Mastering Urge Suppression and Bladder Training

In this empowering episode, I dive deep into the world of bladder training and urge suppression techniques, specifically designed to support women struggling with Overactive Bladder (OAB) and urgency urinary incontinence. These practical, non-invasive methods are recommended by leading health authorities, including the American Urogynecology Society and JAMA.

Key techniques covered include Kegel exercises, urge suppression through pelvic floor contractions, and timed voiding strategies. These methods have improved symptoms in about 50% of women and are foundational even for those requiring additional treatments. 

Practical steps for implementing these techniques and the importance of a strong pelvic floor are emphasized, alongside tips to avoid panic and manage the urgency more effectively.

Join me as we uncover the secrets to taking control of your bladder health and improving your quality of life.

For More Information: Dive deeper into urge suppression strategies in my comprehensive blog post:https://thewomensbladderdoctor.com/urge-suppression/

Additional References:

• AUA Guidelines on Overactive Bladder
• Urinary Incontinence in Women - FPMRS
• PubMed Study on Urge Suppression

Tune in to this episode for a blend of expert insights and practical advice, all designed to empower you to live confidently and comfortably.

Timeline

00:28 Introduction to Bladder Training and Urge Suppression

00:56 Understanding Urgency Urinary Incontinence and Overactive Bladder

01:29 Guidelines and Initial Recommendations

02:24 Techniques for Urge Suppression

04:32 Steps to Manage Urge Suppression

06:25 Timed Voiding Explained

07:09 Implementing Timed Voiding

09:06 Additional Tips and Conclusion

Transcript

 Hi there. Today, I'm going to be talking to you about bladder training and about urge suppression. So once again, my goal here is to give you additional tools to help you with your leaking. Sometimes I think you're just looking for that one thing that might help a lot and a bladder training and urge suppression is something that we recommend for all women who have Overactive bladder or urgency urinary incontinence.

Urgency urinary incontinence is when you leak with a sense of urge, you just can't quite get there on time, your bladder starts contracting before you're in a safe place to empty. Overactive bladder recommends kind of a larger part of the spectrum. of symptoms where you're having an increase in frequency.

So you're going to the bathroom all the time. You have an urge, um, and you worry about not getting there on time, but you can get there on time. Sometimes, it also includes getting up a lot at night to go to the bathroom. The guidelines from the American Neurologic Association, from The American Urogynecology Society, as well as from a recent article from JAMA, all recommend starting with pelvic floor physical therapy, urge suppression, and bladder training.

They also recommend some behavioral changes, but I'm just going to focus on bladder training. And urge suppression. Studies have shown that these basic techniques can improve symptoms in about 50 percent of women. Even women who go on to take medications have been shown to do better if they've mastered these techniques.

And one of the reasons that we always start with recommending these techniques is because they're non invasive, they're low risk, and they're inexpensive. Okay, so let's start with urge suppression. So urge suppression is a technique to help with leaking from urgency urinary incontinence. To do this technique, you need a little bit of patience and you need a strong pelvic floor contraction.

So we think that that urge, the thing that causes that urge is actually that your bladder is contracting. The muscle is actually contracting, and You want to stop the muscle from contracting so that that urge goes away. So, the theory behind urge suppression is this. Your bladder stores urine. The urethra is the tube that leads from the bladder to the outside.

The urethra has a strong sphincter muscle that's attached to your pelvic floor muscles. Your bladder and your urethra are a team, and they should act as a team, and they should always work in concert. So when the bladder relaxes and stores urine, The urethra squeezes to close the opening and when the bladder squeezes to empty, the urethra should relax.

So those things should always work together. When you contract your pelvic floor, you're contracting your urethral  sphincter and you're squeezing the urethra closed. When you do this, this reflexively tells your bladder to stop contracting. Right? And to relax. And so if you do a series of quick Kegel contractions, so somewhere between three to five, and you're not relaxing between the contractions, you're just squeezing on top of the last one, when you feel that sense of urgency, your bladder should stop contracting, and the urge will go away.

So, I think this is a really easy thing to explain. It can become a very difficult thing to do because people tend to get so panicked when they feel that urge. And then you release a lot of cortisol, and then you have to go even more. And so, you, you really need to work on not. Panicking when you're feeling that urge.

