Physiotherapy - Management of Urinary frequency and urgency

This leaflet is to provide you with information regarding urinary urgency, frequency and incontinence. The advice is relevant for both men and women.

You should use this leaflet with the advice given to you by your health professional. If you have any difficulty understanding the information or following the advice you should ask your doctor, specialist Pelvic Health Physiotherapist or continence advisor.

The Bladder

The bladder is a muscle called the detrusor and its function is to store urine. The bladder should fill up gradually and remain relaxed to allow you to hold on until you can get to a toilet. The amount of urine you produce depends on how much and what you eat, drink and sweat.

Symptoms such as urinary frequency, urgency and leakage may happen if the bladder contracts during filling and without your control. For most people the cause of these symptoms are unknown.

Definition of symptoms

• Urinary frequency - Passing small amounts of urine more than 7 times/day
• Urinary urgency - An unexpected strong urge to rush and pass urine
• Urge incontinence - Leaking urine with a strong urge to pass urine
• Nocturia - Being woken up in the night by the need to pass urine
• Overactive bladder (OAB) - This term can be used to describe the above symptoms

What is normal bladder function?

• You should pass urine between 4-7 times a day
• A normal void (wee) should be between 250 - 350mls
• Your bladder should be able to hold a maximum of 400-600mls (first void of the day)
• You should drink about 1500mls a day, however this will vary depending on how hot it is and if you have been exercising

What may aggravate your symptoms?

• Smoking
• Being overweight
• Menopause
• Urinary tract infection (water infection/cystitis)
• Constipation
• Prostate problems
• Gynaecological or pelvic surgery
• Some foods and drinks

How can you help improve your symptoms?

• Quit smoking - If you would like help with this speak to a health professional or the Stop smoking team at Salford on 0161 206 1779
• Ensure you are a healthy weight for your height. If you would like help with this, please speak to a health professional
• You may start with these symptoms during and after the menopause, or they may become worse. Some vaginal hormone treatments can help reduce your symptoms. Contact your GP for further information
• If your symptoms of frequency and urgency have come on suddenly, it may be that you have a urinary tract infection (water infection/cystitis). Speak to a health care professional for advice
• Constipation can be improved by ensuring you drink the correct amount and have a healthy diet. If it does not resolve, then you may require a softener such as Movicol, but speak to your pharmacist or health care professional before starting a new medication

Foods and drinks that may aggravate symptoms are:

• Caffeine (tea, green tea, coffee & chocolate)
• Fizzy drinks
• Alcohol
• Acidic drinks like blackcurrant, Vimto, citrus juice (orange/ grapefruit)
• Artificial sweeteners
• Spicy foods
• Tomatoes/onions

Treatment options

Bladder retraining

Many people with urgency and frequency get into the habit of going to the toilet too often, trying to make sure they are not caught short and leak. This can make the problem of urgency even worse because the bladder gets used to holding less and less urine.

The aim of bladder retraining is for you to be able to hold on for longer, have less urinary leakage, to be able to hold larger volumes of urine and gain more control of your bladder.

Start by trying to hold on for longer when you get the urge to go, initially aim for 2-5 minutes before going to the toilet.

Here are some tips to help you HANG ON:

• Stay calm and wait for the urge to pass
• Do pelvic floor exercise – long gentle squeezes (see pelvic floor leaflet)
• Sit on a hard seat
• Count backwards from 100
• Use deep breathing techniques
• Curl your toes
• Stand on tip toes
• Avoid ‘just-in-case’ visits to the toilet
• Complete a bladder diary to help you monitor your progress
• Be positive, tell yourself you can do it

Bladder retraining can be difficult, but becomes easier with time and practice

With time you should find it becomes easier because your bladder gets used to holding larger amounts of urine. Start by retraining in a ‘safe’ environment for you, for example when you’re at home, as your symptoms improve, you will feel more confident when you are out.

Your health care professional may ask you to complete a frequency/volume chart at home to get a better understanding of your problem. For this you will need to measure all the urine you pass and all the drinks you have over three days. This will be explained in more detail at your appointment.

Other treatment options

Bladder retraining is the first line of treatment for an overactive bladder. If it is not effective, then medication may be recommended in conjunction with bladder training. Your doctor/ nurse will discuss this with you if it is appropriate.

Medication

There are various medicines that can be prescribed if progress is not made. These medicines work by blocking certain nerve impulses to the bladder, which stop it contracting (squeezing) and allows the bladder to hold more urine. You will usually have an initial trial of 6 weeks to see if the medication is helpful for you.

Botox

This is used when other treatments have not been of benefit. The procedure involves passing a telescope into your bladder, through your urethra (waterpipe), and giving several injections of Botox (botulinum toxin A) into your bladder wall. Botox prevents your bladder muscle from contracting (squeezing) too much. This should help you to hold on better and increase the amount of urine your bladder can hold (only offered at a specialist centre).

Sacral nerve stimulation

This is a small device which is put under the skin of your bottom and sends a burst of electrical signals to the nerves that control the bladder. It is usually only offered when no other treatment has worked (only offered at a specialist centre).

All of these other treatment options have different side effects and how successful they are is different with each patient.

Useful contacts

Salford Royal Hospital
Tel: 0161 206 1063
Email: pelvic.health@nca.nhs.uk

Fairfield General Hospital
Tel: 0161 778 3882
Email: FGHphysio@nca.nhs.uk

Rochdale Infirmary
Tel: 01706 517 316
Email: physiori.op@nca.nhs.uk

Royal Oldham Hospital
Tel: 0161 627 8517
Email: physio.therapy@nca.nhs.uk

Resources

Bladder and Bowel UK https://www.bbuk.org.uk/

British Association of Urological Surgeons https://www.baus.org.uk/

British Society of Urogynaecology https://bsug.org.uk/

Pelvic, Obstetric and Gynaecological Physiotherapy (male and female pelvic floor exercises)
https://thepogp.co.uk/patient_information/default.aspx