Understanding Urinary Urgency and Frequency
Some people describe it as an uncontrollable “gotta go” feeling. Some say that they’re always in and out of the bathroom. Some feel a sudden urge to pee the minute they walk in the door. And some experience urinary tract infection (UTI)-like symptoms, but testing comes back negative.
All of this describes urinary urgency, which is a symptom of urge incontinence or overactive bladder (OAB). Urinary urgency means you have a sudden urge to go to the bathroom, often without warning and regardless of how full your bladder is (or isn’t). Urge incontinence can lead to accidents when you can’t make it to the bathroom in time, which can be embarrassing and frustrating.
Unfortunately, many people never discuss these concerns with their provider — they assume it’s just something they have to live with. But there are many effective treatments for urinary urgency, starting with lifestyle changes and physical therapy.
Urgency and Your Pelvic Floor
Urinary urgency and urge incontinence are often related to issues with your pelvic floor muscles. The pelvic floor is a group of muscles that stretches like a hammock between your coccyx (tailbone) and your pubic bone, serving as the base of your core. It supports structures like the bladder and bowel, as well as the uterus and vagina. If pelvic floor muscles are tight or tense, it can affect urinary urgency.
The Brain-Bladder Connection
Urinary urgency is also closely connected with toileting behavior. Here, it’s important to understand the connection between the brain and the bladder. As your bladder fills up, it sends a signal to the brain, which tells the bladder to contract and release urine once you make it to the restroom. The brain constantly communicates with the bladder (and pelvic floor) to coordinate urination.
Your habits can disrupt this reflex loop. Say you have an hour commute to work, so you make a “just-in-case” trip to the bathroom before getting in the car. But if you don’t really have to pee, this can confuse your brain because it didn’t send your bladder the usual “it’s time to go” signal. To compensate, your brain might start sending stronger “urge” signals. These intense urges to urinate don’t always match up with how full your bladder is.
If you empty your bladder with certain triggers (i.e., every time you get home) as opposed to when you truly have to go, your body produces the urge on schedule, no matter how full your bladder is. You can disrupt this process on a neurological level, using urge suppression and bladder retraining.
What Is Urge Suppression?
Urge suppression is a technique used to reset mixed up brain-bladder signals. When you experience the sudden sensation to empty your bladder, try the following:
Stop where you are and stand still or sit down. (Crossing your legs or pushing your knees together helps.)
Perform five quick Kegels or hold a Kegel for five seconds.
Perform three deep belly breaths.
Think of something else. Count backward or tell yourself, “This can wait.”
Perform five heel raises or walk to the bathroom on your tiptoes. (Contracting the muscles in your feet and calves will help contract your pelvic floor.)
When the urge has decreased, calmly and slowly walk to the bathroom as long as it’s been at least two hours since your last bathroom trip.
If it’s been less than two hours, try to delay your bathroom break. Even if you can only delay it a few minutes at first, that’s okay. Slowly increasing the time between bathroom trips gradually trains your bladder to reduce urgency for future episodes.
If you find that you often have an urge to pee more than every two hours, try bladder retraining.
This can help delay emptying your bladder when you get the urge to urinate. Just like you train your muscles at the gym, you can train the muscles that control your bladder. It’s meant for people who pee more frequently than “normal.” (It’s normal to pee about seven times per day, with about two to four hours in between trips.) If you’re not sure how often you go, keep a bladder diary for a few days. Ask your Hinge Health coach or physical therapist for our Bladder Diary resource. Here’s how this works:
Set a goal. Determine what your average bathroom interval is. Add 15 minutes to determine your new goal. (If you currently pee every hour, aim to go every hour and 15 minutes.)
Make a bathroom schedule. Start with when you first wake up and designate subsequent bathroom trips based on your interval calculated.
Practice urge suppression as needed. When you feel the urge to pee before your scheduled trip, use the above urge suppression process. If this stops the urge enough to hold off until your next trip, great. If not, try waiting five minutes before you calmly go to the bathroom.
Monitor your bathroom breaks. If you constantly have to break your schedule, create a new schedule with a shorter interval.
Make slight changes. Each week or so, increase your interval until you reach three to four hours.
It should take about six to 12 weeks to retrain your bladder. As you go through bladder retraining, remember that setbacks are common. Many issues can influence how challenging this is on any given day. Try not to let obstacles discourage you. Keep practicing your pelvic floor exercises and before you know it, you’ll have more “good” than “bad” days.
Other Treatments for Urinary Urgency
Your provider may prescribe medications, biofeedback techniques, injections, nerve stimulation, or surgery depending on the severity of your situation and your health history. We encourage you to try the above techniques first (or in conjunction with other interventions) to maximize benefit and limit unnecessary costs or side effects. You can also try these lifestyle habits:
Practice mindfulness such as breathing exercises or meditation. This can quiet your nervous system which can, in turn, reduce bladder urgency.
Limit bladder irritants.
Add pelvic floor relaxation exercises to your routine (ask your Hinge Health coach or physical therapist if you have questions about this).
Avoid tight-fitting clothing, which can add unnecessary pressure to your pelvic floor muscles and increase urgency.
Starting Pelvic Floor Exercises
When it comes to managing urinary urgency, pelvic floor exercises can make a big difference. Pelvic floor exercises are not just Kegels. Rather, they include a variety of moves that help strengthen and relax the muscles of your pelvic floor, which support your pelvic organs (bladder, bowels, etc.). Be sure to reach out to your Hinge Health physical therapist or coach if you’re interested in adding pelvic floor exercises to your current routine.
Urinary urgency is a condition where you have a very sudden urge to go to the bathroom regardless of how full your bladder is (or isn’t).
Your habits and routines can interfere with the brain-bladder connection. By going to the bathroom before you really have to go, your brain can become conditioned to send a stronger “gotta go” signal to your bladder, causing urinary urge symptoms.
To reduce unpleasant and inconvenient urge symptoms, try urge suppression and bladder retraining techniques.
How To Retrain Your Bladder To Control Leaks. National Association For Continence. (n.d.). https://www.nafc.org/bladder-retraining
Overactive bladder – Diagnosis and Treatment. Mayo Foundation for Medical Education and Research. (2018). https://www.mayoclinic.org/diseases-conditions/overactive-bladder/diagnosis-treatment/drc-20355721
Reynolds, W. S., Fowke, J., & Dmochowski, R. (2016). The burden of overactive bladder on US Public Health. Current Bladder Dysfunction Reports, 11(1), 8–13. doi: 10.1007/s11884-016-0344-9
Bladder training. (September 22, 2021). UCSF Health. https://www.ucsfhealth.org/education/bladder-training