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There are several things that you can do for yourself to improve OAB. These changes are part of behavioral therapy and are the first step to improve your symptoms.  They include:

•Modify your fluid intake
•Avoid dietary irritants
•Pelvic floor strengthening exercises
•Urge suppression
•Improve bowel habits and prevent constipation
•Bladder retraining

29% of patients on the Rogue Medical Solutions OAB pathway through using the Doctella application are satisfied with their improvement after this first step and do not need to move on to medication or advanced treatments.

The links on the left are a resource for you to refer to as you go through the pathway.

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OAB Tools

There needs to be a balance in the amount of water you drink daily. When you cut back on drinking water, your urine gets more concentrated. This strong smelling dark urine can irritate the bladder and intensify your OAB symptoms. In addition, not drinking enough water can lead to constipation. This can also lead to worsening OAB symptoms.

Instead, you should drink when you are thirsty. Sip your water throughout the day instead of gulping it down.

You also receive about 20% of your water from your diet, especially from fruit and vegetables. Keep in mind that what you do eat impacts your OAB symptoms as well. See Dietary Irritants. 

Try these other tips to help you find the perfect amount of water with overactive bladder.

  • Use a smaller cup to fill up when you’re thirsty.

  • If you see the color of your urine getting too dark, you’ll want to drink a little more. Your urine should be light yellow or nearly colorless.

  • Avoid drinking too much water close to bedtime. If you’re urinating more than twice a night, stop drinking fluids after dinner.

10 Healthy Tips to Help Improve Bladder Control

  1. Use the toilet regularly. Make toilet facilities convenient – this may mean a bedside commode, bedpan, or urinal placed within reach.
  2. Wear clothes that are easy to remove when it is time to use the toilet.
  3. Train your bladder. Use a clock to schedule times to toilet. Every hour, then every 1 – ½ hours, etc., until you achieve a satisfactory schedule. Avoid frequent trips to the toilet “just in case.”
  4. Remain at the toilet until you feel your bladder is empty. Do not rush. If you feel there is still some urine in the bladder move around, or stand up if you were sitting, sit back down and lean forward slightly over the knees.
  5. Empty your bladder before you start on a trip of an hour or more. Do not try to wait until you get home or until it’s more convenient.
  6. Learn to squeeze before you sneeze – and before you cough, laugh, get out of a chair, or pick up something heavy.
  7. Establish regular bowel habits. Constipation affects bladder control.
  8. Consider avoiding foods that are known to affect the bladder, such as tomatoes, chocolate, spicy foods, and beverages, including alcohol, and those containing caffeine. These make the bladder more irritable and therefore increase the chance of incontinence.
  9. Watch your weight. Obesity makes bladder control more difficult. Ask your regular doctor about a sensible diet if you are overweight.
  10. Stop smoking. Smoking has been listed as a risk factor for bladder cancer, and it is irritating to the bladder. Also, a smoker’s cough may cause bladder leakage.

Substitutions You Can Make in Your Diet

  • Coffee with acid removed-Kava & Rombauts-two brands found in local grocery stores. Cold brew coffee ok.
  • Herbal tea-provided they don’t contain large amounts of citrus. Weak tea-dunk a tea bag in water four times quickly to color water. Sun-brewed tea.
  • Ovaltine instead of chocolate drinks.
    Fruit juice-Apricot nectar, pear nectar and papaya juice
  • Late harvest dessert wines (low acid content)
  • Fructose, as found in SUPEROSE instead of NutraSweet or Saccharine.
  • Carob for chocolate in a recipe.
  • Orange or lime peel scrapings for flavor. Do not use white part of rind.
  • Pine nuts in place of other types of nuts.
  • Breads made with potato flour, soy flour or rice flour.

Vitamins

Vitamin C only, calcium ascorbate co-buffered with calcium carbonate.  Vitamin E-take in powdered form instead of oil capsules.  B Vitamin-B6 only.

If Bladder symptoms are related to dietary factors, strict adherence to a diet that eliminates the above food products should bring significant relief in 10 days.  The proof is resuming your old dietary habits followed by the return of your symptom complex.  Once you are feeling better, you can begin to add these items back into your diet, one thing at a time.  This way, if something does cause you symptoms, you will be able to identify what it is.  When you do begin to add foods back into your diet, it is crucial that you MAINTAIN A SIGNIFICANT WATER INTAKE.  Water should be the majority of what you drink in a day.

References

You don’t have to live with cystitis:  Larrian Gillespie, MD, Rawson Associates:  New York 2002

CYSTITIS-The complete self-help guide: Angela Kilmartin, Warner Books: New York 1984.

Both of these books have merit in helping further one’s understanding of the complexity of cystitis.  We do not agree with everything that is in these books, but feel they provide a basis for understanding how difficult it is to identify the exact cause of your particular symptom complex.

