Bladder Frequency and Urgency

Do you find yourself running to the bathroom more often than you think you should? Have you always been the person with the “small bladder” that goes to the bathroom three times at a restaurant when your friends don’t go at all? When you have to go pee, is it an urgent urge that makes you uncomfortable to wait?  Do you sometimes not make it to the bathroom on time?

If you experience some or all of these signs, you are not alone and can absolutely improve this. The best news is that the solution is pretty simple!

How is your bladder supposed to work?

Let’s pretend your bladder is your child, your brain is you (the parent) and your child wanting a snack is like your bladder wanting to pee.

We all know that some kids are very chill & relaxed while others can be quite high maintenance (but we still love them!). If your child (aka bladder) is calm and wants a snack (needs to go pee) they will ask “can I please have a snack?” and you (the brain) are able to respond appropriately.

Maybe the answer is “sure, it’s been a while since you have had a snack, absolutely you can have a snack.” Or maybe your answer is “you know what, we just ate lunch and I don’t think you need a snack right now.” If your child/bladder is calm they can usually accept the answer and go on their merry way for a while.

Eventually they’ll feel hungry (need to pee) again, and they will come back to you to ask for a snack again. And once again you can decide if it’s a good time for a snack. If you wait for longer periods the child might get more persistent or ask you more frequently but you are still very much in control of the situation. At the right time, the child gets their snack and everyone is happy.  

This goes very much to the heart of how things are supposed to work: your bladder sends signals to your brain as it’s filling up and it’s up to your brain to decide when is the right time to go pee.

What causes urinary frequency and urgency?

There are many reasons for urinary frequency and urgency. In my experience, the top two factors that we can influence and improve are:

1. Undesirable learned habits

2. Dietary factors

Undesirable Learned Habits

Let’s go back to that example and replace that lovely, polite child with a cranky one. Do cranky children ask for anything nicely or politely? I don’t know about you, but when my children are cranky they are definitely not polite. When cranky children think they need a snack they go “I WANT A SNACK RIGHT NOOOOOOOOOOOW” (even if you happen to be in the middle of the grocery store).

You are then in the precarious position of having to choose between:

1. giving into the tantrum and giving them a snack even though they don’t need a snack, or;

2. telling them “no, you cannot have a snack”.

If you give in, your child learns that tantrum equals guaranteed snack time, leading to more tantrums. If you hold your ground, you get to deal with the potential wrath of said cranky child (for most people, the wrath of a bladder can be in the form of a urine leak, fear of leaking, abdominal discomfort, etc).

This is where the habit starts to form. In general, if you give a kid a snack every single time they ask for a snack they are going to start asking for snacks more often (because snacks are delicious and they are clever little humans). The same applies to your bladder - if you go pee right at the moment you think you have to go and rush immediately to the bathroom, you are reinforcing a bad habit.

Your bladder has a bigger capacity than you think. You can go for hours upon hours at night without going pee. Why do you think you need to go pee before you leave the house when you literally just went pee 15 minutes ago? Did your kidneys magically turned superhuman and filled your bladder up to full capacity in 15 minutes? Probably not! You probably just have a habit of going pee before you leave the house. You might also have a habit of going pee as soon as you get home and maybe that has escalated into you needing to drop your groceries and sprint up the stairs to go pee as soon as you get home even though you didn’t need to pee while at the store.

They’re all learned habits. It’s important before you go pee to ask yourself:

Do I HAVE to go pee or do I just WANT to go pee?

The same way you would ask yourself “do I want a snack or do I need a snack?”. You should be in control of your bladder rather than your bladder controlling you.

I really think of the urge to pee kind of like a hunger cue. Most people do not drop everything they are doing and rush to the kitchen and stuff their faces with food at the first sign of hunger. So why are we sprinting to our bathrooms at the first realization that there is urine in our bladder?

It’s not an emergency, it’s just information. That bladder of yours is sending a friendly neighbourly signal up to your brain that says “FYI, getting kind of full, might want to think about that sometime soon.”

Dietary Factors

To make matters more complicated, you might be making your “child” crankier than it needs to be by eating certain foods and drinks. If your bladder is extra irritated, it’s going to make its presence known a lot louder and more often than you would like.

Foods that may irritate your bladder include:

• Coffee (decaf is better but still not perfect)

• Tea

• Alcohol

• Chocolate

• Carbonated beverages (yes, even plain soda water)

• Artificial sweeteners

• Citrus (oranges, lemons, etc).

• Tomatoes

What can I do about it?

