Let’s Talk About Bladder Habits

Nesin TherapyKeeping It Healthy

Written by: Amanda Spalding, PT DPT, Huntsville Clinic

Most of us don’t spend a lot of time thinking about our bladders unless it’s really, uncomfortably full. Because we only think about our bladders when we have to pee, we never think about the good or bad habits we’re establishing. Check out the lists below to see what bad habits you should be avoiding and what good habits to start implementing!

Bad Bladder Habits:

  • “Just in Case” peeing: How often as a child were you told to “go try” before leaving for a big car ride or before we go somewhere with questionable cleanliness of the bathrooms? How often do we still apply those habits to our daily life? We pee before we leave the house. We pee when we get to our destination. We see a bathroom and we think “I should probably go ahead and use it – just in case”. We try one more time before bed, just to make sure we don’t have to get up in the middle of the night. Our bladders are very habitual. When we start making these habits of going on a very frequent (and not necessary) basis, our bladder starts telling our brains that we have to go, even when our bladder isn’t full, sometimes when our bladder is barely full (nervous pee, anyone?). We will get more into what’s normal and what we can do later. Suffice to say, just in case peeing is bad. Just don’t do it. 
  • Hovering: Let’s set the stage: you’re on a big road trip to the beach, you’ve had the Big Gulp 44 oz Diet Coke, and now have a very full bladder. It always happens in the middle-of-nowhere Alabama, right? You pull over to the next gas station and it’s… disgusting. You can’t wait any longer so grit your teeth and decide to just do it. You’ll just squat and hover over the toilet and avoid all the germs. No problem, right? Wrong. The pelvic floor is considered part of our postural muscles and will always be working at least a little bit when we are upright. When we hover to pee, we aren’t allowing the pelvic floor to fully relax, thereby requiring the bladder to just force the urine out. Urination should be a passive process in which we relax and we empty the bladder. 
  • Pushing when peeing: You’re in a hurry to get to your meeting so you sit down and push it out. Or worse, you hover over the previously mentioned disgusting toilet and push it out. Bad news. You just told your pelvic floor “No need to relax! We got this!” and force the urine out. Instead of allowing urination to be a passive process, you use abdominals and abdominal pressure to void, causing decreased contraction of the detrusor muscle (the muscle around the bladder) which causes weakness. 
  • Doing Kegels while peeing: Kegels this, and Kegels that, you hear about Kegels everywhere.  And you’ve probably heard Kegels described as stopping the flow of urine. The best time to test it is when you’re peeing right? Get a few in while you’re going? Nope.  When you stop the flow of urine midstream, you begin to mess up the automatic process of micturition (fancy word for the action of peeing). While performing Kegels throughout the day can be beneficial, doing them during urination is not. 
  • Avoiding fluids: When patients have leakage with activity, the response is to avoid fluids so they don’t have pee as often. However, you will still have to pee…but also have all the side effects of dehydration too: increased acidity within the bladder, increased risk of UTI, concentrated urine, headaches, and fatigue. Additionally, this more concentrated urine can irritate the inside lining of the bladder, increasing the urge to urinate and further leakage.

Good Bladder Habits:

  • Voiding every 2-4 hours: You should be going to the bathroom about every 2-4 hours. For some of us, that seems like a really long time. However, this is the point in which our bladder is sufficiently full. When we have gotten into some of the bad bladder habits, such as “just in case” peeing, our bodies begin to interpret any fluid in the bladder as necessary to get out, causing us to void on a much more regular basis. Pay attention to timing and whether you actually have to go. Did you just go to the restroom 30 min ago? You probably don’t need to actually go again. Did you go before leaving the office but feel like you need to go once you get to the house? Maybe not. Check in with your body to determine whether it is actually necessary. If not, try to use some urge suppression techniques to reduce the sensation (distracting yourself or performing a few quick pelvic floor contractions). In contrast, make sure you aren’t holding for too long such as a long shift at work or on a car ride to avoid gross bathrooms. This causes stretching of the detrusor muscle, making voiding more difficult. 
  • Fluid intake: The old rule of thumb for fluid intake is out (8 cups of water a day) and the new rule is in! You should be consuming about half your body weight in ounces of fluids a day. For instance, a 150 pound person should be consuming 75 ounces of fluids a day. At least ⅔ of which should be water! Additionally, when consuming fluids that are more diuretic in nature, meaning they can cause dehydration (alcohol, coffee, and sodas), even more water needs to be consumed to help dilute these fluids. 
  • Relaxing: As discussed above, it is important to fully relax the pelvic floor during voiding. If you have trouble doing this, once fully seated, try some deep, diaphragmatic breathing, or belly breathing. This will help relax the pelvic floor and allow for urination to be a passive process.
  • Positioning while voiding: Now that you are sitting fully on the toilet during voiding and allowing it to be a passive process, you need to think about positioning during urination: feet on the floor and slight forward lean. By leaning forward, this helps to reduce the stress/tightness on the pelvic floor, allowing for full relaxation. If you are still having trouble, try taking a few belly breaths to fully relax.

Hopefully everyone reading this is using only the best bladder habits! However, that probably isn’t the case. Start paying attention to your bladder a little more to see if you can make any of these changes in your daily routine. Keep in mind, your pelvic floor and bladder health can be very complicated. There is no one solution for everyone. Additional assessment can be beneficial to determine exactly which treatments are best for you. Call any of our three clinics to set up an evaluation!