Urge incontinence, overactive bladder

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I have always experienced frequent urination since young. I am a male, 56 now. In the last few years, I suddenly developed extreme urge incontinence. When the urge comes, I must go. There is no in between. I leak occasionally if I can't make it.

Sometimes, I danced around to avoid going and successful in holding it, only to find the urge comes back in 1 or 2 minutes, or if the urine volume is still low it may be another 5 or 10 extra minutes. But the urge is always intense when it comes.and more when in standing up position. Sitting or lying positions are less pressure.

I saw a urologist, had ultrasound and CT scan. He commented that my bladder is on the smaller size as during my ultrasound test the full bladder volume was 270ml. My own journal records when urge comes, I normally pass about 210 - 250ml. But many times the urge comes under 200ml.

1) can anyone share momentary remedies for intense urge?
2) what about permanent treatments that you can recommend/experience and the success rate.

Thank you in advance.

 

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@Positive I was told that going too often could lead to smaller bladder. Your bladder is like a ballon and practicing hold it can stretch it. Not totally convinced about this. Your doctors and nurses all have theories. All you can do is try everything. This forum is your best resource. I tried a clamp which helped some for training but not a long term option. I also sleep with external catheters. I sleep straight thru for eight hours. Good luck with your journey. Don’t give up.

 

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Positive,
Welcome to the forum. I’m similar to you with symptoms. Urge incontinence and overactive bladder are the main struggles I have along with the smaller bladder volume. I’ve dealt with this most of my life and there’s probably nothing better than getting checked out for associated health conditions. In my case I’ve developed type 2 diabetes over the course of years and keeping track of my numbers is slowing the progression for now.

Keep a diary of what you eat and drink. You’ll probably find patterns with your symptoms and what you’re eating and drinking. Once you’ve found triggers, avoiding them may improve your symptoms. In my case I haven’t been able to control intense urges and this has been consistent with the last few years of progression. I know there’s medication and such that help with the urges, but the side effects weren’t worth it for me. I just do my best with protection and go on with life.

Wish you the best and feel free to ping the forum with any questions. Lots of sound wisdom here.

 

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Positive,
Yep. Same issue except in my case my OAB showed up after surgery (RP). It's been a year now and it's still an issue. Strong urges would start when I had 125 mm volume, so I've been doing a combination of bladder training, and pelvic floor relaxation.

What affects the urgency/frequency? My experience:
(a) what you eat/drink (some things are bladder irritants..could be spicy foods, cheeses, acidic juices, coffee, etc.). Look up bladder irritants - and try avoiding them.
(b) how much and when you drink. You can reduce your fluid intake but that concentrates the urine and the bladder gets irritated so the urge will occur sooner, or you can drink a lot for health reasons (and pee a lot)...somewhere there is happy medium. I drink around 1.5 L of liquid spaced out over the day.

There is something called bladder training, where you increase the time between voids by learning to suppress the urgency - starting with delaying your voiding for a few minutes, then increasing the the delay time over a period of weeks. The bladder has a mind of its own and the connection to the brain signals are subtle. Some things (like stepping out of a shower into cooler air) are triggers. It has nothing to do with reaching a volume limit, but rather some mind trigger that tells the bladder it is time to release (when in reality there is no need to). By the way, sitting down is one way to reduce the urgency - something that you have discovered already. Anyways there are a number of bladder training techniques that you can try.

There are bladder relaxation and pelvic floor muscle relaxation techniques. I recently started with a Physical Therapist who specializes in pelvic floor health. I was doing a lot of Kegels but it turns out that I my pelvic floor muscles are very tight - so it seems that my issue is too much tension and doing Kegels wasn't helping. For our sphincter muscles to do their job properly, they need to be in a relaxed state before they are activated. I'm not sure if the therapy is helping but it is early in the process.

There are drugs. My urologist suggested Myrbetriq for OAB, but for now I am going to try these other methods as my OAB is manageable but still bothersome. I am not sure whether it is the bladder training or physical therapy but I have developed some holding capacity.

If you've been examined by your urologist and they haven't identified some issue like an enlarged prostate, a UTI or some other condition that may cause your urgency, then you could try the above. I would find a physical therapist that specializes in pelvic health - check with your urologist if you go down this path.

Hope this helps.

 

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Thank you for everybody's encouragement. Thank you.

@Bobsyeruncle, your story rings many bells with me. My urologist, fortunately, did not find health issues, e.g. enlarged prostate.

This week, I went to see a pelvic physiotherapist and did a physical exam (through inside my rectum) and found the same condition as you, i.e. my inner pelvic floor muscles are too tight. She has given me some breathing exercises and other relaxation exercises first before doing any strengthening kegel exercises. I was told to try to relax when the urge comes, but it has not worked because the urge is always intense.

I want to learn from your encouraging experience. What does your bladder training entail? Could I also ask what you do in your physical training?

Most of my breathing exercises are basically breathing in/out slowly into the abdomen. For example, 4 seconds inhale into the belly, gently squeeze PFM, 4 seconds exhale while gently squeezing PFM, and at the end drop release and open PFM.

Much appreciated for your sharing.

