Urinary Incontinence

Bladder

A few facts about the bladder: the bladder is made up of a smooth muscle that squeezes involuntarily, meaning you cannot tell this muscle to squeeze. The maximum amount of wee your bladder can hold is approximately 500 to 600ml. The healthy bladder fills at a rate of 5ml per minute, and your bladder and your pelvic floor muscles work together. The bladder fills with wee at 5ml per minute; the bladder muscle is relaxed, and your pelvic floor muscles are at a resting tone, meaning that the door at the bottom of your bladder is closed. You get the first feeling that you need a wee when there is approximately 100 to 150 millilitres of wee in your bladder. This feeling comes from the muscle within your bladder squeezing, trying to open that door at the bottom of your bladder. However, the feeling to have a wee isn’t strong, meaning you can wait a while and forget about this feeling if you need to. So you decide to wait while you have a wee, your pelvic floor muscles would squeeze, meaning that that door at the bottom of your bladder would close, and your bladder muscle would relax, and that feeling to have a wee would pass. You will then get a second and normal feeling to have a wee when there is approximately 300 to 350 millilitres of wee within your bladder. You would get a stronger feeling to have a wee, meaning the bladder will be squeezing and trying to open that door at the bottom of your bladder. However, your pelvic floor muscles would remain switched on until you get to a toilet to make sure that that door at the bottom of your bladder stays closed, ensuring that you don’t start weeing before you get there. Once you reach the toilet and sit down on the toilet, your pelvic floor muscles would relax, the bladder muscle would squeeze to open that door, and wee would come out. You would then finish weeing; your pelvic floor muscles would switch back to that resting tone to make sure that door was closed, and your bladder would be relaxed, and you’re back at stage one. Healthy bladder function: a healthy fluid intake is around 1.5 to 2 litres of total fluid over a 24-hour period, which would equate to a healthy frequency (meaning how many times you go for a wee) of anything up to eight times over a 24-hour period. It’s normal to wake up once during the night for a wee once you’ve been through the menopause and twice through the night after the age of 70. The biggest wee should be first thing in the morning, and during the day, it should be about 300 to 350 millilitres, which does equate to about 10 seconds of a moderate flow of wee. There are different types of urinary incontinence, and if the pelvic floor muscles are weaker, this may cause leakage of the bladder. So the different types of leakage you can get: firstly, we’ve got stress incontinence, which is known as leakage of urine if you were to cough, sneeze, laugh, lift, or bend over, etc. We’ve got urinary urgency and urge urinary incontinence, which is where you get the urge or the sensation to have a wee, and then you’re unable to control that sensation, and you may leak on the way to the bathroom, or it sends you a really strong urge that you need a wee quite often. Then we’ve also got mixed urinary incontinence, which is a combination of the stress urinary incontinence and the urgency or the urinary incontinence too. So what is stress incontinence? The picture on your screen shows some green arrows, and these indicate an increase in pressure in your abdomen that’s caused by laughing, coughing, or sneezing. When we get this increasing pressure—so if we were to cough—the pelvic floor muscles should squeeze or contract, which tells the bladder muscle to relax, and the external sphincter of your bladder (the part that acts like a door to stop the wee from coming out) would close. But if the pelvic floor muscles do not contract when this happens, then we would leak urine. So how do we help that, and what can we do? Well, we would recommend something called The Knack. The Knack is shown as a contraction that we do voluntarily, meaning we would do a squeeze of the pelvic floor muscles before coughing and sneezing to support the bladder and prevent the leakage. You could also close your legs or apply pressure to the area, as this is closed. You can also close your legs or apply pressure to the area, and this can prevent leakage from occurring. So urinary urgency and urge urinary incontinence: when the bladder fills with urine, the muscle within the bladder contracts. This increases the pressure within the bladder, and it causes an urgent desire or a need to have a wee. So if you think about those receptors we mentioned earlier, they can become hyper-aware that your bladder is filling with wee, and they can send a more intense signal to your brain to tell you that you need a wee, and that would make you go for a wee more frequently than the normal bladder. Urge urinary incontinence usually occurs when you’re unable to defer the urge to have a wee, and you may leak before you get to the bathroom. So how can we help with that urge and urge urinary incontinence? Firstly, heel raises: this comes under the term of bladder retraining. With heel raises, the nerve that controls the muscle within your bladder is also the same nerve that controls your calf muscles, which are the muscles at the backs of your legs just below your knees. Heel raises can act as a distraction technique; you can either do that in sitting or standing, depending upon your level of function. A pelvic floor squeeze: we know if you contract your pelvic floor muscle, we know that that tells the bladder muscle to relax, which therefore would reduce or remove that urge to have a wee. You could cross your legs or sit on a firm surface. You could just distract yourself for a few minutes, and then once that urge to have a wee has passed, then go for a wee once you feel like you’ve got control over your bladder. Deep breathing and relaxation as well.
So what do we drink? As humans, we drink lots and lots of different things—it could be tea or coffee or water, carbonated drinks, alcohol, juices, whatever it may be. We know that we should be drinking about 1.5 to 2 litres of fluid per day, and this can include things like water, dilutes, and decaffeinated drinks. We shouldn’t be drinking things such as caffeine or carbonated drinks, and this is because they can irritate the bladder and cause more of an urge to urinate. We recommend you do this really slowly, and the logic behind that is to stop or reduce any withdrawal symptoms you will get from any caffeine or carbonated drinks. If you are experiencing any bladder symptoms, we ask that you fill out a bladder diary for three days. If this is something you identify with, this can be discussed in more detail if you want an appointment.