We have all had the moment when a stressful or nervous situation comes up and immediately our bladder starts sending us to the toilet. Want to know what to do about it? Let me explain…
The moment a sudden bladder urge comes on can exacerbate an already stressful situation when you need to find a bathroom, quick! Making things worse, this urgency can come on even when you don’t have much in your bladder.
As a pelvic health physical therapist (physio) I often see clients struggling with overactive bladder symptoms such as urgency and frequency. It is puzzling and often frustrating when you get an urge to go to the toilet and nothing much comes out! Leaving you to ask, what was that about?
Why does bladder urgency come on even when my bladder is empty?
Normally, your bladder will send you an urge when your bladder is half full. This happens when the bladder walls stretch, and an urge signal is generated.
However, another way urges are created is in response to stress, and the stress triggers can vary depending on how you are feeling. The triggers can be as simple as leaving the house to go shopping or as complex as going on stage to give a speech.
In either case, the stress of the situation can generate a feeling of bladder urgency without bladder fullness. This type of bladder urgency is called bladder sensory urgency.
Bladder sensory urge is different than bladder muscle-related urge because it is generated by our nervous system. These urges can happen in empty bladder states when your bladder would normally be expected to be quiet.
What brings on this type of bladder urgency?
Stress activates our sympathetic nervous system also known as our fight or flight system that keeps us safe in the face of adversity. The greater the adversity the larger our fight or flight response.
Once activated, however, this protective mechanism may keep your nervous system sensitive and more likely to focus on bodily sensations like urinary urgency. As a result, you are more likely to feel bladder urge signals especially if you’ve had a bad experience in the past.
All it takes is one strong bladder urge episode where you don’t or nearly don’t make it to the toilet in time and your nervous system stays on guard to make sure that doesn’t happen again.
Your brain then becomes sensitive to ANY bladder signals small or large that come along. How do you change bladder sensitivity?
How you feel about your bladder is an important part of reclaiming bladder control.
If you feel that you are at ‘war’ with your bladder or ‘alarmed’ at the sudden urges, the negative feelings you have will likely feed into the distress you have regarding your bladder. To counter this negative cycle and put you back in control, it’s important to practice calming techniques for your nervous system. Examples include;
- Diaphragmatic or Belly Breathing
- Mindfulness meditation practices like body scanning for relaxation
- Positive mantras or affirmations
What all of these practices have in common is the intentional calming of your nervous system. In calming your nervous system you turn down the fight or flight signaling, decrease the intensity of urgency triggers and instead feel a sense of well-being.
If you are new to these practices or have been frustrated with meditation, this is what I recommend.
As a pelvic health specialist, I often have my clients practice diaphragmatic breathing as a foundational practice when dealing with overactive bladder. The intentional focus on your breathing is calming to your nervous system and helps to decrease bladder urgency.
How do I start a diaphragmatic breathing practice?
Diaphragmatic breathing is an intentional way of breathing that emphasizes the expansion of the abdomen at the level of the belly button with each inhaled breath. When we breathe from our belly, the muscles of the abdomen relax, lengthen and protrude outward.
Our ribs are important for belly breathing as well. Think of your rib cage like an umbrella. When you breathe in, your ribs open up, expanding outward and your chest will lift slightly. As the air leaves your body, your ribs will return down to their resting position and the chest will drop.
It’s also important to remember that our ribs circle our entire chest, so make sure you are breathing into the sides and back of the chest to get all parts of your umbrella.
Let’s give diaphragmatic breathing a try!
Start by sitting in a comfortable chair with good back support. Make sure both feet are flat on the ground and your hips relaxed and (ideally) slightly higher than your knees.
- Close your eyes, or make them soft by keeping them open halfway.
- Place one hand in the middle of your upper chest over your sternum and the other over your belly button. Either hand is fine, so long as your arms are comfortable by your side.
- Take a deep inhale breath through your nose, and let the air out through barely open lips. Keeping your lips barely open or ‘pursed’ means that the air will be slower to leave your body, as opposed to having an open mouth.
- As you inhale, gently direct your breath towards your belly button. Actively allow the abdominal muscles to relax and lengthen as if you are inflating a beach ball. This gentle inflation should reach from your belly button to your pubic bone. Try to avoid pushing outward, which involves breath-holding.
- Focus your mind on the flow of your breath into and out of the nostrils. Sometimes flaring the nostrils with the inhale can help to keep your mind focused.
- With each repetition focus on making your belly a little larger, and moving the ribs open a little wider.
- Repeat the above sequence ten to fifteen times, without rushing.
Try this technique when you are nervous and notice your bladder urgency. Hold off on rushing to the toilet, and meet the urgency with a few calming deep breaths. Once your bladder urgency has subsided, check-in with your body and decide if you really need to go.
If you do, please empty your bladder. If not, go about your business with confidence knowing you have successfully met your bladder urgency with a positive, proactive response that puts you in the driver’s seat.
Add this technique to your bladder management toolbox. A toolbox that enables you to change how you react to bladder urges, and puts you back in charge.
Because being free of the insecurity of bladder urgency is true freedom!
Finding this helpful? Grab your free printable, Diaphragmatic Breathing for Bladder Urges!
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Happy Bladder Wishes! 
~ Tami
Tami Lines is a licensed Physical Therapist with certifications in Pelvic Rehabilitation and Women’s Health Coaching. She is the founder of Pelvic-Health-Matters. Tami has over 15 years of experience with expertise in bladder Health, and pelvic floor muscle dysfunction for adolescent and adult women. She is also a mom of two wonderful young adults working their way through college.
References:
Adelstein, Sarah & Lee, Una. (2016). The Role of Mindfulness in Urinary Urgency Symptoms. Current Bladder Dysfunction Reports. 11. 10.1007/s11884-016-0348-5.
Baker J, Costa D, Guarino JM, Nygaard I. Comparison of mindfulness-based stress reduction versus yoga on urinary urge incontinence: a randomized pilot study. with 6-month and 1-year follow-up visits. Female Pelvic Med Reconstr Surg. 2014 May-Jun;20(3):141-6.