There are several things you can do to take control of your bladder health. Some are fairly self-explanatory like decreasing or moderating your intake of the irritating foods listed above.

One of the main things you can do: drink more water. It’s counter-intuitive, but drinking more water more often than not helps you pee less frequently. I’ll say that one more time for the people in the back:

You can go pee less frequently if you drink more water.

Want to know why? If you are dehydrated, your urine will be very concentrated. Concentrated urine can really irritate the inner lining of the bladder and will want to get rid of that fluid ASAP. Your bladder is much happier to hold a larger amount of dilute fluid rather than a small amount of concentrated or irritating fluid.

There are also cognitive and physical techniques known as urge suppression techniques. They can help you deal with a strong urinary urge, avoid leaking and rushing to the bathroom, and normalize the number of trips you make to the bathroom. These should be taught to you on an individual basis by a doctor or pelvic floor physiotherapist that knows your individual situation and can determine which techniques are best for you.

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Your Takeaway Points!

If you suffer with urinary frequency and urgency, please remember these key points:

• Needing to go pee should not feel like an emergency

• Foods and drinks such as coffee, alcohol, and chocolate can irritate bladders

• A significant amount of urinary frequency and urgency is behavioral and can be modified

• Ask yourself if you have to go pee or you just want to go pee? Is the signal coming from your bladder or your brain?

• Drinking more water can decrease urinary frequency and urgency

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If you would like to know more about these or have an evaluation by one of our pelvic floor physiotherapists please feel free to contact the clinic at 778-630-8800 or clinic@ladnervillagephysio.com to book an appointment.

Meet Sofy!

Our newest orthopaedic and pelvic floor physiotherapist, Sofy was born in Taiwan before moving to Kimberley, BC at a young age. She eventually ventured down to Vancouver to complete her degrees and now calls this beautiful city home. Growing up in the East Kootenays introduced Sofy to many sports and outdoor activities, where she spent most of her time in the mountains or at the golf courses. Besides being a physiotherapist, Sofy is also an artist. She loves oil painting and everything art! 

What is something totally random that people won’t know about you?

I moved to Kimberley because I had terrible eczema and allergies living in Taiwan and Kimberley was the only place that magically made my symptoms disappear (after exploring several countries and cities).

When did you decide you wanted to be a physio? 

I wanted to become a dentist since I was 8 years old. It wasn’t until 3rd year university when I realized that I couldn’t talk to people if I was working inside of their mouths. I love talking and getting to know people as well as learning about how the human body works. After exploring a few different professions, physiotherapy seemed to be the perfect fit!

Which sports are you into? 

Golf, golf, and golf! Tennis in the summer, squash in the winter. Rock climbing, spikeball, and volleyball are pretty fun too. 

Where did you grow up?

Taiwan and Kimberley BC. 

What is your favourite orthopaedic condition to treat?

I like them all! Each body part is fascinating in their own ways in my opinion, hard to pick a favourite. I took a special interest in hands and the upper extremities early on in my career, but now I like to treat everything. 

What makes you happiest? 

Camping on top of a mountain or painting away in my little studio. 

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs

Favourite food? Thai food

Favourite dessert: Tiramisu 

Favourite Junk food: Instant noodles

Beach or mountains: Mountains

Favourite colour: Baby pink

Favourite music: Pop

Favorite day of the week? Sunday

Nickname? Sof, Meng (but I really don’t like it)

Would you rather be able to speak every language in the world or be able to talk to animals? Speak every language

Favorite holiday? Christmas

How long does it take you to get ready? 30 mins

Invisibility or super strength? Invisibility

Is it wrong for a vegetarian to eat animal crackers? No

Dawn or dusk? Dusk

Do you snore? I “breathe loudly” 

Place you most want to travel? Nepal, South America

Last Halloween costume? Cannot remember the last time I dressed up

Favorite number? 3

Have you ever worn socks with sandals? Whenever I’m too lazy to put on shoes

Would you rather cuddle with a baby panda or a baby penguin? Baby panda

Would you want to live forever? No

What's for dinner tonight? Turkey burger with yam fries

Yep, she painted that.

Diastasis Rectus Abdominis 101: All About The "Mummy Tummy"

Abdominal diastasis, diastasis rectus abdominis, diastasis recti, abdominal separation, ab gap, “mummy tummy” ….. it has a lot of names. But whatever you call it, I want you to know a little bit more about it so you can be better equipped to manage it.

What is it an abdominal diastasis?

