George Krucik, MD, MBA
Frequent urination can be caused by diabetes, an enlarged prostate, pregnancy, infection, interstitial cystitis, bladder prolapse, hypersensitivity of the nerves in the bladder or urethra, or a developed habit. The latter two describe a condition called Overactive Bladder or OAB that affects one in eleven adults in the United States according to the National Over Active Bladder Evaluation Study.
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Find the cause of your frequent urination. Start with a urination and a Hemoglobin A1C test for diabetes. If you are a man, have a prostate exam and if you are a woman, schedule a pelvic exam to check for a prolapsed bladder and also for enlargement of the uterus, which can exert pressure on the bladder.
Change your diet. Once everything else is ruled out and the diagnosis of OAB is made you need a diet that doesn't irritate your bladder. The Cystitis and Over Active Bladder Foundation recommends eliminating alcohol, caffeine, tomato based foods, highly spiced foods and citrus fruits and juices. Add 1/2 cup a day of pure cranberry juice which may prevent both infection and irritation.
Drink to calm your bladder urges. Start by filling a water bottle with 2 quarts of water. Drink this in small amount over the course of a day when you are going to be at home in case it causes the need for frequent visits to the rest room. Finish drinking by 6:00 p.m. to decrease the chance of night time urination. In a journal record how many times you urinate and rate the strength of the urge you feel on a scale from 0 to 5. The next day decrease the amount of water you drink to 1 1/2 quarts. This 25 percent decrease should result in a significant reduction in the urgency and frequency of day time urges to void and reduce night time urinary symptoms or nocturia as noted in the February 2008 issue of the "British Journal of Urologists in India."
Take your bladder to school. Stanford Professor of Urology Christopher Payne, M.D., considers the first step in taking control of you bladder to be learning about the lower urinary track's functions. In brief, the bladder fills with urine from the kidneys and once a critical level is reached it stimulates the nerve pathways and alerts you of the need to empty the bladder. But the crucial point is that this is advance warning. Like all mammals the early warning system evolved in humans as a way to allow you to move away from your living area for the purpose of urination, so that predators couldn't find you by your scent. Thousands of years later, your bladder has to be taught how powerful it can become.
Coach your bladder to become a mighty muscle. Start by determining how long you can comfortably wait once you have received notice of the need to urinate. Journal each time you feel the urge and when you actually urinate. Average those times for the course of one day. The next day increase time between feeling the urge and urinating by 5 minutes and continue to do so each day until you can wait for 30 minutes without any worry of incontinence.
Tell your bladder who's in charge. If you ever noticed how strong the urge to urinate becomes when you walk into the bathroom you have discovered the key to mastering your bladder. You have been letting your bladder call the shots now its time to take back control. Walk into the bathroom, stay fully dressed and take 10 deep, slow breaths while saying silently "I am in charge of my bladder." After the 10 breaths are complete, calmly allow yourself to urinate.
Lift your pelvic floor. While urinating contract the muscles surrounding the lower bladder and urethra to start and stop the flow of urine. This teaches you the muscles that need to be strengthened in both men and women. Then, while standing in line at the bank, having a talk with your boss or falling asleep at night practice tightening the entire pelvic floor and lifting it higher and higher. Hold this lift for 10 seconds and then very slowly relax the muscles. Repeat as often as possible. Work on doing it without also scrunching up your face and these lifts, known as Kegal exercises, will be invisible to the world at large.
REFERENCES & RESOURCES
- "Uro-Today"; National Over Active Bladder Evaluation Study: 2009
- Cystitis and Over Active Bladder Foundation: Diet
- "British Journal of Urology, International"; How Should patients with OAB Manipulate Their Fluid Intake?; Hashim Hashim and Paul Abrams; February 2008
- "Urology"; Behavioral Therapy for Over Active Bladder; Christopher Payne, M.D.; May 2000
- Cystitits and Over Active Bladder Foundation: Patient Guide to OAB