Fruits & Juices

OK

Apples
Apricots
Bananas
Blueberries
Cherries
Cranberries
Grapes
Peaches
Pears

 AVOID/LIMIT

All Melons
Grapefruit
Guava
Kiwi Fruit
Lemons
Limes
Nectarines
Oranges
Pineapple
Plums
Strawberries
Tangerines

Beverages

OK

Herbal Tea
Water

AVOID/LIMIT

Alcoholic
Apple Juice
Anything Caffeinated
Carbonated beverages
Coffee
Lemon Juice
Milk or Milk Products
Regular Tea

Miscellaneous

OK

All Meats
Carob
Olive Oil
Splenda, Sweet and Low, Fructose
All Vegetables except for tomatoes

 AVOID/LIMIT

Aspartame or NutraSweet
All wheat, rye, corn, oats, barley, & derivatives
All Vegetable Fats
Chocolate
Chilies
Ground nuts, spices, and cocoa beans
Gluten containing foods
High Doses of Vitamin B & C
Highly spiced foods
Liquid Sugar
Medications with caffeine (Excedrin, Anacin, some cold medicines)
Onions
Tomatoes or tomato-based foods
Vinegar

happy-woman-using-computer

This diary is a very important part of your urologic evaluation.

It will provide information that may relate to your symptoms and will therefore be useful in making a diagnosis. Please continue with your normal daily habits, so that we may have a representation of your normal daily intake of liquids and voiding patterns.

Carry this diary and a measuring device with you for a 48-hour period.

Measure all urinary output and write the amount in the appropriate space provided below.

Place a mark in the “leakage” column if you experience leakage. Note the type of activity you were engaged in when the leakage occurred (e.g. Sneeze, cough, climbing stairs, sleeping) and quantify the amount of leakage (e.g. few drops, soaked pad).

Write the amount and type of fluid intake and the appropriate column. Try to be as accurate as possible. Example: 8 ounce cup of milk, 12 ounce beer, 6 ounce coffee, etc.

Kegel or pelvic floor muscle exercises are to help strengthen weak muscles around the bladder. When these muscles are weak, urine can leak from the bladder. These exercises called Kegels (kay-gull) are named after Dr. Arnold Kegel, who developed them to strengthen the pelvic floor muscles. There is a sling of muscles extending from the inside of the pubic bone to the anus and surrounds the vagina in women, and the  urethra and rectum in men and women. This group of muscles help indirectly control the contractions of the bladder muscle and directly compress the  urethra. These muscles contract and relax under your command to control the opening and closing of your urethral sphincters, or the muscles that give you urinary control. Through regular exercise, you may be able to build up their strength and endurance to gain better bladder control.

Why Kegel exercises matter

Many factors can weaken your pelvic floor muscles, including pregnancy, childbirth, surgery, aging, excessive straining from constipation or chronic coughing, and being overweight.

You might benefit from doing Kegel exercises if you:

  • Leak some urine while sneezing, laughing or coughing (stress incontinence)
  • Have a strong, sudden urge to urinate just before losing a large amount of urine (urge incontinence)
  • Leak some stool (fecal incontinence)

Begin by locating the muscles to be exercised:

  1. As you begin urinating, try to stop the urine without tensing the muscles of your legs, buttocks, or abdomen. It is very important not to use these muscles because only the pelvic floor muscles help with bladder control.
  2. When you are able to slow or stop the stream of urine, you have located the correct muscles. Feel the sensation of the muscles pulling inward and upward.

Helpful Hint: Squeeze in rectal area to tighten anus as if trying not to pass gas. You will be using the correct muscles.

Don’t continue Kegel exercises to start and stop your urine stream. Doing Kegel exercises while emptying your bladder can lead to incomplete emptying of the bladder and increase the risk of a urinary tract infection.

Now you are ready to exercise regularly.

Set aside two times each day for exercising: morning and evening.

Set 1

Quick Contractons (QC) –  Tighten and relax the sphincter steadily without a break between.

Set 2

Slow Contractons (SC) –  Tighten the sphincter and hold for a count of 3, (gradually increasing to 10 seconds per exercise daily) then RELAX completely before the next contraction.

In the beginning check yourself frequently by looking in the mirror or by placing a hand on your abdomen and buttocks to ensure that you do not feel you belly, thigh, or buttock’s muscle move. If there is movement, continue to experiment until you have isolated just the muscles of the pelvic floor. Your bladder control should begin to improve in 3-6 weeks. If you keep a record of urine leakage each day, you should begin to notice fewer marks in the bladder leakage column.

For example: During week 1 do 5 quick contractions, 10 slow contractions to a count of 3, and 5 quick contractions.

