I Heart Overactive Bladder

I recently went to a talk about overactive bladder.  It left me the opposite of speechless.  It left me speechfull.  (This, I write, on the tail end of a conversation in which I told someone that my boss likes “persistency”.  30 seconds later, I am informed that that is not a word, however, the point went across and now you can call me Saraspeare.)

Full of speech I am.  For in this talk of the bladder that is fulleth, I have resigned mine own self to the awareness that the measures I employ to empty thy bladder are most assuredly unbeknownst to much of the bleeders of this land.*

*(I have a lot to say because apparently many doctors don’t understand how physical therapy can treat overactive bladder.)

Overactive bladder can be part of someone’s pain experience, or it can stand alone.  Either way, it’s unbecoming and annoying.  It can threaten your sleep and your love life and your ability to watch The Bachelor.  That is why I love to treat this: it changes your quality of life.

From this talk, albeit only a snapshot – or even just a few physicians’ thoughts, really – it appears that we don’t actually define “overactive bladder”.  It’s just the need to pee a lot.  So, in this hazy description, we’ve created a world of options that I view as overtreatment.  You can get your bladder Botox’d.  You can get on a variety of antibiotics for infections you do or do not have.  You can get instillations or bladder distentions – all uncomfortable and invasive.  But, what this talk didn’t want to talk about was physical therapy.

I love to treat overactive bladder because not only does it return my patients’ quality of life, it also saves them money.  In a few treatments, a patient has the potential to get off of prescription medication.  I initially wrote “In a few treatments I can get patients off prescription medication”, but then I thought that might sound conceited.  However, it’s not actually conceited because when I say “I can do this”, I mean that “I, as a physical therapist, can do this” and so can other physical therapists.

There are many things I consider, and here are two:

  •  Calming the urge.  Tell it to “sit down!”.  The most superficial layer of fascia, the pannicular layer, can be a culprit for a lot of weird things, including inappropriate urinary urge.  The urinary urge is inappropriate when it’s signaling you to pee when your bladder isn’t full.  The appropriate time for your bladder to signal that you need to pee is when it is full.  Otherwise, it is just being a nuisance…so we need to shut it up.  We can do this by chilling out the superficial fascial layer of any areas of binding/tightness/restriction/tenderness/parts that don’t want to move, etc.  These bladder talky talky parts are typically going to be located between the ribs and the knees – like the abdomen, bony pelvis, inner thighs, among others.  After just one treatment I truly expect a change.  I don’t tell my patient that – I don’t want them lying to me because they think I’ll be disappointed otherwise.  In fact, I usually start most assessments with “No humoring me – are you better or worse or the same?  Don’t lie to me.”  I kid you not.  Ask any of my patients.
  • Retraining the bladder.  So, there are these things called “mechanoreceptors” in the lining of the bladder.  They are like scales measuring weight.  Imagine that if urine is filling the bladder, then at a certain point, there will be enough urine in the bladder to place pressure on the sides of the bladder, essentially pressing on these scales.  Once a certain amount of pressure is placed on these scales, then they alert the brain that it’s time to pee.  However, if you give in to each and every silly willy bladder urge, then these scales re-calibrate.  They receive less pressure and think it’s time to tell the brain that the body needs to pee.  That is annoying.  That is disturbing.  No one wants to deal with that.  That’s why we re-train the bladder.  We give small, achievable goals in trying to get the bladder scales to re-calibrate.  And they do.  They have to.  That’s how the body works.  And then you get off your medications, save some extra money and go on a cruise and buy three shot glasses and give one to your neighbors, one to your niece and keep one for yourself.  Done.

There are tons of options for overactive bladder, so you don’t have to resign yourself to taking a pill or putting a catheter up your own urethra.  Likely, your doctor isn’t going to offer you the option of physical therapy because they likely don’t know that we treat this.  Hell, even some physical therapists don’t know we treat this.  But we do.  Damn it.  We do.


If you have any questions or comments, please leave them anonymously in the comment section below or email me at [email protected]  Please email me if you would like to be added to the Alcove Education email list.

7 thoughts on “I Heart Overactive Bladder”

  1. Great speech! Bravo. Yes, we as PTs need to educate our doctors much better in what we can do. I too find that doctors, nurse practitioners , physician’s assistants do no know how PT can help patients with bladder, bowel and sexual dysfunction. Your blog is a great education tool!

  2. Hi Sara,

    Firstly i would like to thank you for creating such an informative and compassionate blog for both chronic pelvic pain and pelvic dysfunction sufferers and therapists. As a 38 year old man who has been suffering this life changing illness for 4 months your blog is comforting and hope-inspiring.

    There are many excellent posts of yours i found enlightening and i would like to ask you questions about at a later date if you dont mind. I will post on the related posts i have queries about.

    With regards to OAB, this was a severe symptom for me initially (urge to urinates about 30 times a day, and up multiple times in the night, with hesitant and weak urine stream and sense of not completely voiding).
    Thankfully after 6 specialist physio sessions, a careful diet, and a few supplements that i have found effective, i have reduced this particular issue to almost ‘normal’ levels – i.e i can comfortably go for 3 + hours without needing to urinate, and lately i have been able to sleep through almost the entire night without getting up once. However, i do still have one annoying urinary symptom – for a number of hours after a bowel movement i keep getting the urge to urinate, yet have difficulty doing so ‘productively’ (i.e. not much urine expelled, with a sense of incomplete voiding. After a few hours, this subsides and my bladder habits return to a relatively normal state. Is this something you have heard of with chronic pelvic pain and pelvic floor dysfunction? Do you have any ideas on what specific treatment might alleviate it?

  3. I have had OAB for three years. Along with this I have uti’s that mimic some of the same symptoms. I have been on Myerbertiq for 3 months. It seems to be working but then I get spasms and feel the urge to empty my bladder. My area throbs and is achy often. I am miserable! I want what you are offering.

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