Bladder Urgency and Overactive Bladder: Understanding and Physiotherapy Manageme

Overactive bladder is a broader syndrome characterized by urgency, frequent urination (more than eight times per day), nocturia (waking up at night to urinate), and, in some cases, urgency urinary incontinence (Abrams et al., 2017). While not life-threatening, these conditions can disrupt daily activities, sleep, and emotional well-being. Physiotherapy offers effective, non-invasive approaches to managing OAB and urgency symptoms, focusing on improving bladder control and addressing contributing factors.

Causes and Mechanisms

Bladder urgency and OAB result from an overactive detrusor muscle, the muscle responsible for contracting the bladder to release urine. In OAB, the detrusor muscle contracts involuntarily, even when the bladder is not full, leading to the sensation of urgency. This can occur due to:

1. Neurological Causes: Conditions like multiple sclerosis, stroke, or spinal cord injuries can disrupt communication between the brain and bladder.
2. Hormonal Changes: oestrogen deficiency during menopause may weaken bladder and urethral tissues.
3. Bladder Irritants: Consuming excessive caffeine, alcohol, or acidic foods can irritate the bladder lining, exacerbating symptoms.
4. Pelvic Floor Dysfunction: Weak or higher tone pelvic floor muscles may impair bladder control, contributing to urgency and incontinence.
5. Age-Related Changes: Reduced bladder capacity and decreased ability to suppress detrusor contractions occur with aging.

Symptoms and Impact

OAB and urgency can lead to frequent interruptions in daily life, including work, travel, and social activities. Women may avoid drinking fluids to reduce symptoms, increasing the risk of dehydration and urinary tract infections. Sleep disturbances from nocturia contribute to fatigue and irritability, while the fear of leakage can lead to embarrassment, social isolation, and diminished self-esteem (Coyne et al., 2012).

Physiotherapy Management of Bladder Urgency and Overactive Bladder

Physiotherapy offers a holistic approach to managing bladder urgency and OAB, targeting bladder control, pelvic floor function, and lifestyle factors. Key components include:

1. Pelvic Floor Muscle Training (PFMT)

Pelvic floor muscle training strengthens the pelvic floor muscles, improving bladder control and reducing urgency. Physiotherapists guide patients in identifying and correctly activating these muscles. Consistent practice improves the ability to suppress involuntary detrusor contractions by engaging the pelvic floor in response to urgency (Dumoulin et al., 2018).

2. Bladder Training

Bladder training aims to increase the bladder’s capacity and delay the urge to urinate. This involves:

• Scheduled Voiding: Gradually extending the time between voids to retrain the bladder to hold more urine.
• Urgency Suppression Techniques: Teaching techniques like slow, deep breathing or pelvic floor contractions to manage the sensation of urgency.

3. Behavioural and Lifestyle Modifications

Physiotherapists address bladder irritants and provide strategies to manage symptoms. Recommendations include:

• Limiting caffeine, alcohol, and acidic foods.
• Maintaining proper hydration without overconsumption.
• Establishing regular bowel habits to reduce pelvic floor strain caused by constipation.

4. Biofeedback and Electrical Stimulation

• Biofeedback: Helps patients visualize and understand pelvic floor activity, ensuring correct muscle use during training.
• Electrical Stimulation: Used in cases of severe OAB or weak pelvic floor muscles, it enhances muscle activation and bladder control.

5. Core and Postural Training

The pelvic floor functions as part of a system with the core muscles. Strengthening the core improves pelvic stability, supporting better bladder control. Physiotherapists may incorporate exercises to enhance posture and reduce strain on the pelvic floor.

6. Education and Support

Physiotherapists provide education on bladder health, anatomy, and coping strategies. Empowering patients with knowledge reduces anxiety around symptoms and fosters adherence to treatment plans.

Effectiveness of Physiotherapy

Physiotherapy has been shown to effectively reduce OAB symptoms, including urgency, frequency, and incontinence. PFMT combined with bladder training is particularly effective, with symptom improvement rates of up to 70% in women (Dumoulin et al., 2018). Physiotherapy offers long-term benefits without the side effects associated with medications or invasive procedures.

Conclusion

Bladder urgency and overactive bladder significantly affect quality of life, but physiotherapy provides effective, evidence-based management strategies. Through pelvic floor training, bladder retraining, lifestyle adjustments, and education, physiotherapy addresses the root causes of urgency and OAB, helping patients regain control and improve their well-being. Early intervention and consistent practice are essential for achieving lasting results.

References

• Abrams, P., Cardozo, L., Wagg, A., & Wein, A. (2017). Incontinence: 6th International Consultation on Incontinence. International Continence Society.
• Coyne, K. S., Margolis, M. K., Kopp, Z. S., & Abrams, P. (2012). The impact of urinary incontinence on quality of life and economic burden in the United States. BJU International, 110(8), 1361–1367.
• Dumoulin, C., Hay-Smith, J., & Mac Habée-Séguin, G. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, 10, CD005654.