There are many different things that can happen to the bladder. No matter what it is, know that physiotherapy can help.

Types of bladder dysfunction

• Increased urinary urgency (strong desire to void)

• Increased urinary frequency during the day, and/or overnight (nocturia)

• Involuntary leakage of urine associated with movement/effort (such as a cough, or jumping). See stress urinary incontinence.

• Involuntary leakage of urine associated with an urge or desire to empty the bladder

• Bladder pain

Causes of bladder dysfunction

Why your bladder habits have changed can be complicated and it is important to comprehensively assess the body to understand individual symptoms.

• Muscles: The continence mechanism is reliant on the normal function of several muscles. This includes the pelvic floor muscles, the urethral sphincter muscles (muscles around the outlet tube from the bladder), and the detrusor muscle (the muscle around the bladder, which when it contracts will empty your bladder) . See illustration.

• Nerves: Bladder function depends on messages we receive from nerves. When this system isn’t working well there can have ramifications for the bladder.

• Hormones: Oestrogen levels in particular influences continence and bladder function.

• Dietary irritants in drinks and foods such as coffee and carbonated drinks

• Constipation

• Mechanical changes such as prolapse of one or more pelvic organs

• Loading patterns in the way we move, breathe, and how we empty our bladder and bowel

How is it assessed

• Subjective questioning: We will ask you detailed questions about your bladder and bowel habits. We may require you to complete a bladder diary to look at these patterns in more depth.

• Realtime Ultrasound: We can look at your bladder using both the transabdominal and transperineal ultrasound. This is very useful to see bladder volumes, as well picking up structural changes such as with prolapse.

• Internal assessment: We complete this to understand pelvic floor muscle function, sensation, and assess for prolapse.

• Full body assessment: We look at how you move noting any poor loading strategies that might be influencing your bladder and your symptoms.

Treatment

• Pelvic floor muscle retraining. This can include exercises, and muscle release techniques.

• Pelvic organ support as needed with pessaries

• Deferral techniques to inhibit the bladder including trigger retraining

• Bladder retraining such as using timed voiding

• Dietary advice including identifying and removing bladder irritants and monitoring fluid volumes

• Management of constipation

• Retraining poor loading strategies elsewhere in the body. This may include hands on release work, stretches and exercises.

• Referral/liaison within the multidisciplinary team including GP, urologist, gynaecologist, psychologist, or exercise professional.