Why do I need to pee all the time?

It was so lovely to receive a message from one of my most recent group programme members about her progress.

“Didn’t practice for a week, just fell out of the habit 🙈 And my most annoying symptom of feeling like I need to go to the loo all of the time is back. Have been back on track for two days, lesson learnt. Hypopressives work.”

It's prompted me to delve into urgency and overactive bladder in this weeks newsletter.

It's one of the most common symptoms I see in women, whether it's the constant urge to pee without a full bladder or the key in the door panic to get to the loo.

I know full well how annoying urgency and overactive bladder can be- for those of us reluctant to wear a pad (this was me 5 years ago) these symptoms mean changing your knickers multiple times a day.

If you go the the Dr's and have further investigation chances are you've been offered medication for those symptoms but the side affects are hideous and they will never get to the root cause of the problem- they'll just cover it up.

These two conditions are rarely ever due to weak pelvic floor muscles - it's often nervous system related.

The bladder is controlled by a mix of the autonomic nervous system (parasympathetic and sympathetic) and voluntary control from the brain, it's one of the few organs where you have both automatic and conscious control layered together.

Normally, as the bladder fills, stretch receptors send signals up to the brain, and the brain sends inhibitory signals back down to keep the detrusor muscle (bladder wall) relaxed until you decide it's time to go.

In OAB, the detrusor muscle contracts involuntarily before the bladder is actually full, this is often called "detrusor overactivity." This is what I was diagnosed with. The brain's inhibitory control isn't successfully suppressing those contractions, or the signaling between bladder and brain is miscalibrated.

This is why OAB is sometimes described as a "sensory processing" problem as much as a muscular one, the bladder may be sending urgency signals out of proportion to how full it actually is, or the brain may be less able to override those signals.

The question I was left with was why is this happening to me? What's causing my overactive bladder?

Let's explore what can cause it and then i'll let you know which camp I fall into.....

Neurological disruption (the pathway itself is damaged)

Anything that damages the actual nerve pathways between bladder and brain (or the spinal cord in between) can weaken inhibitory control:

• Stroke, Parkinson's disease, multiple sclerosis, spinal cord injury

• In these cases, OAB is a direct, mechanical consequence- the "wiring" carrying the stop signal is literally interrupted or degraded

Age-related changes

• Nerve conduction and receptor sensitivity change with age and the brain's inhibitory centers (especially in the frontal lobe, which plays a big role in top-down suppression) can become less efficient

• This is part of why OAB prevalence rises significantly with age, even without an identifiable neurological disease

Local bladder changes that increase "excitatory noise"

Sometimes it's not that your brain's "calm down" signal is too weak, it's that your bladder's "gotta go" signal is too strong or firing too often, so it drowns out the calming signal even when that signal is working fine. Things like bladder irritation, infections, or an overly sensitive bladder lining can cause that "shouting" — making the urgency signal itself too loud, rather than the brain's control being at fault. There are a few things that can affect this....

• Bladder wall changes with age or hormonal shifts (like reduced estrogen in menopause, since estrogen affects bladder and urethral tissue integrity)

• Chronic irritation from bladder irritants (caffeine, alcohol, acidic foods) sensitizing nerve endings

• Urinary tract infections, which acutely irritate the bladder lining and cause misfiring urgency signals

• Bladder outlet obstruction (e.g., in men with enlarged prostate), which increases pressure and stretch receptor firing

Learned/behavioral miscalibration

• If someone goes for that "just in case" wee when the bladder is only part full (a very common habit), the bladder essentially gets retrained over time to signal urgency at smaller and smaller volumes

• The brain starts associating a lower fill level with "time to go," so the threshold for triggering urgency drops

• This is why bladder retraining (gradually extending time between voids) can reduce OAB symptoms in many people

Psychological/nervous system state

• Anxiety and chronic stress increase sympathetic nervous system tone, which can lower the threshold for urgency signals and reduce the brain's capacity for calm, top-down inhibition

• This is part of why OAB symptoms often flare during stressful periods even when nothing physically has changed

For me my overactive bladder seemed to be caused by the state of my nervous system- as someone always on the go, doing everything at 100 miles an hour and often in an up-regulated state. 

As soon as I started hypopressives my overactive bladder started to improve- it was one of the quickest symptoms to reduce. 

As you can see from my group programme clients message it also helped her too. 

Annoyingly it's the first symptom to come back when you fall off the wagon with your practice but it does prove the practice works.

If you’re interested in giving hypopressives a go to help relieve those annoying bladder urges then my beginners workshop is the perfect place to start.

And if you’ve tried hypopressives already and want to go deeper, progress gradually to help see your symptoms improve then I have 1.1, group programmes and on-demand courses. Read more about them here