Managing Urinary Urgency: Techniques and Triggers

Dr. Jessica Gingerich // #ICEPelvic // www.ptonice.com

In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Jess Gingerich discusses subjective & objective measurements to use to track & manage urinary urgency, as well as tools and techniques to utilize in the clinic with patients who are actively symptomatic. 

Take a listen to learn how to better serve this population of patients & athletes.

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EPISODE TRANSCRIPTION

INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today’s episode, I want to talk to you about VersaLifts. Today’s episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today’s show notes to get your VersaLifts today.

JESS GINGERICH Good morning. I'm sorry about that. I think I was having some difficulty with my internet. Welcome to the PT on ICE daily show. My name is Dr. Jessica Gingrich and I am on faculty here with the pelvic division at ICE. I hope everyone had an awesome Thanksgiving and was able to spend some time with some family and enjoy some downtime. Today, we are going to talk about some clinical pearls of urinary urgency. How can we get objective data to track this progress? And some powerful interventions to help get this under control and really get your patients their lives back. So this can be something that really holds people back from living their life, whether that's at the gym or really doing anything, going out and doing fun things with family and friends, going out shopping. It can really be controlling. So before we get started, we're gonna talk about some housekeeping items. Our next online cohort begins January 9th. So head over to the website to sign up and secure your spot. We have a few more live courses to round out the year. So if you are looking to dial in some of your internal assessments and then treat that higher-level athlete, Head over to ptonice.com to sign up. We also have some certifications rolling out in the new year, so keep a lookout for what you need in order to become ICE-certified for whatever division you're interested in. URINARY URGENCY So, no one talks about bladder habits that we should or really maybe even should not be paying attention to. No one tells us that some of our favorite things like coffee and carbonated beverages, alcohol, can be negatively impacting our brain's ability to tell us when we're full or even if it's irritating to the inner lining of our bladder. We learn to pee just in case or to ignore our first urge and replace it with something other than water. So again, caffeine, carbonated beverages, et cetera. We learn habits that allow our bladder to control us rather than us controlling our bladder. So urinary urgency is a strong and sometimes uncontrollable urge to urinate. This is something where it is smacking someone in the face. They have no heads-up. It is zero to 60. This may or may not be accompanied by urinary frequency. and or urinary urgency so urinary frequency is just going to be peeing a lot in your day we oftentimes get the question of is this what's the magic number really is it's if it's affecting them and if they feel like uh it is controlling them and then urinary incontinence is just um peeing in your pants being unable to control your bladder and there are different forms of that as well So we're going to talk about three objective measures which are interesting because they are subjective objective measures to track progress and then four tools to help give your clients their lives back. So it is important to know if they are experiencing any other symptoms with urinary urgency because as we start to train this we need to be mindful of those symptoms and also how comfortable they are potentially experiencing those symptoms. For example, if they are peeing in their pants and we are now training this, do they have things like a pad? So when they are trying to hold their bladder a little bit longer and they leak a little bit, are they gonna be okay with that? These other symptoms include leakage, feelings of heaviness, constipation, and urinary frequency. Other subjective data includes daily habits like whether are they drinking or how much are they drinking. Are they drinking enough? Are they drinking too much? Timing of what they drink and if they notice any foods or specific beverages that increase their urgency or if they pee just in case. So three objective data points and again like I said these are more subjective but they are so very meaningful so when you go to follow up if these are um changing that is going to be a really big deal. TRACKING STRENGTH OF URGENCY So When their first urge presents, how strong is it? Is it like, Oh my gosh, I cannot control this? It's kind of like, ah, it's more of like a medium or is it more light? Like, yes, it's there. Um, but I'm able, to push it out a bit. Are they able to hold it? So with that urge, are they also leaking or are they just having the urge and no leakage with that? And then do they notice anything that triggers this urge? So for example, some common things that I hear are gonna be seeing a toilet. So they walk into a bathroom, they see the toilet and it is like, whoa. Walking into your home, that kind of like key in the door trigger. Running water or even being in the shower. So a lot of people will pee in the shower and it becomes this thing where you are in the shower and it hits you really, really hard. So when you are confident that they are experiencing urinary urgency, it's time to teach them to remain calm when they have that large urge. Then you're going to teach them how to do a Kegel. Show them what it means to be up in the attic and then also relax on the first floor. When they are able to do a Kibel, we can teach them an urge suppression technique. I'm going to go over that here in a minute. Then once you have the urge suppression technique down, we can start to train them in the presence of triggers. I call this trigger training. So urge suppression looks like this. So there you're going to educate them to when this happens when the urge hits them to stop what they're doing, They can sit, they can stand, whatever it is they're going to stop what they're doing. They're going to take five deep breaths. Do five Kegels, then take five more deep breaths. Then you're going to talk to them about finding a way to distract themselves. This may be, getting back to work. This may be doing a load of laundry, um, playing with their kid, something to distract themselves. After a few times of practicing this, be sure to track when their first urge presents. Is it less or more than what they came in with? Are they able to control it? Are they able to continue what they're doing or does it stop them? And are they able to do it in the presence of those original triggers? So give this a go. Have your patients try this for a week or so. Check-in with them about those objective measures, and subjective objective measures. And we'll see you next Monday.

OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.