So what we tell people to do is when you feel a strong urge to go to the bathroom and you're worried about leaking, do the following. Take a deep breath. Sit if you can. Do a series of quick Kegel contractions. So three to five. Don't relax the pelvic floor, but you want to make sure your shoulders are relaxed.

You want to release any tension that you are storing. Then you want to think of something relaxing, wait for the urge to resolve, and then walk to the toilet. The think of something relaxing. You want to have thought of this ahead of time so that you're prepared and you know what you're going to think of.

Maybe it's a mantra, maybe you could do some meditation here, but if you do this, the contraction is more likely to go away and you are more likely to get to the bathroom compared to if you were to just run to the bathroom, you're much more likely to leak in that situation. So the key to all of this is don't panic.

Thank you. Distract yourself. Wait for the contraction to pass. The stronger your pelvic floor muscles are, the better this will work. It takes practice, right? Because at the beginning, you're going to want to run to the bathroom. But again, that running just makes things a little bit worse. So if you need some more instruction on urge to compression, I do have Some written information on my website, and you're more than welcome to check that out at the women's bladder doctor.

com. But again, with a little bit of practice, these techniques can help with urgency, urinary incontinence, and. Over 50 percent of women are dramatically helped with this technique. One of the other techniques that we mention frequently is timed voiding, and I feel like this is something that I talk about a lot, but we never really go into detail into how you would do that. 

So, we use timed voiding when someone is going to the bathroom too frequently. Ideally, you should be going every three to four hours. And in timed voiding, what we do is we actually have you go by the clock and not have you go when you feel a sensation so that you kind of reset the interaction between your brain and your bladder.

The first step is to figure out how frequently you're going to the bathroom. How often? Right? And let's say you're going to the bathroom every hour. So then what I would have you do is I would have you go to the bathroom every 45 minutes for three days while you're awake. We don't want you waking up to do that. 

And then after three days, you're going to increase it by 15 minutes to an hour. So then you would be going to the bathroom every hour and you would do that for three days. After those three days, you would increase it again by 15 minutes and then go to the bathroom every hour in 15 minutes and do that for three days.

And then, every three days, you're going to keep increasing the interval by 15 minutes until you get to the interval that works for you. So even though I said that you should go to the bathroom every three to four hours, for some people, every two, two and a half hours works better for them. For some people, a shorter interval is better.

Works fine. So even though I said that you should be avoiding every three to four hours, if two and a half hours is acceptable to you, that's absolutely fine. And, you know, this going to the bathroom by the clock and you, you really have to, you know, set an alarm so that you're doing this. while you're awake, again, not waking up at night, kind of resets your brain and your bladder and the way they interact.

And it gets you to ignore some of those cues, um, and reset some of your behaviors. I find this works really well in moms with newer babies, sometimes. You know, moms, um, end up going to the bathroom when they're getting up and doing something with their baby, maybe right before breastfeeding, maybe right after breastfeeding, maybe whenever the baby is asleep.

And then they can develop some bad habits. And so this kind of resets those habits. It works for lots of other women as well, but that's just an example of a population where this works really well. So, again, all of these techniques are for urgency urinary incontinence and the greater overactive bladder spectrum of symptoms.

We frequently recommend starting with urge suppression and with bladder training, and these two things can help a lot. Urge suppression works best if you have a strong pelvic floor, so you need to be strengthening your pelvic floor at the same time. You need to be sure that you are contracting your pelvic floor correctly, and that's kind of best done with a provider double checking for you.

to make sure that you can contract and relax your muscles at the same time. The couple of things that I would say about overactive bladder and urgency urinary incontinence is that there are a lot of treatments for this syndrome and there are more and more treatments coming out all the time because this is such a big problem for so many women.

It is more common as we get older and so with the aging of the population, we expect to see more and more. women having these symptoms. So there are a lot of treatments out there. So you shouldn't feel like this is a hopeless situation for you. But even patients who go on to more invasive treatments or medications do better when they are aware of these behavioral techniques and when they have a strong pelvic floor.

So this hard work, component. And this part that takes a lot of homework on your part is really, you know, it's really the foundation of your getting better, right? The, the work that you need to do to get to where you want to go. So if you need any additional help or information, you can always check out my course that's online bladder one on one that's available at my website, but I hope these techniques help you as you're getting better.