Symptoms of urinary urgency or frequency are very common and can be incredibly disruptive to your life. It is not a good feeling to have to run your life by where your next bathroom is.
A physiotherapist with advanced training to treat pelvic floor dysfunction can help! There are several factors that you need to look at:
1. Consider your pelvic floor: the pelvic floor muscles work like every other muscle in the body, they’re just inside. It is important to make sure you can properly engage those muscles and also relax the muscles easily. These muscles can be involved with issues with urinary urgency and frequency or pelvic-area pain.
2. Measure things: sometimes certain tools can be used to get a big-picture sense of what is going on, and can help your Physio design the plan that will help you fastest. These can include tests like:
- Bladder diary- provides a picture of your bladder and bowel habits, how much and what you drink to figure out any patterns. Constipation is important to address as it can impact bladder function as well as pelvic pain.
- DASS (Depression, Anxiety and Stress Scale)
- PCS (Pain Catastrophization Scale)
4. Look at everything: a thorough physiotherapy assessment includes looking at how you breathe, your posture, how you move, your lower back, and overall strength—not just the pelvic floor itself. The pelvic floor muscles are very important with urinating, having a bowel movement, and sexual function. There are many reasons for the onset of overactive pelvic floor muscles, and it is important to get to the driver or source of this in order to move symptoms forward.
5. Diet modification– caffeine, alcohol, carbonated beverages, tomato products, citrus fruits and juices and cranberry juice are several irritants that can contribute to intense discomfort. Sometimes they need to be stopped for a period of time to help symptoms.
6. Breathing– HOW you are breathing matters! Purposeful deep breathing can calm your nervous system, and can be one of the easiest, yet most effective, interventions to learn.
7. Help improve sleep– three out of four people who have ongoing pelvic pain have difficulty staying asleep, and that is worse if you have to get up in the night to pee. Going to sleep at the same time every day, staying warm, and no screens right before bed can all be helpful.
8. Manual therapy– different treatment techniques will be helpful for different people—one thing does not work for everyone, of course! Your Physio will likely want to work with stretching or strengthening different muscles (pelvic floor and others), and techniques for your nerves and connective tissue With the pelvic floor, it is possible to be both too tight and too weak, and lengthening must be addressed first.
9. Exercise: exercises that are fun, non-irritating and novel will help to change the brain to look at pain differently.
All of these things can help change pain, frequency or urgency issues to help get better, faster!