 

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Hi Positive.
Glad you are trying the Physical Therapy. There is lots of info available on Bladder Training (from medical websites) - but it involves urge suppression techniques so you increase the time between voids if your bladder is telling you to void waaay before it is anywhere near full. If I sit down in a reclined position I can delay voiding, but I've tried rubbing behind my thighs, curling my toes, going up on my toes, distractions, and as you are doing: belly breathing...sometimes they work, other times not.

The idea is to try to achieve a regular voiding frequency - so if it is every hour then to stretch it by 10 min, then increase the delay time so in several weeks you are at 2 hours. I've been doing this for many, many months now and I think it has helped but it has been slow. I think my urge suppression is better tho, or maybe I am just reading my body and managing it better.

I know I am very sensitive to bladder irritants (foods and drink) so if I have a lot of tomatoes, then the frequency/urge goes up. Foods and drinks are probably the biggest factors in my OAB.

Physical therapy involves belly breathing with pelvic floor muscle relaxation (open the PFM). Your exercises are more structured that what I have been doing, so I will have to try them! Other exercises involve stretching the PFM to open them up by doing various positions - youtube has a number of stretching exercises for this but your PT will have some for you as well.

I am curious about one thing in your situation. Your voiding volumes are not too far off your bladder capacity - unless I am missing something doesn't it mean that you are voiding in response to a near full bladder? In my case my urgency occurs far below my bladder capacity.

Anyways, hope this helps.

 

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Hi @Bobsyeruncle,

Yes, your message helps a lot. It validates my understanding of what you wrote earlier. As I start to be more clinical with my analysis, I need clarity on what people say.

Regarding my voiding volume vs bladder capacity, I passed 350 ml during the day once and 300 ml of nocturia once in the last three days. At all other times, the median is around 210ml. However, I would say I also get the urge when it's under 200ml, like around 150ml. Therefore, I do get terrible urges below my capacity.

So, it may be true that I have a smaller-sized bladder, but I get intense urges well before the bladder capacity. I hope to reduce these false urges. And at the same time, my urologist told me that our bladder can also be trained to increase capacity. My physiotherapist told me that maybe I can't increase the capacity to the average size of 500 ml, but hoping for urges to only come around after 350 ml. This would be a good result.

I have just created a new topic (https://forum.nafc.org/topic/3813/tibial-nerve-stimulation-for-an-overactive-bladder/). Have you tried tibial nerve simulation? My physiotherapist discussed it, and I watched some youtube videos and have just started daily simulation using a portable TENS machine.

Thank you for helping

 

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Hi Positive,

I'm soon 63 yr. old and have a combined urge and dribble IC since about 1 1/2 years, in my case started as side effects of a meds cocktail I have to take daily (and forever) since now 4 years after a heart stroke in combination with some other preconditions.

Often - and at the beginning I did myself - with an urge IC you start to limit your fluid intake, often use the toilet in order to avoid the urges coming, going with the first signs that you might have to go. All this behavior is counter-productive for you bladder health. Drinking too less - besides other unhealthy aspects - concentrates your urine which can cause additional bladder irritation, peeing too often and too early causes in long term your bladder to shrink.

The key for me was accepting my IC and wearing proper protection while drinking regular amounts of liquid (mostly water of course). The wearing of protection enables me, whenever I want to, to experiment with holding in if an urge hits. Sometimes it works, the urge goes away, and I can train my bladder to hold higher amounts - and if it doesn't work, it's no problem thanks to the protection. So, during the time, I still could hold my bladder volume (around 450 ml). On the other hand, wearing according diapers, I'm still able to live my normal, active and social life in nearly the same way than before of my IC without significant limitations. In your case, additional physiotherapy might also be a good help to enhance your condition as your diagnosis seems to be OAB and not Urge IC, which is slightly different!

Best Regards
Helmut

 

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What does your bladder training entail? Could I also ask what you do in your physical training?

In addition to what @Bobsyeruncle talked about (great detailed summary), I was recommended to try stretching exercises, yoga, breathing, and relaxation (mindfulness) to help lower tension in the pelvic floor region. These included yoga - child's pose, knees to chest, and butterfly.

When an intense urge strikes try to relax and breath through it. Seems counterintuitive doesn't it? The emotional and physical stress can create a negative feedback that the breathing/relaxing helps with. Just prepare for failures and don't stress out about it (another negative feedback loop).

@Positive, there is biofeedback that you can discuss with your PT. It helps you to see how much PF tension you have and how breathing and relaxation can affect (lower) the tension. It can be awkward as the monitoring is internal though surface sensors can be used if you have a strong aversion to internal monitoring.

Lastly, your urologist has a set of (levels) therapies to try - PT, medication, and surgery. It is up to you to determine what you want to try. One option to try is Botox (trade name) to help calm the bladder. Usually this is suggested after PT and medication, though you can ask about (for) it earlier.

 

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My urge urinary incontinence was an unexpected consequence of complications after surgery when I was 14 years old. I'm 81 now; So I've been coping with it for a long time. I've never been reliably dry at night since the operation. During the day, urges to urinate come on suddenly and are only somewhat correlated with what or how much I've had to drink during the previous several hours. When an urge happens, I will wet myself unless I can get to a bathroom within 5 minutes or so. At night. urges usually wake me up, but I will generally wet myself when I stand up after getting out of be; and sometime I wet myself while sleeping. So I always wear a diaper at night and during the day if I'm going somewhere or doing something where I can't be sure of getting to a bathroom quickly wken I need to to