Make pelvic floor exercises a part of your daily routine; whether you are doing pelvic muscles exercises to improve or maintain bladder control, you must do them regularly on a lifetime basis. Use daily routines such as watching TV, reading, stopping at traffic lights and waiting in the grocery store checkout lines as cues to perform a few exercises.

Kegel or pelvic floor muscle exercises are to help strengthen weak muscles around the bladder. When these muscles are weak, urine can leak from the bladder. These exercises called Kegels (kay-gull) are named after Dr. Arnold Kegel, who developed them to strengthen the pelvic floor muscles. There is a sling of muscles extending from the inside of the pubic bone to the anus and surrounds the vagina in women, and the  urethra and rectum in men and women. This group of muscles help indirectly control the contractions of the bladder muscle and directly compress the  urethra. These muscles contract and relax under your command to control the opening and closing of your urethral sphincters, or the muscles that give you urinary control. Through regular exercise, you may be able to build up their strength and endurance to gain better bladder control.

What is the Pelvic Floor?

The Pelvic Floor is a “hammock” of muscles that supports the internal abdominal and pelvic organs. These muscles run in different directions and are different sizes. The job of these muscles is to support, lift and control the muscles that close the urethra (the tube that urine passes through).

How do I exercise these muscles?

You exercise these muscles by squeezing and relaxing them. This takes effort and practice.

How do I find the right muscles?

  • In order to make sure that you are exercising the right muscles, try starting and stopping your urine stream. This exercise will help you find the correct muscles. Do not tighten your buttock or thigh muscles when doing these exercises. Relax your stomach muscles as much as possible.
  • When you are standing and squeeze your pelvic floor muscles, you should see your penis move slightly.

Don’t continue Kegel exercises to start and stop your urine stream. Doing Kegel exercises while emptying your bladder can lead to incomplete emptying of the bladder and increase the risk of a urinary tract infection.

How do I exercise these muscles?

  • Begin by squeezing the muscles for a count of four (4), then relax for a count of four (4). At first, you can only squeeze the muscles for 1-2 seconds, but as your muscles get stronger, you will be able to hold to the count of four (4).
  • Work up to repeating these exercises for five (5) minutes twice a day.
  • Remember to relax between each squeeze and just let the muscles go loose. Do not push down.

Where do I do these exercises?

When you first start doing the exercises, you will need to set aside time when you can do them without being interrupted. After you have done them for a while, you can practice these exercises anytime and anywhere.

Always squeeze your pelvic floor muscles when you:

  • Sit up from lying down
  • Stand from a sitting position
  • Lift something heavy

You can practice squeezing these muscles when you are watching TV, standing in line, or driving a car. Since these muscles are inside your body, people do not know you are doing exercises. It usually takes 6-12 weeks to see results. Do these exercises regularly.

Are there precautions?

  • Some people exercise more than they should, hoping that they will regain bladder control quicker. If you exercise too much or too soon, your bladder control may get worse for a while. Start slowly and increase the amount of exercise slowly. Follow the guidelines that your health care team has given you.
  • Be sure to breathe during the exercises. Holding your breath may put extra pressure on your pelvic muscles.
  • Do you rush to the bathroom for fear of losing urine?

  • Do you ever dribble urine on your way to the bathroom?

The feeling of urgency to get to the bathroom is most likely caused by bladder spasms. Rushing to the bathroom during spasms or urge causes your bladder to bounce. This causes more bladder spasms. Learning urge suppression may help you control and/or eliminate these spasms so that you can stop the feeling of urgency and walk to the bathroom calmly.

To stop the feeling of urgency to urinate:

  1. Remain in the same position in which you began having the feeling to urinate. If you are sitting, remain seated.
  2. Tighten your rectum, then let go a little, tighten again and let go a little. Keep doing this until the urge feeling has passed (about 15-30 seconds). By tightening and letting go of your rectum, you stimulate a nerve in the pelvic muscles which cause the bladder to relax. This stops the strong feeling to urinate.
  3. Tell yourself that you are in control of your bladder-not the other way around.
  4. Once the urge is over, take a deep breath and relax. Then walk to the bathroom calmly.

Best time to walk to the bathroom

No urge

Worst time to walk to the bathroom

Urge feeling

What is bladder retraining?

This technique helps you hold more urine before you get the signal to urinate.

How do you accomplish bladder retraining?

Bladder retraining involves training yourself to delay voiding when you feel an urge to urinate. It starts with building strength through Kegel exercises. You begin with 5 minute delays by performing an urge suppression. This will turn off your bladder’s signal to empty and allow your bladder to hold more urine. You will gradually work your way up to urinating every three to four hours.

How does a physical therapist help with bladder retraining?

A physical therapist (PT) can help you better identify the muscles you use in Kegel exercises. They have tools such as biofeedback that help you gauge the strength of your contractions. PT helps maximize your pelvic floor strengthening.

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