Feeling like you have to go to the bathroom all the time? Waking up at night multiple times? Social situations have you worried? Always thinking of where the bathroom is and IF there is one when you go out? Keep on reading.

The “normal” amount of times to urinate per day is 5-8 times, and this obviously changes if fluid intake is increased or decreased, including any diuretics such as alcohol and caffeine. However, the important part is more likely if you feel uncomfortable holding your bladder or feel you have to go so many times that it is affecting your day to day living or social and work life.

The first thing to know is that your brain plays an important role in controlling your bladder AND we can retrain the brain. The more you go to the bathroom, the more your brain thinks you have to go to the bathroom and it can become a habit. To retrain this habit, do the following:

1. When you get urgency, try doing belly breathing, focus on slowing down your breath

2. Walk slowly to the bathroom (no rushing allowed!) and change your clothes slowly before sitting down

3. Once doing the above a few times, work on delaying before you go to the bathroom - this could be as short as a few seconds. Over time, increase the time you delay before going to the bathroom. For some people, the urgency fades away and they wonder if they actually had to go in the first place!

4. You can also try distracting yourself by counting backwards from 100, or busying yourself with housework so your brain has something else to think of. Or you can focus on the breathing for a few minutes as you delay.

Over time, you will train your brain to not send signals to go to the bathroom which will also help the bladder properly relay to you when it actually is full so you know it was a time when you really did need to go and empty.

Practice this at home first and then in public, especially if you feel you will urinate yourself if you don’t rush to the bathroom. Most often, even if there is leakage initially, it should resolve if you continue to work away on the above strategies. If your urgency resolves but leakage remains, you may experience mixed urinary incontinence or urge incontinence, which is explained in a later article.

If you try these techniques and are still experiencing bladder urgency, book in with a Pelvic Floor Physiotherapist who can help you assess and treat exactly what is going on.

Pushing and straining to get it out? Sitting on the toilet for what seems like hours? Here are some tips to help deal with chronic constipation from the point of view of pelvic floor physiotherapy. You have probably already been told a thousand times to eat more fiber and, don’t worry, this post is not about that.

The pelvic floor muscles act as a sling, supporting the bowel, bladder, and uterus. In the first blog post, we went over what is normally supposed to happen with a bowel movement. In this article, we provide you with tips to help with chronic constipation (given that it may be coming from pelvic floor muscles and not stomach/digestion issues!).

1. NO STRAINING BUT DO BREATHE, PLEASE

Wait...what? Aren't we supposed to push with bowel movements? Excessive straining can lead to hemorrhoids, prolapse, and pelvic muscle dysfunction. Instead, practice doing long belly inhales and exhales, focusing on relaxing and letting go the pelvic floor muscles.

2. USING A STOOL

These days, toilet seats have been going higher and higher, for comfort. Especially with the population in the mid 50s to elderly having more knee and hip replacements, this makes complete sense. However, the pelvic muscles are more relaxed if you are in a squat position versus standing (pretty hard to poop in standing!). So, using a stool under your feet can help with relaxation of the muscles, so you have to work less hard at getting that bowel movement out. 

Note: Use a stool that can accommodate your feet a few inches apart and brings your knees slightly higher than your hips - see above picture.

3. POSITIONING

For some, the toilet seat is low and using a stool can make you feel like you are sitting in a budget airline flight, with your knees up against your chest. In this case, chuck the stool and just lean forward so your forearms are on your thighs.

4. DO BOTH

Or...you can do both. As in, use a stool AND lean forward, only if this feels comfortable. For some, this can be the best position to relax in.

If you try the above and your constipation is not improving, seek out the help of a Pelvic Floor Physiotherapist to assess the muscles and give you appropriate exercises. 

Tight, overactive, or hypertonic pelvic floor muscles may be the cause of various pelvic floor concerns such as painful sex, urinary and bowel urgency, frequency, constipation, urinary and bowel retention, and pelvic pain. Tight muscles may also contribute to bladder leakages. In clinic, we have seen clients with overactive muscles not being able to kegel (because they are in a constant state of “kegel-ing”) and when a cough or sneeze comes, the pelvic muscles let go instead.

Achieving a state where the pelvic floor muscles are able to coordinate being tight with relaxation is the first step in treating many of the above symptoms. The following tools may be discussed and prescribed by your Pelvic Floor Physiotherapist depending on the assessment findings.

Breathing

The diaphragm is a large muscles underneath the ribcage that helps us breathe deep into the belly and also works with the pelvic floor in a sump-pump fashion. As it moves down when we inhale, the pelvic floor also moves down and they both move up on the exhale. Using the breath to connect with the pelvic floor during the day and in different stretches can help alleviate symptoms.

Dilators or Pelvic Wand

Depending on your needs, manual therapy and release may be performed by your Physiotherapist or prescribed to you as homework at home. Both dilators and wands are useful in different ways to help stretch and massage muscles internally. Please follow your therapist’s instructions carefully on how to use these tools. To find out more about the pelvic wand, click here.

Stretches

Along with breathing, yoga and stretching can help retrain the pelvic floor muscles. Commonly prescribed stretches may include child’s pose, cobbler’s pose and happy baby. When stretching, you should not have any other aches or pains. This is a sign to stop the stretch and consult with your healthcare provider to ensure you are dong them correctly.

Consult with your Family Physician or Gynaecologist/Specialist

Sometimes tightness in muscles can be a sign of tissue atrophy, degeneration, lichens sclerosis, or be due to another condition or menopause. Your physician may prescribe additional testing or a topical cream or hormonal solution to help the tissues which may complement the above prescribed therapies.

It is best to work both with your Physiotherapist and Physician to find the solutions you need for a health pelvic floor. Never be afraid to ask questions and continue to ask questions from different providers until you get the help you need. We are here for you.

Questions? Please comment below, email us at hello@kaaiaa.co, or book a free phone consult.