“The length of a film should be directly related to the endurance of the human bladder.” This quote, attributed to Alfred Hitchcock, brings to light one of the ways that we have structured life around one of the most basic functions of being human — having to use the bathroom at semi-regular intervals throughout the day (and sometimes night). When body systems are working together, we don’t give this much thought. However, sometimes things happen that can lead to changes in bladder functioning. This can significantly interfere with daily life and assistance from a healthcare provider can be extremely beneficial. To understand these symptoms as well as their treatment and the role of pelvic floor physical therapy, it’s helpful to understand how the bladder functions normally.
What does the urinary bladder do?
The urinary bladder is a balloon-like organ within the pelvic cavity that serves to collect, store, and eliminate fluid waste from the body. Urine is formed in the kidneys and funneled to the bladder via ureters. The bladder then stores this urine until it is eliminated from the body via the urethra. While urine is being collected and stored in the bladder, the detrusor muscle, which is a muscle that forms one of the layers of the bladder itself, is relaxed. As the bladder fills with urine, it stretches, much like a balloon being filled with air. This stretching sensation is interpreted by the brain as an urge to urinate. When being emptied, then, the detrusor muscle activates, contracts, and thereby squeezes to empty the bladder.
What is normal bladder function?
When functioning normally in an adult, the bladder can hold more than 2 cups of urine but the first urge to urinate occurs when the bladder is about half full. After the first urge, the bladder will keep filling and can be held until an appropriate time to urinate. It takes approximately 2-4 hours for the bladder to fill, and thereby it is considered normal to urinate between 5-8 times in a 24-hour period (and hence, many movies time in at around the 2-hour mark).
Sometimes, however, this does not function as smoothly as described above which can result in an increase in urinary frequency. In other words, dysfunction can lead to the feeling of needing to urinate more (sometimes much more) than 5-8 times per day. This can happen for a variety of reasons, some of which are described below, and can lead to feelings of frustration and helplessness. Significant mental health consequences can also be experienced including anxiety and avoidance or fear of being in situations where going to the bathroom is not an option.
What causes increased urinary frequency?
Below are descriptions of four common causes of increased urinary frequency. Note that this is not an exhaustive list and more serious causes of urinary frequency (including an infection, bladder cancer, bladder stones, and diabetes) should be ruled out by a trained healthcare provider.
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Dietary bladder irritants
Certain foods and drinks, such as coffee, carbonated drinks, and alcohol, may be irritating to the bladder. This irritation can result in a sense of urinary urge despite decreased urine volume. Pelvic floor physical therapy can assist with identification of bladder irritants and, subsequently, decreasing or eliminating consumption of the irritant often resolves urinary frequency caused by dietary bladder irritants. -
Muscle tension
Increased pelvic floor muscle tension, especially around the urethra, can cause a sense of urinary urge which, can lead to increased urinary frequency. Physical therapy treatment strategies such as manual relaxation techniques, breathing exercises, and stretches can be helpful in reducing muscle tension related to increased urinary frequency. -
Decreased bladder emptying
If the bladder is unable to empty, increased urinary frequency as well as increased urinary volume often occurs. Incomplete emptying can be caused by obstruction of the urethra such as with Benign Prostate Hyperplasia (BPH), surgical scarring, vaginal bladder prolapse (cystocele), nerve damage, or decreased ability of the pelvic floor muscles to relax. This list is also not exhaustive, and the specific cause of the symptoms will determine how it is treated. Treatments administered by a pelvic floor physical therapist can include education on voiding posture and techniques as well as pelvic floor muscle strengthening and the muscle relaxation strategies described above. -
Poor bladder habits
If the bladder is repeatedly emptied prior to being full, this can lead to maladaptive “training” of the bladder. For example, if the bladder is frequently emptied when it is only half full, very strong urinary urge will occur at this point although physiologically the bladder can still hold more urine. This strong urge is then coupled with increased frequency. The best treatment for increased urinary frequency caused by a habitual training of the bladder is to gradually increase time between urination in order to “retrain” the bladder. Pelvic floor physical therapy can help walk you through this, giving you guidance, strategies, and exercises to “retrain” the bladder.
When functioning normally, the bladder can hold substantial amounts of urine as it fills and then empty when the time is appropriate. However, this process requires normal function of many different body systems and when one is not working properly, can have many physical as well as psychological consequences. If you are struggling with an increased frequency of urge to use the bathroom, pelvic floor physical therapy may be able to help you get back to living a life untethered to your bladder!
Pelvic floor physical therapy can help.
Many people suffer unnecessarily with increased urinary frequency. Treatment options depend on the underlying cause of a person’s frequent urination, but once serious underlying problems are ruled out by a trained healthcare provider, a pelvic health physical therapist can help by addressing pelvic floor muscle disfunction.
