Urge suppression is a pelvic floor muscle technique to help with leaking from urgency incontinence (or OAB).  To do it, you need some patience, some practice, and a strong pelvic floor contraction.  Let’s talk about urge suppression!

The theory behind urge suppression

Your bladder is like a balloon that stores urine.  The urethra is the tube that leads from the bladder to the outside.  The urethra has a strong sphincter muscle that is attached to your pelvic floor muscles.  You should think of your bladder and your urethra like a team- they should always work together.  When the bladder relaxes and stores urine, the urethra squeezes to close the opening.  When the bladder squeezes and empties, the urethra should relax.

When you deliberately squeeze your pelvic floor, you also squeeze the urethra  and it closes.  This reflexively tells the bladder to stop contracting and relax and suppresses the urge that you are feeling.  If you do a series of quick contractions (relax for just a second between the contractions) when you feel bladder urgency, your bladder will stop contracting and the urge will go away.

How to do it

So when you feel a strong urge to go to the bathroom and you are worried about leaking, do the following:

• First, exhale.  Sit if you can.
• Next, do a series of quick kegels and don’t relax the pelvic floor.
• Then, relax your shoulders and release the tension.  (Easier said than done, I know!)
• Think of something relaxing.
• Then, wait for the urge to resolve.
• Finally, walk to the toilet.

Tips to remember

The key with urge suppression is not to panic.  If you can contract your muscles and distract yourself, the contraction will pass.  The stronger your kegel muscles are, the better this will work.  It takes practice to not drop everything and run to the bathroom.  But the running will release a little adrenalin, which makes your bladder want to empty more and it will make things worse.

Think about this before you need to use it.  Work on your pelvic floor strength.  Think about the cues that make your bladder react.  It might be running water or putting your key in the door.  Try to minimize the cues.  And think about the relaxing image you will use so you have a mental distraction technique prepared.

Pelvic floor physical therapists work through this strategy with their patients.  If you have trouble doing it on your own, it may be time to ask for help.  Urge suppression and behavioral modification is the first line of treatment for urgency incontinence.  There are many studies to support this strategy.  Even if we add in medications, women are drier if they have mastered these techniques.  It is hard work and requires practice, but the reward is worth it!

JAMA (2017);318(16):1592-1604.