Urinary Urgency, Frequency, and Incontinence– What’s New in Research?

I’m sort of nerdy (you already knew that though, didn’t you!)… so periodically, I like to go to my favorite medical search engines to find what is new in the literature regarding all things pelvic health. This helps me to keep aware of new treatments that are available, and helps me to constantly re-evaluate the treatments I provide for patients to make sure I am providing the best treatment I can!

Urinary urgency/frequency, urge incontinence, and overactive bladder problems are often not as frequently discussed in physical therapy circles as stress incontinence. Surprisingly, pelvic PTs actually treat these problems equally as often, if not more! A comprehensive PT program can be extremely effective for these types of problems! (So, if you are having urinary urgency, frequency or overactive bladder problems, and you live near Atlanta, give me a call! :))

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So, what’s new in the research to help with overactive bladder problems and urge-related incontinence?  

  1. Myofascial release techniques can be very helpful for patients with urinary urgency and frequency. I was pretty excited to see this study come out in the Journal of Female Pelvic Medicine and Reconstructive Surgery. Pelvic PTs have noticed for quite a while that many men and women with urinary urgency  and frequency actually tend to have hypervigilant overactive pelvic floor muscles rather than the traditional weak and stretched out muscles people like to think they have. Manual therapy, included within a comprehensive rehabilitation approach, can be very effective for helping this population, and I’m excited to see a recent study supporting the same thing!
  2. Mindfulness-based stress reduction (MBSR) seems promising in helping to reduce symptoms of overactive bladder and urge incontinence.    I didn’t find this surprising at all, but was again, excited to see this coming out in the literature. If you see in my first note above, many people with urinary urgency and frequency actually have a “hypervigilant” or “overactive” pelvic floor muscles. Stress reduction and mindfulness techniques help to calm the whole body–pelvic floor included! Along with this, we often find that people with urgency/frequency problems tend to live in a more sympathetic nervous system dominated state (basically, the “fight or flight” response is in overdrive!). Calming this system can be very helpful in calming the bladder.
  3. Pelvic floor muscle training continues to be recommended as a first line treatment for stress, urge or mixed incontinence.  It’s true, the most updated Cochrane Review published in 2014 continued to recommend pelvic floor muscle training to assist in improving all bladder symptoms. Their review showed close to a 55% cure rate–which is pretty good, considering this was just retraining the muscles in isolation. Imagine what could happen when the right retraining of the pelvic floor muscle is combined with behavioral retraining, dietary training and retraining the pelvic floor within the body as a whole? I bet the results would be much much better.
  4. Percutaneous tibial nerve stimulation may help to reduce urinary frequency and urge-related incontinence. This started becoming popular a few years ago, and honestly, there needs to be more higher quality studies in order for us to really see how effective this treatment is or isn’t. But, that being said, some of the initial results seem promising. If you are not familiar with this technique, it utilizes a very thin needle which is placed near the ankle to stimulate the posterior tibial nerve with a low electrical current. The thought is that this nerve comes from the same level in the spinal cord that the nerves to the bladder originate, so stimulation could possibly help modulate an overactive bladder. (Similar concept to the Interstim treatment which stimulates at the sacral nerves, but less invasive) Looking forward to what the research shows on this treatment in the future!
  5. Losing weight can help improve bladder symptoms.  This is true for both urge related incontinence and stress incontinence (although, seems to help stress incontinence a bit more). In this particular study, 46% of the participants in the weight loss program achieved more than a 70% reduction in their incontinence symptoms. So, if you are overweight or obese, beginning a weight loss program may be a great first step toward improving your bladder function.

The great news is that we continue to learn more and advance in our understanding of helping men and women with these problems every day! What new research have you seen that is promising? As always, I’d love to hear from you!

**Note: I didn’t include medication in this list… not because I don’t think it’s effective or that the research is exciting, it really is! Mostly, because this is where my search took me this time around. The right medication can be a significant helper to many people having these problems– perhaps a future blog can talk about that! 🙂 

 

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3 responses to “Urinary Urgency, Frequency, and Incontinence– What’s New in Research?

  1. Love it!!!

    Best Regards,

    Andrew Reale

    Andrew Reale
    Senior Development Director
    Atlanta Area Council, BSA
    B 770.956.3182 | C 404.374.7641
    http://www.atlantabsa.org
    Andrew Reale Linkedin Profile

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  2. What about urinary retention? Your site discusses all things urinary except for retention. Do you believe PT can cure urinary retention? If so, how? More specifically, how does PT relate to urinary retention? Is there a specific muscle or nerve involved?

    Do you have personal experience in treating urinary retention? If so, have you been successful with it?

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    • Hi Laura,
      You’re right, I haven’t discussed urinary retention or voiding dysfunction in detail on the blog yet–there are SO many pelvic floor related topics, and I honestly feel like my posts thus far have just started to scratch the surface! Thankfully, that means, lots of writing material for years to come!

      In regards to retention and voiding dysfunction (meaning, a problem with the emptying phase of urinary function), success in physical therapy depends on the reason for the problem. I have treated many people with problems varying from mild difficulty with urination (slow stream, slow start) to retention requiring catheterization. Some people can have tender, tight, or overactive pelvic floor muscles which make it difficult to empty the bladder–and in those cases, PT can be very successful. Improving habits related to urinary health can also be an important aspect of care. On the other hand, if someone has neurological urinary retention (like can occur with certain neurological disorders), there are still some interventions we can try (electrical stimulation, trying to get muscles firing in the best pattern, behavioral training), but I tend to find less success.

      I hope that is helpful! Please feel free to e-mail or message me privately if you have any additional questions!

      ~ Jessica

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