What is an overactive bladder?

Being diagnosed with “overactive bladder” is common, and it’s a condition that affects millions of women worldwide. Even though this is usually thought of to only affect older women, it can also be quite prevalent in younger women also! Studies show that 9-43% (1) of women have OAB symptoms, and it’s probably more but a lot of people may not be reporting their symptoms because they may feel embarrassed.

What are the symptoms of an overactive bladder?

An overactive bladder is characterized by the following symptoms:

  • a significant and hard to ignore “urge” or feeling to urinate, with or without leaking urine,

  • having to urinate more frequently than you maybe used to, waking up more than 2 times a night to go to the bathroom, and experiencing these symptoms when there isn’t an infection or other medical reason why.

What causes an overactive bladder?

Sometimes OAB symptoms (frequency and urgency) can be from something temporary and medical, like a urinary tract or bladder infection, or even kidney stones. Sometimes it also can be from changes in hormones, nerve problems, or other medical disease.

Most of the time, however, it can be due to some of our habits or behaviors, and most of the time we don’t even know that what we are doing can be contributing to frequency, urgency, or leaking. For example, drinking a lot of beverages with caffeine, drinking alcohol, or even been dehydrated can cause those symptoms. It can be difficult however, to identify a specific cause for OAB symptoms. Usually it’s a combination of factors, and pelvic floor muscle dysfunction can be one of them!

Why does an overactive bladder happen?

The bladder is like a balloon, and it has it’s own muscle, called the Detrusor, that wraps around it. The detrusor relaxes and allows the bladder to fill with urine, and when the bladder is full and it’s time to void, the detrusor contracts and helps to push urine out. Inside the detrusor, there are special nerves that can sense when the bladder is filling and being stretched out, and when they sense that movement, they send signals to the brain that signal “urge”. This is how we know it’s time to void!

In the case of OAB, that detrusor muscle sometimes starts contracting and squeezing urine out of the bladder at the wrong time, and it usually happens when the bladder isn’t totally full (2). This can happen when we aren’t ready for it, like on our way to the restroom, for example.
How does an hyperactive bladder work?

How to treat an overactive bladder?

With the right treatment, the symptoms of OAB can be managed successfully. Treatment includes testing to make sure there isn’t an infection or other medical problem, starting bladder re-training, medication sometimes, and changing lifestyle habits (3,4). Pelvic floor physical therapy can be a great treatment option for someone with OAB symptoms, and it helps to treat the pelvic floor muscle contributions to urge, frequency, and leaking. Sometimes strengthening exercises, like Kegels can help, and other times we have to teach the muscles to relax and start to work properly to help support the bladder and normal urination.

Treatments that don’t require medication (like pelvic floor physical therapy) have shown to have similar long term outcomes to the use of drugs to treat the bladder (5). Lifestyle changes are challenging, but often very successful. Choosing to try pelvic floor PT is a great option, is successful, conservative, and has no side-effects, compared to medication.

What are the best pelvic floor / Kegel exercises to treat an overactive bladder?

Just like other muscles in our body, the PFM should be strong, have good endurance, and normal coordination. They have to be able to contract fast and slowly, in order to support the bladder and keep us dry. The endurance of these muscles need to be able to hold urine in for longer periods of time, like when we are walking to the bathroom, or working at our computers. Special Kegel exercises are used to train both types of the pelvic floor muscle fibers, both fast and slow twitch (6). For OAB, the pelvic floor needs to be relaxed, and needs to have good strength, endurance, and control to help the bladder stay relaxed while filling, and to help the bladder hold urine in when we get the signal to void (urge).

How to train slow twitch muscle fibers of the pelvic floor?

When we work on the slow twitch muscle fibers of the pelvic floor, we are training the endurance portion of the muscle. This means they can stay on and working for long periods of time. There are studies to support that training the pelvic floor muscles can decrease OAB symptoms and improve quality of life of women who experience OAB (8). In order to effectively treat OAB, pelvic floor muscle training should be a large part of the program. 

Perifit has a specialized program that is designed specifically for OAB symptoms. This program helps to develop endurance and focuses on the slow twitch fibers of the PFM. It’s important to train the muscles like we train any muscle: by increasing load and hold times (9). It’s also important to make sure the muscles are relaxing fully after each long contraction. Relaxing is just as important as strengthening, and Perifit can help you make sure you are training them correctly.

One piece of advice: we need to be careful that we don’t over-do it on the PFM training. We don’t want to fatigue the muscles so much that they don’t work! This specialized training program can help with OAB symptoms, and it’s always a good idea to talk with your doctor and your pelvic floor PT about adding in PeriFit programs to your treatment regime.

Article written by
Marcy Crouch, PT, DPT, WCS
Board Certified in Women's Health Physical Therapy 
Creator and founder of The DT Method™️: The Standard for Birth Prep & PostPartum Recovery
@thedowntheredoc

 

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References:

1 Corcos, J., Przydacz, M., Campeau, L., Witten, J., Hickling, D., Honeine, C., . . . Wagg, A. (2017). CUA guideline on adult overactive bladder. In Can Urol Assoc J (Vol. 11, pp. E142-173)

2 Srikrishna S, Robinson D, Cardozo L, Vella M. Management of overactive bladder syndrome.  Postgraduate medical journal. 832007. p. 481-6.

3 Wolz-Beck, M., Reisenauer, C., Kolenic, G. E., Hahn, S., Brucker, S. Y., & Huebner, M. (2017). Physiotherapy and behavior therapy for the treatment of overactive bladder syndrome: a prospective cohort study. Arch Gynecol Obstet, 295(5), 1211-1217. doi:10.1007/s00404-017-4357-1

4 Barkin, J., Habert, J., Wong, A., & Lee, L. Y. T. (2017). The practical update for family physicians in the diagnosis and management of overactive bladder and lower urinary tract symptoms. Can J Urol, 24(5s1), 1-11.

5 Azuri, J., Kafri, R., Ziv-Baran, T., & Stav, K. (2017). Outcomes of different protocols of pelvic floor physical therapy and anti-cholinergics in women with wet over-active bladder: A 4-year follow-up. Neurourol Urodyn, 36(3), 755-758. doi:10.1002/nau.23016

6 Powers S, Howley E. Exercise Physiology: Theory and application to fitness and performance. 6th ed. New York, NY: McGraw Hill; 2007.

7 Kegel exercises: A how-to guide for women. (2018). Retrieved from https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/kegel-exercises/art-20045283

8 Fitz, F., Sartori, M., Girao, M. J., & Castro, R. (2017). Pelvic floor muscle training for overactive bladder symptoms - A prospective study. Rev Assoc Med Bras (1992), 63(12), 1032-1038. doi:10.1590/1806-9282.63.12.1032

9 Powers S, Howley E. Exercise Physiology: Theory and application to fitness and performance. 6th ed. New York, NY: McGraw Hill; 2007.