Diastasis Rectus Abdominis (also known as DRA) is a common occurrence where the linea alba (the line of connective tissue between your six-pack muscles) gets stretched. Note that I said stretched, not torn. Think of pizza dough - stretching the pizza dough is a diastasis, but there are no holes or tears in the pizza dough (which would be a hernia).

DRA most commonly occurs during pregnancy but can also occur in people who have never been pregnant, such as people who lift really heavy weights with poor abdominal engagement and technique.

DRA is considered a normal change in pregnancy!

Your body stretches to accommodate the growing baby and honestly, stretching is kind of the name of the game when it comes to pregnancy. Did you know that uterine capacity increases from 4ml to 4000ml at term and abdominal length increases by an average of 115% at 38 weeks gestation? Can you imagine how uncomfortable pregnancy would be if your stomach didn’t stretch? I can only imagine the heartburn.

So I hope we can all agree that the stretch is a good thing and we are on team stretch - yay for stretch! But unfortunately, as with other body parts faced with a sudden increase and then decrease in size (RIP pre-baby boobs), it is also quite common for that stretch to remain after pregnancy.

How common is DRA?

Way more common than you think! Here’s the research from Mota et al and Sperstad et al showing how common DRA is in pregnancy:

• 33.1% of women at 21 weeks pregnant

• 100% of women at 35 weeks pregnant

• 60% of women at 6 weeks post-partum

• 32% of women at 12 months post-partum

How do I know if I have a diastasis?

There are a few ways to tell! The most obvious sign that people notice is the presence of an abdominal “dome”, “cone” or “triangling” of their stomach when they exercise or during daily activities (like getting up from the couch or straining on the toilet). This is a protrusion or bulge down the center line of your stomach when you attempt to use your muscles without correctly preparing or stabilizing first.

Some common movements which can cause doming are crunches, “V” sits, Russian twists, pull ups and getting up from bed or a reclined position.  This picture is someone with a diastasis doing a double leg lift without any preparation for the movement. Can you see the peak down the middle of her tummy? This is what we are talking about when we say “the dome.”

Avoiding the dome is one of the biggest considerations for proper DRA management.

If you haven’t noticed a dome you may also be able to feel the increased space between your abdominals.

To test yourself for DRA:

• Lie flat on your back and press your fingers into your midline right underneath your sternum.

• Press again a few inches down and keep going all the way down to your pubic bone.

• When you press you might feel that some places feel firm and springy while in other places your fingers might sink in deeper. This could indicate an area that has stretched.

• You can confirm this with a head lift test: with your fingers in the soft spot do a mini crunch and lift your head and shoulders off the ground, does the soft spot narrow? If it does that is another indication that you likely have a diastasis (the narrowing is a good thing, don’t let it freak you out!).

Need a visual? Check out this youtube video for a guide to assessing your own DRA.

Still not sure if you have a DRA? A pelvic floor physio, midwife or OB could also tell you right away if you have a diastasis and give you further direction.

Is it my fault?

This is a question I hear a lot and the answer is usually a resounding NO. Women often say to me “maybe if I didn’t gain so much weight” or “maybe if I was younger then my gap wouldn’t be so big” but according to the research this simply isn’t true.

According to a wide body of research, here is a list of things that are NOT risk factors for DRA:

• Age 

• Ethnicity

• Height 

• Pre-pregnancy weight

• Duration of labour  

• Method of delivery

• Weight gain during pregnancy 

• Baby weight at birth

• Gestational age 

• Exercise training before, during and after pregnancy

• BMI before pregnancy or at 6 months postpartum

Some things that we think might contribute to a diastasis are:

• Having multiple pregnancies close together

• Being pregnant with multiples

• Heavy lifting using a Valsalva technique

• Genetics

Will it go away?

While some natural recovery can occur in the first 8 weeks postpartum a large number of women will still have a DRA and need to learn how to properly manage it going forwards.

How do I manage my DRA?

Management will include learning proper movement and abdominal techniques so you can exercise without worsening your diastasis. You will need to avoid the dome. I know I mentioned that earlier but it needs to be repeated.

Exercises and movements which cause a dome will need to be modified until you are strong enough to maintain control throughout the entire movement.

Take a look at the pictures on the right hand side. You can see the doming in the DRA in the top picture. Through proper technique, this doming can be controlled - this is demonstrated in the bottom picture. This person has properly activated the rest of her abdomen and is in control of the movement. Can you see how her stomach remains flat even when she lifts her legs?

