by guest blogger, Michelle Herbst, MPT, DPT
The holiday season is upon us. Our to-do lists are getting longer. School continues to be in session and parent-teacher conferences have been held or are scheduled. Your child or possibly you are eagerly looking at the finish line – the conclusion of the fall semester.
My last two blogs focused on building up our knowledge base regarding incontinence and bladder habits. My current topic moves us to the problem of urge incontinence. The increased stress of managing work, kids, and the holidays can aggravate urge incontinence symptoms. You may be asking “why?” Good, I am glad you are scratching your head. But first let’s revisit what urge incontinence is and what normal bladder habits are.
In Bladder 101, I shared definitions for both Urge Incontinence and Normal Bladder Habits. As a refresher:
Urge Incontinence: the loss of urine in the presence of a strong urge to urinate. Leakage usually occurs during moments of increased anxiety, stress or the presence of temperature changes. Urge incontinence is sometimes called ‘Overactive Bladder’ which describes an increased activity of the detrusor muscle which causes the bladder to empty. Persons demonstrating urge incontinence may urinate more frequently than every 2 hours.
Normal Bladder Habits: It is normal to urinate up to 7 to 9 times during the day or every 2 hours. Waking up to urinate is considered normal only after the completion of menopause. Urinary Incontinence regardless of the amount is not considered normal.
The Mechanism for Urge Incontinence and its Influences
In the National Institutes of Health’s A.D.A.M. Medical Encyclopedia, Urge Incontinence is described as the bladder muscles contracting at the wrong time despite the amount of urine being held in the bladder. An untimely contraction or spasm of the detrusor muscle results in the bladder emptying despite having the strong desire NOT to urinate. Periods of prolonged stress can alter our “fight or flight” mechanism, also known as our autonomic nervous system (ANS), causing an uptick in urinary frequency and the symptoms of urge incontinence. What is the mechanism behind this? Could it be from the high drive from our ANS and/or change in dietary habits during bouts of stress? Dehydration and consuming acidic and caffeinated beverages may act as bladder irritants resulting in unwanted spasm or contraction of the detrusor muscle.
Plan to Reduce Stress, Assess and Change Dietary Habits and Kegels (Contraction of the pelvic basket)
1) Stress Reduction
How do you effectively and in a healthy way diminish stress? Do you walk, meditate, journal? Are you a problem solver and combat stress through a task-oriented approach? Or, do you need to release stress by seeing a ‘chick flick’ and laugh yourself to a happier you?
Specifically, do you need to reframe your current stressors? Meaning, do you have a warm home, food on the table and a reliable car. Are your basic needs being met? If so, breathe deeply, taking in a big belly breath at that. Calm and slow yourself down. By turning your flight or fight mechanism down, or your ANS, you will slow down the nerve input to the bladder driving the urge.
2) Dietary Influences on the Bladder
Just remember weak lemonade. Yes, you heard me – weak lemonade. When you urinate, the color of urine should be that of weak lemonade. We all have heard that we should drink eight, 8 oz glasses of water to remain hydrated but this depends on what you are consuming and your activity level. So, my recommendation is this – moderation. Acidic and caffeine-filled beverages and foods are linked to increases in urge incontinence.
Now, I do not want you to eliminate all acidic and caffeine-filled foods or beverages. I want you to seriously and objectively assess your use of them. Simply ask yourself, is your consumption average or moderate? If not, I suggest you decrease your consumption to a moderate level and increase your water intake to achieve the desired concentration of urine to the color of weak lemonade. Staying hydrated will keep your urine from more being too concentrated thereby decreasing the frequency and intensity of unwanted detrusor muscle contractions.
3) Kegel – To Suppress and Control The Urge
Tasha and I have made multiple references to Dr. Kegel and Kegeling. If you do not know what a Kegel is – now is the time to know. A Kegel is contraction of the muscles located between the pubic bone and tail bone. Contracting this group of muscles involves the sphincters and multiple layers of the lower pelvic basket.
A Kegel in the presences of an untimely and strong urge to urinate can calm down the detrusor muscle and close the urethral via use of the sphincter muscles. Its successful use can buy you more time and delay the urge to urinate. I recommend holding the Kegel at a strong intensity while deep breathing for as a long as you need or are able.
As a clinician, I have come to suspect and accept that there may be multiple inputs or sources contributing to the patient’s current situation. This typically is the case with the diagnosis of urge incontinence. Therefore, I recommend multiple strategies to attack the urge: stress reduction, dietary changes and Kegels. A multi-pronged approach will calm the urge quickly and effectively within a few weeks. If not, it is time to see the doc.
References: National Center for Biotechnology Information. Bethesda MD. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002250/. Accessed November 1, 2012.