What is urinary urgency?

Normally the bladder expands steadily as it fills, until an appropriate time and place for the process of emptying. Then the sphincter which has been holding the bladder outlet closed is opened and the muscles in the bladder contract and squeeze the urine out. The bladder then relaxes again for the process of refilling. It is normal to pass water four to eight times a day, including once or perhaps twice at night.

Some people find their bladders do not work like this. Instead, the muscles are liable to contract uncontrollably at the wrong time. If you have an overactive bladder, you may feel very little warning of the need to pass urine and this is called ‘urgency’. Some people have difficulty in making it to the toilet on time because their bladder gives them little warning, which may result in urine leaking. This is called ‘urge incontinence’.

What are urge suppression techniques and how might they help?

Panic and fear of leaking can often make the feelings of urgency worse. Urge suppression techniques can be used to help you regain bladder control. Many people with urgency will get into the habit of going to the toilet too often – trying to make sure they are never ‘caught short’. This can make the problem of urgency even worse. The bladder gets used to holding less urine, so it becomes even more sensitive.

The suggestions below may help you to retrain your bladder and may help you reach the toilet in time.

If you have any questions, please feel free to ask your specialist nurse or specialist physiotherapist.

• Remove cause of urgency, for example turning off taps or taking hands out of water.
• Stand still and cross your legs, if possible.
• Contract your pelvic floor muscle for up to 20 seconds.
• Think of or do something else, for example a crossword or stop and look in a shop window.
• Stand on tip-toes or change position.
• Contract buttock muscles when standing.
• Sitting on the edge of a hard chair or pressing your spine against the back of a chair to relax the abdominal muscles for 60 seconds until the urge subsides.
• Try relaxed breathing.
• Stay calm. Do not try and rush to the toilet ‘mid-urge’.
• Try and reduce your caffeine intake as this may irritate your bladder.
• Stopping or reducing smoking may help.
• Drink adequate fluids for your body weight (30mls per kg of body weight if no medical restrictions in place).
• Avoid food and drinks which are known to irritate the bladder, such as citric juices and spicy food.
• Your nurse can give you a list of bladder friendly drinks.
• Do not cut down the amount you drink – this makes your urine even more concentrated and can make bladder problems worse.
• Avoid constipation.

If the urge persists after practicing these steps and you feel you must go to the bathroom, then it is important you:

• walk slowly and calmly to the toilet
• maintain calm breathing
• refrain from undressing until you are standing over the toilet
• do not rush to the toilet as this will only encourage strong bladder urges and leaking.

Bladder retraining takes time and determination. A cure does not happen overnight, but it can be very successful if you persevere.