(For what its worth, this lady deserves a lot of credit because that move is really hard to do properly and I’m sure it took some time and practice to get to this level!)  

The most important thing to remember:

AVOID THE DOME. Say no to the dome. You are now a dome-free zone.

A pelvic floor physiotherapist will be able to assess your abdominal diastasis, teach you correct abdominal control techniques, give you exercises to increase your abdominal strength and endurance, and help you transition back to your preferred type of exercise.

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If you suspect you have an abdominal diastasis and want to investigate further, please feel free to book with Nicole at Ladner Village Physiotherapy by booking online or calling us at (778) 630-8800. She will be happy to help!

What Is A Pessary?

Nicole Coffey is our resident pelvic health guru and expert on all things related. Read as Nicole answers a Q& A about what exactly a pessary is and who could benefit from one.

What is a pessary? I get this question a lot.

A pessary is an internal vaginal support device typically made of medical grade silicone. They are generally used by women who experience bothersome symptoms from prolapse (when one or more of the abdominal organs including the bladder, uterus or rectum descend and decrease the space within the vaginal canal - find more information in my earlier blogs Part 1: What is Prolapse? and Part 2: I Have A Prolapse! Now What?). This can lead to symptoms such as vaginal heaviness, pressure, a sensation that something is “up there”, or noticing tissue protruding from your body. There might also be bladder and bowel symptoms such as incomplete emptying. Pessaries can also be used to treat urinary stress incontinence, which is accidental urine leakage with activities such as coughing, sneezing, jumping, running, and so on. The pessary acts like an internal shelf to hold the organs up, keeping them away from the entrance of the vagina.

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Typical Pelvic Floor Anatomy

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Uterine Prolapse

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Inserted Pessary

For some people, surgery is an option. For people who do not want to have surgery or who are not surgical candidates, a pessary can be a fantastic option for treatment. (For the record, pelvic floor exercises are also awesome and can help as well, but we are talking about pessaries today).  

So what holds people back? Pessaries can be intimidating. But have no fear, I am here to show you that they aren’t so bad after all!

Take a look at the most common questions I get about pessaries:

1.       Do they hurt?

No! The best thing about a pessary is when it is inserted you can’t feel the pessary and you can’t feel your prolapse! This is why they are so magical. Some women who have a history of vaginal pain (such as pain with intercourse and tampon use) might have discomfort while inserting and removing the pessary. Other women report an initial discomfort when inserting and removing the pessary until they get the hang of it but the majority of users report no pain.  If you do feel pain when inserting and removing the pessary and you are post-menopausal you might benefit from vaginal estrogen cream (this is an excellent conversation to have with your doctor).

2.       Are they hard to get in and out?

Not really. Some styles are trickier than others and require a little bit of skill, but with a little bit of practice you will be a pro at managing your pessary.

3.       When do I wear it?

This is mostly up to you. Some women only wear their pessaries during high intensity exercise. Some women insert it every morning and remove it every night. Others wear theirs for 3-5 days at a time. If a gynaecologist fits you with a pessary there is an option to wear it for longer periods (up to 3 months at a time), but this again is a conversation to have with your specialist.

4.       Can I have intercourse when I am wearing my pessary?

Usually no. There are some types (ring pessaries) that would allow for penetrative vaginal intercourse, but the majority of pessaries need to be removed for intercourse.

5.       How soon after having my baby can I be fit with a pessary?

I personally do not fit people with pessaries before 12 weeks post-partum because your body is still healing and changing. I also do not fit people who are currently pregnant. Again, if you see a gynaecologist they will be able to work with you in these situations as needed.

6.       I don’t have prolapse but I leak urine, can I still use a pessary?

If you leak urine due to stress incontinence (coughing, running, jumping, etc.), a pessary absolutely can help. It will probably just be a slightly different type and you likely will only have to wear it at times that you leak such as while at the gym. A pessary will not help with urge incontinence (leaking due to a very sudden and strong urge to pee).

7.       How do I know what size and type I need?

This one is unfortunately a little tricky. Fitting a pessary is a combination of experience, art, and some trial and error. During your appointment I discuss with you which type of pessary I think would be best for you to try first and why. Then we proceed to try a few different sizes and shapes as needed until the perfect one is found. Sometimes this happens right away and sometimes it takes a few tries. It might take more than one appointment but it is worth it in the end to have a pessary that fits properly.

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If you have any further questions about pessaries or would like to book a pessary fitting, book online, send us an email at clinic@ladnervillagephysio.com or give us a call at (778) 630-8800.