muscle, at stopping those contractions, in
order to suppress the urge.
My personal favorite urge suppression technique is to perform 4 or 5 strong pelvic floor contractions,
or kegels, in a row. Not an endurance hold, not contracting and holding the pelvic floor,
but instead intentional and well defined, contract-relax, contract-relax four or five
times in a row when you feel urgent in order to suppress the urge.
Why does this work? How does this technique help the bladder to relax? Well, the bladder
and pelvic floor actually have an inverse relationship. While it may be counterintuitive
at first, if you can imagine your bladder living on top of your urethra, and your pelvic
floor acting as a sphincter around your urethra, you may be able to imagine that when you urinate,
ideally, your bladder is contracting to squeeze out your urine, but your pelvic floor is relaxing,
to open that urethral sphincter. There’s a reflexive, inverse relationship here, where
a relaxed pelvic floor tells the bladder to contract. When you do the opposite, when you
contract your pelvic floor, you can tell the bladder to relax, which can suppress urgency.
Another urge suppression technique is to apply external pressure to your saddle area. Have
you ever seen a little kid who really needs to pee instinctively hold their saddle? That
instinct occurs because applying pressure externally in that way to the pelvic floor
can also tell the bladder muscle to relax and, therefore, suppress an urge! Of course,
pending on where you are, you can’t always apply pressure with your hand to your saddle,
so you can try sitting down, crossing your legs, or sitting on your hand pending on where
you are.
A third technique is to implement some sort of relaxation strategy. Urgency is a very
sympathetic, fight or flight, I gotta go right now it’s an emergency, kind of event. If
you can relax your breathing, your body, and your brain, you can sometimes trigger a relaxation
response in the bladder. I, personally, lean towards relaxation breathing techniques in
the clinic. First asking yourself, am I holding my breath? If yes, can I let myself exhale.
And then maybe trying a 4x4 breath where you inhale for four seconds, hold for 4, exhale
for 4, hold for 4, and repeat that 4 times. Of course, you don’t have to use a breathing
relaxation technique, any relaxation technique that you like that resonates with you is worth
trialing.
And, finally, a fourth technique is distraction. I think everyone has experienced at least
once in their life getting an urge to pee, getting distracted, and then, when you weren’t
paying attention, the urge went away. There are a lot of different distraction techniques
that you can play with, a few of my favorites include difficult math problems, like trying
to count down from a weird number like 93 by factors of an odd number like 7, 93, 86,
79, 72, 65 and on down. You can also try focusing on a different part of the body and trying
to do something mentally challenging, like rolling your ankle to the right but trying
to draw a circle in the air to the left with your finger. And I’ve even had some patients
report success with having conversations with their bladder, as a sort of distraction. Like
a, “hey bladder, thanks for this message but I’m busy with my work right now, I’m
currently working on x, y, and z, and I’m problem solving this particular issue…”
and just sharing a lot of detail with your bladder about what you’re doing until the
urge dissipates.
The thing with distraction or any other urge suppression technique is that you’re going
to have to have a trial and error period devoted to figuring out what technique or techniques
work the best for you and your unique body. I always recommend picking one of the techniques
and trialing that technique for at least an entire day when you’re at home and it’s
okay if you an accident. Go through each of the different options for a day or two, and
see which one is the most effective. Once you’ve identified which technique or techniques
work the best for you, it’s time to use them as a bladder retraining strategy, pair
them with other retraining strategies, or both!
Regardless of whether or not you’ll be pairing the urge suppression techniques with other
strategies, it’s very important to use them to redefine your behavior on the way to the
toilet. A lot of times with urgency/frequency, because getting to the bathroom can be such
a sympathetic, fight or flight, emergency-esque activity, people will run to the bathroom,
undress on the way, and even starting peeing before they’re comfortably seated on or
standing by the toilet. I highly recommend retraining that response, so that the brain
learns that toileting is not an emergency, and you gain back your control over your bladder.
Instead of running to the toilet and undressing along the way, use the urge suppression technique
that works best for you to give yourself a window of time to walk slowly and calmly to
the bathroom, don’t undress until you’re in the bathroom, and sit on the toilet properly
to pee before you start peeing. We’ll discuss proper toilet positioning in detail in the
next and final video in this series.
If you’re someone who leaks, who experiences urge incontinence, that might get worse before
it gets better during your retraining. As frustrating as that might be, it’s okay,
as counterintuitive as it might seem, it’s better to leak walking slowly and calmly to
the toilet, than to barely make it without leaking after running and undressing along
the way. The latter reinforces the brain’s sympathetic, fight or flight, emergency response
to urgency, and we can’t rewire that response if we don’t break the cycle.
