When you’ve got to get to the toilet RIGHT NOW

Bladder urgency and frequency is a common problem. Sometimes it’s paired with urinary incontinence but often it’s just that feeling of ‘I’ve got to go right now!’. Women will often report that they are going to the toilet ten or more times per day and often they see that as being just a normal thing that happens and they’re completely unaware that with a few strategies they can regain control of their bladder.

I liken an urgent bladder to a 2 year old child- provide it with no discipline or direction and you will have a naughty bladder that screams at you that it wants to go to the toilet now, absolutely can’t wait and isn’t taking no for an answer. We just need to implement some basic discipline and it will begin to behave.

So exactly how do I look after my bladder you say?

Somebody about a hundred years ago came up with the ‘fact’ that we need to consume  2 litres of water to be healthy and health professionals have been spouting that ever since. Humans consume an awfully big range of fluids each day and your needs will vary depending on your body size, activity levels, how hot it is where you live, etc . There isn’t a perfect amount of water you need to drink each day. Studies have shown that we stay hydrated and cell function continues within large ranges of fluid intake. A good rule is to have a look at your wee and if it’s got anything more than a light straw colour or an odour you should probably take a bit more in. If it’s completely clear then it might be time to lay off the fluids for a little while. Don’t forget than any kind of fluid is fluid- it can enter your body via watery foods, cups of tea or coffee, juice or herbal tea. Just be mindful that some bladders are sensitive to too much caffeine, alcohol or certain foods such as chilli or artificial sweeteners. The take home message: sip regularly throughout the day, avoid too much caffeine or other irritants and monitor the colour of your wee!

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Another common problem is people going ‘just in case’. When we leave the house, before a road trip, before we leave for the shops it seems commonplace that even though our bladder isn’t making a squeak of noise we think it’s probably best we empty it lest it gets full when we’re in a public place. Now I see the logic because some of us are not so fond of a public toilets but if we tell our bladder that at half capacity all the time it needs to be emptied it gets used to that and so each time it gets half full it starts telling you that it’s time to go. And so begins the cycle of the reduced bladder capacity. Maybe it started when you were a little kid and Mum wanted everyone to go before you left the house so you weren’t stranded by the side of the road. The good news is it’s not too late- before you catch yourself going just because stop and think ‘no I’ll just wait’.

Some women experience triggers, such as the key in the lock when they first get home or running their hands under the cold tape. Over time when we respond to these triggers by going to the toilet we are strengthening the idea that our bladder/brain has that each time we get the key out it’s time to go to the toilet. Avoid responding to triggers and wait until the urgency has subsided before you rush off. You might find you don’t need to go to the toilet just yet.

If you’ve got a bladder that takes you to the toilet more than 8 times a day, more than once at night, if it yells at you that it’s got to go right now and makes you rush or if you’re not making it in time it might be time for a trip down to your local women’s health physiotherapist to work out some of the particulars. Women’s health physiotherapists can help you with retraining your pelvic floor to hang on to your bladder for longer, strategies for calming your bladder down and provide individualised assessment and treatment of your bladder concerns.

Don’t get caught out ever again- get back to doing the things you love and don’t let your bladder rule your life!

 

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Welcome!

Welcome to Amy Lamb Physiotherapy where I talk about all things physiotherapy related from before birth and beyond. If you’re a new mum; somebody keen to get back to exercise after birth or injury; or a physiotherapist or personal trainer with an enquiring mind then this site is for you. I enjoy working with both women and men in managing incontinence; pelvic organ prolapse; sexual dysfunction and pelvic pain; return to exercise post injury, surgery or birth; and lots more. Let’s do this thing and learn some things.IMG_4932

Vaginal Laser! What’s that?

Patients keep filtering through the clinic each week telling me they’ve seen an advertisement somewhere for ‘vaginal rejuvenation therapies’ offering them the world without having to do a single pelvic floor exercise or change a single thing about their life. I did a bit of hunting and found that a number of local clinics were offering various types of vaginal laser, claiming to be able to firm and tone the tissues, tighten the vagina and even cure incontinence. Great. Wonderful. Somebody has come up with a solution to all of the issues that walk through my door, I can go on a holiday!

Anybody that walks through my clinic door has their own individual set of concerns which require individualised assessment and treatment. I regularly treat anything from vaginal laxity, incontinence, pelvic organ prolapse or pelvic pain and every single time the solutions are multi-faceted. This means that patients walk away with a set of goals to work towards which involve personal effort; forming new habits or behaviours; and lifestyle changes. If there was a magic pill believe me I wouldn’t be sitting here asking you to make all these changes. I’d be marching you off to the doctors office office for a magic pill prescription.

monalisa touch

Generally in physiotherapy we pride ourselves on being an evidence-based profession. One that strives to constantly prove, through high quality clinical research, that what we do works. Despite the claims being thrown around and some very convincing testimonials from satisfied patients if you go back and sift through the research around vaginal rejuvenation therapies there are currently no high quality randomised controlled clinical trials to prove that these vaginal dovalackies actually work. However, there are some currently being conducted. So let’s watch that space with baited breath in case the magic pill works shall we!

I will hold off on making a final decision for after I’ve either seen enough patients who come back cured or until I’ve read some good quality research stating unequivocably that it works. On the other hand there is level 1a evidence (the best you can get) recommending that pelvic floor muscle training be offered, as first line therapy, to all women with stress, urge or mixed urinary incontinence (Abrams et al ICI 2009, 2013). There was a good study by Braekken et al in 2010 which demonstrates that pelvic floor muscle training can both reverse pelvic organ prolapse and most importantly reduce prolapse symptoms. Also, a number of studies have been conducted which show that female sexual function improves with regular pelvic floor exercise (Zahariou et al, 2008). So let’s not throw the baby out with the bath water and give up on your trusted pelvic health physiotherapist just yet.

vaginal tightening

All vaginal rejuvenators do not come in the same shape and size- broadly there is vaginal laser and vaginal thermal rejuvenation. At a recent in-service at our monthly women’s health journal club by the very knowledgeable and experienced women’s health physiotherapist Rachael Boniface of Nurture Family Allied Health Centre (where I am lucky enough work) I learnt the difference.

Vaginal laser is a mildly ablative type therapy which can be a little painful. It comes under the brand name Mona Lisa Touch and at least three treatments are recommended to cure you of vaginal laxity, vulvovaginal atrophy, stress incontinence, overactive bladder, etc. The other kind which sounds more appealing is the radiofrequency based energy devices going by the brand name Thermiva which claims to increase blood flow through to the vaginal tissues with only a light feeling of warmth. The thermiva is cheaper and I prefer the idea of using warmth and radiowaves to increase blood flow than having my vaginal tissues ablated (ouch).

I’ll keep my mind open about whether these therapies might be useful in our patients but as per physiotherapy protocols I will wait until there is some good quality evidence before I start suggesting that women should be accessing these therapies. thermiva2