Urinary Dysfunction
I get the most questions regarding these three main functions of the pelvic floor (The 3 P’s): peeing, pooping, and your personal life. This will be the first in a series of three blogs covering these topics. So…because it is often referred to as “going #1,” I will start with pee.
Ok, technically it’s called urine, but you get the idea. There is a lot of anatomical and physiological detail that goes into how we make pee, how we go pee, and what happens when you are have issues with peeing. In general, you drink something…blah blah blah…you make urine and eventually it winds up in your bladder. At some point you (hopefully) feel the urge to go, and can make it to the bathroom.
Sounds simple enough, right? Not so much. There are LOTS of ways things can get messed up along the way. Just ask any parent trying to potty train their child. As someone who has just gone through this with my oldest, you have my sincere condolences. The neural pathway responsible for even being aware that you need to pee isn't fully developed until around 2 years old. Those parents who say that they have “potty trained” their 8 month old, have really just trained themselves to be in tune with the child’s cues of when they need to go. So let’s talk about some of the common ways issues arise and some general advice to help.
Frequent Urination
I have to pee AALLLL THE TIME
What's normal? Up to 7x during the day and 1x at night
What causes this? Many things can cause this including medications, habit (frequently the case), UTI (urinary tract infection), anxiety, overactive bladder syndrome, pregnancy (both from hormones and the uterus sitting on top of the bladder), or an STI (sexually transmitted infection)
This list is certainly not exhaustive. There are many other medical conditions that can cause these changes. That is why it’s important to be consistent with your check ups and tell your provider about any changes.
How much am I supposed to pee? Whenever urinating, you should be peeing at least “8 Mississippi’s”. That means a steady stream for at least 8 seconds.
As long as the frequent urination is not due to a serious medical condition, there are several bladder habits that can be changed to help with this.
Double Voiding. It’s possible that you have to pee so frequently because your bladder isn’t fully emptying when you sit on the toilet. Double voiding is when you pee, stand up and move your pelvis in all directions (potty hula if you will), sit back down, and try to pee again. If you are able to urinate some more, your bladder wasn’t fully empty to begin with.
Bladder irritants, There are many drinks and foods that are irritating to the bladder and may make you have to pee more frequently. These often include
Caffeine
Alcohol
Acidic foods/drinks such as tomato-based items
Chocolate
Carbonated drinks
Click here for a more exhaustive list
Urge suppression. There are some tips to try and lessen the strong urge to urinate. The bladder and pelvic floor have somewhat of a reciprocal relationship. That is, when one contracts, typically the other relaxes. Normally, your bladder contracts to tell your brain you need to pee, your pelvic floor relaxes and opens the sphincters to allow urine to exit.
Quick Flicks : When you get a strong urge, complete a couple of quick pelvic floor contractions (kegels/quick flicks) to help quiet the bladder contraction
Cross your legs : Most of us already do this. That’s because your inner thigh muscles often contract with your pelvic floor. By squeezing your knees together, you are passively increasing the strength of your pelvic floor contraction.
Avoid JIC-ing. JIC-ing is when we go to the bathroom "just in case". This is often the case before a long car ride, in between patients (as a provider), during your plan period, etc. A lot of us are guilty of this, but it is a bad habit to start.
JIC-ing starts to train the bladder that it needs to empty at lower volumes.
Urinary Hesitancy
I have a shy bladder
Why is it harder to pee in pubic?Difficulty starting a stream of urine is often caused by incoordination of the pelvic floor muscles. People have difficulty relaxing the muscles properly to allow urination, or they strain to try and “push out” the pee.
I CANNOT sit on public toilets! Gross! First of all, the toilet seat is not the dirtiest thing in the bathroom. The faucet and door handles are what should gross you out. Do not strain or hover over the toilet. Your pelvic floor helps stabilize your pelvis and hips. If you are hovering over the toilet, your muscles are contracted. But you need to relax those same muscles to allow urination. You can see where this could create issues. If you are one of those people who "hover" over the toilet, try to just use the toilet seat cover or carry anti-bacterial wipes with you.
My prostate is enlarged. Your prostate gland surrounds the urethra (the tube connecting your bladder and the outside world). If your prostate is enlarged, then it crowds and narrows that tube making it difficult to initiate urination. Click here for more info on prostate cancer.
NOTE: only men have a prostate. Pelvic organ prolapse can have the same effect on urination on women. Various organs can fall down and crowd the vaginal wall. That is a topic for another day.
Urine Leakage
There are two main types of urinary leakage, or incontinence.
I pee whenever I sneeze or cough.
Stress incontinence = leaking with activities that cause an increase in intra-abdominal pressure (i.e.. sneezing, coughing, laughing, jumping, running, heavy lifting)
How does that work? Imaging your torso is an upside down tube of toothpaste and your pelvic floor is the cap. If the cap is loose (aka weak or over-active/shortened pelvic floor) and you squeeze the tube of toothpaste, what happens? Toothpaste comes out, right? The same happens when you have an increase in abdominal pressure (cough, sneeze, laugh, lifting something heavy, etc.) and your “lid” is not on tight enough to withstand the pressure. Only with this analogy, the leakage is urine.
Trick: contract your pelvic floor just prior to a known bout of increase in intra-abdominal pressure to “tighten” the lid. You also want to make sure you don't hold your breath when lifting, as this will increase intra-abdominal pressure. Breathe out when doing these activities (especially if you leak when doing them). Think about a pressure cooker and the release valve. You exhaling is like allowing some of the pressure to escape instead of creating extra work for your pelvic floor.
Click here for more information on stress incontinence from the Mayo Clinic
P.S. you should NEVER pee when sneezing. See a pelvic floor therapist for that :)
I just can't quite make it all the way to the bathroom.Once I put the key in the door I have to pee sooo bad.
Urge incontinence = when you have a strong, sudden need to urinate. The bladder then squeezes, or spasms, and you lose urine.
How does that work?you leak urine because the bladder muscles squeeze, or contract, at the wrong times. These contractions often occur no matter how much urine is in the bladder.
Tricks: See urge suppression section above. There are A LOT of bladder/behavioral modifications that can be effective. That's why going for a formal PT evaluation is key. The PT can tailor a treatment program to your individual needs.
Click here for more information on urge incontinence from Medline Plus
I leak urine with sneezing, coughing, jumping, and on the way to the bathroom. I'm in there probably 15 times a day and I may only pee for 3 seconds.
Rarely does incontinence come in nice, neat little packages. Most people have a combination of symptoms. Mixed incontinence is when someone has more than one type of incontinence. There is also overflow incontinence (frequent or constant dribbling of urine due to a bladder that doesn't empty completely) and functional incontinence (A physical or mental impairment keeps you from making it to the toilet in time.).
The information in this blog is by no means an exhaustive list of the urinary dysfunctions that can occur, just the most common. Click here if you would like to read further on the topic of bladder dysfunctions. There are many exceptions to these rules and you should always speak with your health care provider to rule out any serious conditions. After all, there is an entire medical specialty related to urinary function (urologists).
