Don’t Make Me Laugh: How to Improve Bladder Control

Faulty plumbing.

There are a lot of reasons why we seem to get more leaky as we get older. But, as with breast cancer, the main risk factor for developing some form of urinary incontinence is being female. We get used to it early, in a way. Once we start menstruating, we leak blood every month. When we are sexually aroused, we leak vaginal fluids. Then things happen that disturb our urinary control. We have babies. We have urinary tract infections. We have surgery that may require the insertion of a catheter during and after our time in the operating room. We take hormone inhibitors as part of cancer treatment. But men develop urinary and bladder problems, too, often for similar reasons, such as treatment for an enlarged prostate or prostate cancer, infections, medications, or catheter placement during hospitalizations. And, common to both sexes, as we get older, stuff wears out. Our nerve signals may not work as well as they used to, so we may not know as quickly as we should when our bladder is full. Our strength and endurance may decline, making it harder to get to the bathroom in time. After giving birth, or going through menopause, breast cancer treatment, hysterectomies and oophorectomies, or other experiences that can change our hormones, our muscles and mucosa may get thinner and weaker. Our thirst signals may not work as well, so we may not drink enough fluids, leading to concentrated urine that can irritate the bladder. We may get constipated more easily, which affects bladder function. There are lots of reasons why we may leak, and I won’t try to cover them all. But I will say this: we can very often improve things fairly easily.

It’s always good to check in with your doctor — primary care, gynecologist, urologist — to rule out medical issues. But you may also want to see a physical therapist. Lots of us physical therapists are trained in treating urinary incontinence. And some PT’s are specialists in pelvic rehab. Particularly if you have pelvic pain, problems during and after pregnancy, painful sexual intercourse, a neurological disorder, or a prolapsed bladder, you may want to find a specialist physical therapist for pelvic disorders. You can start by doing an internet search for “pelvic physical therapy,” and adding your geographic location. One of my friends locally is a specialist and runs a clinic devoted to pelvic disorders. In my work in home care, I assess every patient I visit for urinary issues, like dribbling, urgency, bothersome frequency, and nighttime urination. Often, these problems are temporary, and develop after other medical issues that decondition my patients or require them to take new medications. So, their urinary issues may resolve on their own once we address those other problems. But a little instruction specific to urinary incontinence is usually helpful.

The First Thing to Do — Take Your Time

One of the easiest things to do to help improve bladder function is to take your time when you do have to urinate. And to wait. Very often, when we think we’re finished urinating, we’re not. Our bladders still may contain urine, and if we don’t try to empty them completely, we can develop a condition called urinary retention. Urinary retention can lead to all sorts of problems, like irritating your bladder and causing you to feel like you have to urinate every two minutes, all the way up to bladder and kidney infections and permanent bladder dysfunction. So, even if you think you’re done, just relax and wait a minute. Or two. Chances are that more urine will come out, and your bladder will work better.

How to Strengthen Your Pelvic Floor — It’s Easy.

I’m not going to bore you with a lot of physiology. I usually teach people how to do a few simple exercises in a seated position. The main one is learning how to find and strengthen the pelvic floor. Basically, the pelvic floor is what you’re sitting on when you sit, and it acts like a sling to keep our innards in. For all of us, the anal sphincter is in the middle of it, and for women, our vaginal wall is near the front of it. If you sit up straight and comfortably, feet on the floor, and close up your anal sphincter like you are trying not to pass wind, you’re using your pelvic floor muscles. If you’re tightening your belly or your buttocks, you’re working the wrong muscles. It’s basically a gentle exercise that looks like you’re not doing anything. But when you do it right, you’ll feel a section of your pelvic floor pull gently up and slightly forward. If you do that ten times quickly, and then five times slowly and deliberately, you’ve got yourself an exercise program to help reduce urinary incontinence. I had a female patient recently who, when she had to urinate, would start gushing urine as soon as she stood up. A few minutes after the first time I had her practice doing what I just described above, she felt the need to urinate, stood up, and for the first time in months, was able to get to the bathroom without leaking first. Admittedly, that was a pretty dramatic result, but if you hang in there and do this every day, you should notice some improvement in a week or two.

