What is an overactive bladder?

An overactive bladder is a common syndrome that affects millions of women worldwide. This is characterized by the compelling need to urinate with or without involuntary leakage of, urinating more often than what one is accustomed to, and waking up to urinate two or more times in a night without any obvious pathological cause.

Usually more commonly seen in the elderly, studies have seen that the prevalence in women in the general population ranges from 9 to 43%.(1) The huge discrepancy in prevalence lends credence to the underreporting in studies due to the embarrassing nature of the symptoms.

 

Why does an overactive bladder happen?

The problem lies in what is called the detrusor muscle, which is wrapped around the bladder, and allows the bladder to expand and contracts the bladder to release the contents. When sensors in the bladder feel the bladder expanding, it tells the brain that the bladder is filling with urine, which creates the urge to urinate.

Normally, the bladder allows the release of urine at the appropriate time. An overactive bladder results primarily from involuntary contractions of the detrusor muscle, despite not enough urine to expand the bladder.(2) With the of loss of control of detrusor activity, urination happens at inopportune times.

overactive bladder

 

How to treat an overactive bladder?

With the right treatment, the symptoms can be significantly reduced. Treatment involves testing for and curing the possible primary cause, behavioural therapy, and pharmacotherapy. As is usually the case, in the absence of a causative condition, behavioral therapy and/or lifestyle changes are primary options for treatment.(3,4) Behavioural therapy includes pelvic floor physical therapy, which revolves around Kegel exercises to strengthen the pelvic floor.

Nonpharmacologic treatment requires education, pelvic floor training, and commitment but studies have shown that pelvic floor physical therapy and drug therapy have similar long-term outcomes in women.(5) Non-pharmacological treatment can be combined with drug therapy, if necessary, and are non-invasive and do not suffer from possible side effects that come with taking medicines. Thus, Kegel exercises offer a non-invasive, safe, and effective way to treat the symptoms of an overactive bladder.

 

What are the best pelvic floor exercises to treat overactive bladder?

As with regular muscle training, pelvic floor muscles should be developed for strength, stamina, and coordination. Speed of muscle contraction plays into strength, as seen in fast twitch muscles, and endurance, as seen in slow twitch muscles.(6) It is vital that the pelvic floor muscles are able to contract for long periods of time, thus the focus on slow movements, and slow twitch muscle fibers. In a nutshell, the best pelvic floor exercises to treat overactive bladder are the exercises that will focus on the slow twitch muscle fibers of the pelvic floor.

 

How to train slow twitch muscle fibers of the pelvic floor?

If properly done, exercises of the pelvic floor focus on slow twitch fibers, muscle strands that produce less power and strength but can maintain activity for longer periods of time. Pelvic floor muscle training has been seen to lessen the symptoms of an overactive bladder and increase the quality of life of women.(8) It is therefore vital that proper training and monitoring of the pelvic floor be done by those with an overactive bladder to mitigate symptoms.

Perifit has a training program that is designed to treat overactive bladder and focuses on slow twitch muscles for developing stamina. Overloading (doing more work than usual) the pelvic floor muscles through increased hold contractions is necessary to ensure training effectivity.(9)

It must be stated that for effective and safe training for an overactive bladder, holding contractions should not go beyond the time indicated in the training regimen, to not induce over fatigue. The information and training regimen found in Perifit can also be shown to physicians as part of the treatment plan.

 

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References:

1 Corcos, J., Przydacz, M., Campeau, L., Witten, J., Hickling, D., Honeine, C., . . . Wagg, A. (2017). CUA guideline on adult overactive bladder. In Can Urol Assoc J (Vol. 11, pp. E142-173)

2 Srikrishna S, Robinson D, Cardozo L, Vella M. Management of overactive bladder syndrome.  Postgraduate medical journal. 832007. p. 481-6.

3 Wolz-Beck, M., Reisenauer, C., Kolenic, G. E., Hahn, S., Brucker, S. Y., & Huebner, M. (2017). Physiotherapy and behavior therapy for the treatment of overactive bladder syndrome: a prospective cohort study. Arch Gynecol Obstet, 295(5), 1211-1217. doi:10.1007/s00404-017-4357-1

4 Barkin, J., Habert, J., Wong, A., & Lee, L. Y. T. (2017). The practical update for family physicians in the diagnosis and management of overactive bladder and lower urinary tract symptoms. Can J Urol, 24(5s1), 1-11.

5 Azuri, J., Kafri, R., Ziv-Baran, T., & Stav, K. (2017). Outcomes of different protocols of pelvic floor physical therapy and anti-cholinergics in women with wet over-active bladder: A 4-year follow-up. Neurourol Urodyn, 36(3), 755-758. doi:10.1002/nau.23016

6 Powers S, Howley E. Exercise Physiology: Theory and application to fitness and performance. 6th ed. New York, NY: McGraw Hill; 2007.

7 Kegel exercises: A how-to guide for women. (2018). Retrieved from https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/kegel-exercises/art-20045283

8 Fitz, F., Sartori, M., Girao, M. J., & Castro, R. (2017). Pelvic floor muscle training for overactive bladder symptoms - A prospective study. Rev Assoc Med Bras (1992), 63(12), 1032-1038. doi:10.1590/1806-9282.63.12.1032

9 Powers S, Howley E. Exercise Physiology: Theory and application to fitness and performance. 6th ed. New York, NY: McGraw Hill; 2007.