Finally, urge suppression techniques are a practice and they effect different people
differently. Some of us will be able to implement them and they’ll suppress an urge for 15
minutes right away, and others will implement them and they’ll suppress an urge for 15
seconds. That’s okay, keep practicing, trust that it’ll improve over time, and do your
best. There’s nothing more you can do. Also, using the urge suppression techniques to recognize
what is a true urge versus a trained urge due to poor bladder habits is also a practice.
When you implement an urge suppression technique, take a moment to reason through whether or
not you need to act on the urge. Did you recently consume a bladder irritant? When’s the last
time you peed? Are you experiencing a true urge that you should act on or is this just
a habit you’ve formed? And if you’re not sure, that’s okay, use the urge suppression
technique to buy some time to slowly and calmly walk to the bathroom, undress when you’re
in the bathroom, sit on the toilet properly, and pee. With practice, you’ll learn what’s
a true urge and what’s a habitual urge.
In the previous video in this series, we discussed identifying just in case peeing habits, and
activity triggers, and I mentioned that urge suppression techniques and proper behavior
surrounding toileting would both be the best strategies to kick these habits and retrain
your bladder.
With just in case peeing, having one or more urge suppression techniques in your tool box
that you know work and can help you suppress an urge should one occur makes kicking the
habit so much easier, because now you’re not only aware of when and why you’re just
in case peeing, but you also have a strategy that you know works that you can use to suppress
an urge—so that you no longer need to pee just in case an urge might arise, and you
can buy yourself some time to calmly and slowly get yourself to a bathroom should you have
an urge.
When it comes to activity triggers, urge suppression techniques are immensely helpful, because
now you’ve identified what triggers you, and you have a technique that you can use
to suppress your urge, evaluate whether or not you truly need to go to the bathroom,
and get yourself calmly and slowly to the bathroom if you actually need to go. For example,
if your trigger is the classic key-in-the-door urgency, where you’ve just gotten home and
you’re about to open your front door and all of a sudden you have a huge urge, implement
an urge suppression technique, give yourself a moment to evaluate—did I drink a bunch
of coffee or have another bladder irritant recently, when’s the last time I went to
the bathroom, is this a real urge that I should act on or is just a habit I’ve formed?—and
if it is a real urge or if you’re not sure, that’s okay, use the urge suppression technique
to buy some time to slowly open the door, calmly walk to the bathroom, undress when
you’re in the bathroom, sit on the toilet properly, and pee.
Finally, if you’re someone who implements all of the strategies that we’ve discussed
thus far for a couple of months with little to no success, you may benefit from pairing
them with a more regimented bladder retraining strategy, where you purposefully pee after
a certain amount of time passes regardless of whether or not you have to, and you use
urge suppression to slowly increase the time interval between those voids. Usually this
strategy is warranted when someone has more severe urgency/frequency, like maybe this
person is peeing every 15 to 20 minutes no matter what. In that case, you might try peeing
every 15 minutes on a timer, getting your bladder accustomed to being able to manage
that much volume while still practicing proper behavior surrounding and toileting positioning
during urination and all of the other relevant strategies we’ve discussed, for a week.
Then, after that week has passed, start using urge suppression to increase that interval
to every 20 minutes. Then 25 the next week, 30 the next, and on up, slowly but surely,
until ideally you can go about two hours or so inbetween voids.
However, as I said in the first video in this series, I do not think that bladder retraining
should be laser focused on replicating “bladder norms.” Instead, I think bladder retraining
should be focused on you regaining control over your bladder, instead of your bladder
constantly controlling you. Again, I’m not as concerned about whether or not you’re
urinating once every 2-3 hours so much as I want you to feel in control and no longer
feel distressed about your bladder. Finally, if none of these strategies are working well
for you, consider the health of your bowels. The rectum and bladder are very close together
in the pelvis, and someone with chronic constipation or chronic diarrhea can irritate their bladder
over time, and sometimes that urgency frequency won’t fully resolve until the bowel issues
are resolved.
On that note, stay tuned for the final video in this series, where we’ll discuss proper
urination toileting positioning, and thank you so much for watching! If you enjoyed this
video or found it helpful, please do give it a thumbs up, and if you didn’t like it,
give it a thumbs down and let me know what I can do to improve in the future. Feel free
to comment absolutely anything below—questions, feedback, content suggestions, anything really—I
do try really hard to read and respond to all of my comments. Don’t forget to check
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and I also make videos about life things. Thank you again so much for watching, I hope
you have a wonderful rest of your day and I will see you in the next video, bye.