There is this wonderful pelvic physical therapist in Australia, Michelle Kenway, who has an entire website full of resources, including videos, that covers every aspect of pelvic disorders. She has a video which describes in more detail how to do the above exercise to strengthen your pelvic floor, which you can view here:

In case you have trouble playing the video from this page, here is the link to it on YouTube: How to Control Bladder Leaks and Get ‘The Knack’

A Caveat: Why I hate the word, “Kegels,” and never refer to pelvic floor exercises by that name.

Years ago, when I first got some continuing education in urinary incontinence, I confirmed a theory I already had, which was that Dr. Kegel, who apparently invented them, had an incomplete understanding of anatomy. Or that everyone teaching women how to do Kegels did. The way Kegels often used to be taught was that you were instructed to strengthen your pelvic floor muscles by stopping your urine stream. Period. And guess what? It didn’t work, and women still had urinary problems. Here’s the thing I learned in continuing ed. When you stop your urine stream, you may be using your pelvic floor muscles, but you are also interfering with the bladder’s own signals, which tell the bladder muscle to keep urine inside while you’re walking around, and then to release it when you urinate. So, when you start to urinate, and then stop your urine stream deliberately, you are confusing your own bladder. And thus, rather than improving things, you can make everything worse. So, please don’t EVER sit on a toilet, start peeing, and then try to stop yourself. EVER. Unless you are being assessed by a physical therapist who instructs you to do it, ONCE maybe, as a test, or to help you find your pelvic floor muscles in the first place. And even then, there is usually no need to literally stop your urine stream, because there are other ways of locating the pelvic floor. Unfortunately, pelvic floor strengthening exercises are still referred to by some folks as Kegels, and a lot of women still get the wrong instructions.

How to help the bladder indirectly.

In the months leading up to when I first took that continuing ed course, I was working in outpatient rehab, and I had a lot of patients with back pain. And, among other things, I would try to help them loosen up and strengthen their hip rotator muscles, which are deep inside the buttocks and near our sacroiliac joints, as part of an exercise program to help them improve the function of their core muscles. And what often happened was that, after a week or two, they would mention in passing that they noticed they weren’t leaking urine or having to wear pads to bed anymore. At the urinary incontinence course, I discovered why. It turns out that the bladder muscle, called the detrusor, relaxes to hold urine in, and contracts to push it out. And the nerve fibers that signal it are apparently shared by the muscles that rotate our hips. So, it is thought that by doing exercises for our hip rotator muscles, we can indirectly help the detrusor. In my experience, it certainly seems to help the situation, so here is the simplest hip rotator exercise. You can click on the picture and save it, too:

Finally, some general advice. Please try to get enough fluids every day. I can’t tell you how many of my patients end up in the hospital for dehydration. And urinary tract infections. Our thirst signal gets more unreliable as we get older, so don’t wait until you’re gasping of thirst to drink something. But try to avoid carbonated sodas. You don’t have to slug back eight glasses of plain water a day though. Other drinks count. And eating fruits count. And green veggies count. And soup counts. Just get enough. You’ll help prevent constipation, which can also lead to bladder problems. Check with your pharmacist about medication side effects, too.

If you want a summary of all this to save to your computer, here are two helpful brochures:
Bladder & Bowel Community Pelvic Floor Exercises for Women
Bladder & Bowel Community Pelvic Floor Exercises for Men
A whole page of downloadable pamphlets on related issues can be found at this link: Bladder & Bowel Community Downloads

Good luck!

This entry was written by Kathi, posted on Friday, April 13, 2018 at 06:04 pm, filed under Health & Healthcare, Nitty Gritty, Survivorship and tagged , , , , , . Bookmark the permalink . Post a comment below or leave a trackback: Trackback URL.

4 Responses to “Don’t Make Me Laugh: How to Improve Bladder Control”

  1. Wonderful and helpful to read . Thanks you, Kathi! Love you! Neuropathy includes bladder and internal difficulties which no one mentions when patients are wondering why they have bladder problems. That kegel word, grrr

  2. Yes, it does. Neuropathy can cause so much misery. I’m so glad you found this helpful, Indi. xoxo

  3. Thank you for this helpful advice! You really know your stuff. This information will be helpful to so many people, including me.

  4. Sooner or later, we all need to work on this. 🙂

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