It happens a lot, and at the most inopportune times: mid-movie, the killer is about to be unmasked, and you gotta go. Road trips require pit stops seemingly every few miles. And for some reason, the millisecond you walk into your front door from work or shopping, you have to make a beeline to the bathroom. That sudden and strong urge to urinate is called urinary urgency — a symptom of urge incontinence or overactive bladder (OAB). It can happen without warning, regardless of how full your bladder is (or isn’t). Urinary urgency can often lead to urinary incontinence, or leakage. Urinary frequency means you’re going to the bathroom often. Urinary urgency and frequency can be frustrating — and when you don’t make it to the toilet on time, embarrassing. You might even feel ashamed to mention it to your healthcare providers. But rest assured, these are symptoms they’ve heard many times before. Urinary problems are common and there are solutions. 

Read on to learn about what causes urinary urgency and frequency, how the connection between your brain and bladder can impact symptoms, and how you can help regain bladder control with lifestyle changes and physical therapy.

Causes of Urinary Urgency and Frequency

Urinary urgency and frequency can be caused by lifestyle habits, underlying health conditions, or physical problems. A common issue can be a urinary tract infection (UTI), which is a bacterial infection of your bladder and urethra. A UTI often occurs with dysuria, or pain, burning, or stinging with urination. But urinary urgency and frequency can also occur without any infection. Often, it’s related to issues with your pelvic floor. Pelvic floor muscles stretch like a hammock between your tailbone and pubic bone, supporting the bladder, bowel, uterus, and vagina. Your bladder sits on top of the pelvic floor, and the two are connected by fascia (connective tissue). When tension builds up in your pelvic muscles, it can pull on the fascia and give your bladder the urge to pee.

Pelvic organ prolapse can sometimes lead to urinary frequency. Urinary symptoms are often unrelated to prolapse. But if your bladder moves down from its usual position and presses into the wall of the vagina (cystocele), it can block the flow of urine through the urethra. This can make it harder to fully empty your bladder and lead to an urge to urinate again soon after “emptying.”  

Symptoms of Urinary Urgency and Frequency

The symptoms of urinary urgency and frequency may seem pretty hard to ignore, but some may be more subtle, or you may not realize that these seemingly “normal” things are actually signs of urinary issues:

• Having a strong and immediate urge to urinate that’s difficult to control

• Needing to pee every more often than normal (such as more than every 2 to 3 hours) 

Urinary urgency and frequency can occur along with other urinary issues, such as:

• Leaking urine 

• Being unable to reach the toilet in time

• Feeling pain or discomfort when passing peeing

The Brain-Bladder Connection

Your brain is in constant communication with the bladder and pelvic floor to coordinate urination. As your bladder fills up, it sends a signal to your brain. When you sit on the toilet, your brain tells your pelvic muscles to relax and your bladder to contract to release urine. But your habits can disrupt that brain-bladder reflex loop. Say you have an hour commute to work every day. Before you get in the car, you always make a “just-in-case” pit stop in the bathroom. If you don’t really have to pee at that moment, this can confuse your brain because it didn’t send your bladder the usual “it’s time to go” signal. To make up for it, your brain might start sending stronger “urge” signals. These intense urges to urinate may not always match up with how full your bladder is.

If you empty your bladder with certain triggers (such as every time you leave the house or as soon as 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. The good news: You can help reset signals between your brain and bladder to better control urges and frequent urination with behavioral techniques, such as urge suppression and bladder retraining.

Urge Suppression: How to Control Your Bladder

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 Kegel exercises, or hold a Kegel for five seconds.

• Take three deep belly breaths.

• Count backward or tell yourself ‘this can wait.’

• Do 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 has been two hours or more since your last bathroom trip. If it has been less than two hours, try to wait even just a few minutes.

If you find that you often have an urge to pee more than every two hours, try bladder retraining.

Bladder Retraining

It's normal to pee about seven times per day, with about two to four hours between trips. If you go more frequently, this technique can help train the muscles that control your bladder to help delay your trips to the bathroom when you get the urge to urinate. Before you start, keep a diary of your bladder activity for a few days to get an accurate sense of how often you go. Here’s how bladder training works:

1. Set your first goal. Using your bladder diary, determine the average time between your bathroom trips. Then add 15 minutes – and that’s your first interval goal. (For example, if you currently pee every 45 minutes, your first goal will be to stretch the time to an hour.)

2. Create a bathroom schedule. Empty your bladder as soon as you wake up in the morning. Starting at that time, calculate your day’s bathroom trips based on your interval goal.

3. Practice urge suppression, when needed. If you feel the urge to pee before your set goal, try urge suppression techniques (above) to help delay your bathroom trip until your next scheduled time. If you can’t hold off, then try waiting just five minutes before you calmly go to the bathroom.

4. Monitor your schedule breaks. If you constantly go to the bathroom before your set time, adjust your bathroom schedule with shorter intervals.

5. Gradually set new goals. Every week or so, increase your interval time until you reach three to four hours between bathroom trips. It takes about six to 12 weeks to retrain your bladder. As you go through the process, remember that setbacks are common and some days may be more challenging than others. Stay the course and you'll reach your goal before you know it.

More Ways to Treat Urinary Urgency and Frequency

Based on the cause and severity of your symptoms, your provider may prescribe medications, or recommend biofeedback therapy, injections, nerve stimulation, or surgery as part of your bladder function treatment plan. There are also strategies and lifestyle habits that can help improve your bladder function and manage urges and frequent urination, such as:

•  Practice mindfulness (including deep breathing exercises or meditation). It can help calm your nervous system, which may decrease feelings of urgency.

•  Limit bladder irritants. If certain foods or drinks increase your symptoms, consider either cutting them from your diet, or reducing your intake.

• Avoid tight-fitting clothing, which can add unnecessary pressure to your pelvic floor muscles and increase urgency.

Physical Therapy for Urinary Urgency and Frequency

When problems with your pelvic floor muscles are causing urinary problems, pelvic floor physical therapists (PTs) can help. To help ease urinary urgency and frequency, pelvic floor physical therapists can recommend a variety of exercises to help both strengthen and relax your pelvic floor muscles. 

It’s important to remember that pelvic floor exercises are not just Kegel exercises, and in some cases, they may make urinary problems worse. A PT can help determine the best exercises for you. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

PT Tip: Knowledge Matters 

“When it comes to treating urinary urgency and frequency, knowledge is power,” says Kandis Daroski, PT, DPT, a Hinge Health pelvic floor physical therapist. “There are so many small adjustments you can make to your diet, lifestyle, and bladder habits that can greatly improve symptoms. A pelvic floor physical therapist can help you make these changes and assess your pelvic floor to set you up with the best exercise plan to reduce your symptoms.”

Learn More About Hinge Health for Pelvic Symptom Relief

If you have pelvic symptoms are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

References

1. Bandyopadhyay, S., Pal, M., & Chowdhury, R. (2021). Urge suppression and modified fluid consumption in the management of female overactive bladder symptoms. Urology Annals, 13(3), 263. doi.org/10.4103/ua.ua_52_20

2. Definition & Facts for Bladder Control Problems (Urinary Incontinence) | NIDDK. (2021, July). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems/definition-facts 

3. How To Retrain Your Bladder To Control Leaks. National Association For Continence. (n.d.). https://www.nafc.org/bladder-retraining

4. 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

5. Wrenn, K. (2012). Dysuria, Frequency, and Urgency. Nih.gov; Butterworths. www.ncbi.nlm.nih.gov/books/NBK291/