Could your habit of going for a pee before you leave the house “just in case!” be the reason you are getting caught short?
So I'm going to give you the geeky breakdown.... I know.... I know.... its all numbers but if you understand how the bladder works I'm hoping you will be able to understand for yourself how your common daily habits may be scuppering your bladder control.... so here goes...
A healthy adult bladder can normally hold between 300 and 400mls (one and a half to two cups) of urine during the day and up to 800mls (four cups) of urine at night. The bladder never totally empties, even when you have been for a pee there will usually be a residual 50 to 100ml of urine left in the bladder.
You should be able to go 3 to 4 hours between pee's and be able to go the whole night with no trips - or only one trip - to the bathroom.
So that's what the "white coats" recognise as normal.... where are you on this spectrum?
So how does the bladder work?
The bladder wall is a muscle that contains stretch receptors. As the bladder fills the bladder wall stretches and the receptors in the muscle send a message to your brain to let you know you need to "void" or in layman's term you need to pee. We perceive this - unsurprisingly - as the sensation that you need to pee.
If this system is working well the receptors will send the first message to the brain when the bladder is about half full.... just as a heads up, but we should be able to wait about two hours after our brain receives that first message before we actually need to empty the bladder.
Ideally we shouldn’t pee before we have the sensation of needing to pee…. If we habitually pee before we get this message from the brain, the stretch receptors in the bladder muscle reset and end up telling the brain that we need to empty the bladder as soon as they sense ANY urine in the bladder, and bearing in mind that residual 50 to 100mls of urine we mentioned earlier that could be every five minutes.
How many times do you think “I’ll just pee before I leave the house” or “I’m near a toilet so I’ll go now.... just in case”. If when you do this you haven't been to the toilet for a couple of hours that's fine. But if you regularly do this when its been barely an hour since you last went to the toilet you may be reprogramming the receptors in your bladder to be less tolerant and inform the brain you need to empty your bladder when there is less and less fluid in the bladder.
This is Similar to the way rechargeable batteries work, particularly phone batteries. Ideally you let them run down completely before you recharge them, constantly recharging phone batteries before they were empty meant they were gradually able to hold less and less charge.…. As the bladder never totally empties (remember that residual 50 to 100ml) you will always be able to squeeze a little urine out even though it may only a dribble, which often reinforces the idea that you DID need to pee after all.
A good check for how you are doing is to see how often you need to pee. It is normal to need to pee every 2 to 4 hours depending on how much you are drinking and what you are drinking. If your chugging down "Caf-pows" by the gallon you will need to pee more often and remember many of our popular choices of beverage can be bladder irritants.... that's a subject for another blog but essentially some things we consume irritate the bladder causing the bladder to spasm and need to empty.... Caffeine if the most common culprit.
It is also worth timing yourself when you pee, seriously, count how many seconds you pee for. You should be peeing for roughly 8 to 12 seconds. Doesn't sound long does it. But time your self and see how you do. If you are peeing for 6 seconds or less less then you may have a petulant bladder on your hands. When I get clients I am coaching to do this 4 seconds seems to be the average to begin with.
The correct way to check this is to keep a bladder diary and measure the volume of fluids you consume/drink and the volume of urine you pee out. Often medical health care workers (Physiotherapists, urologists etc) will ask patients to do this. However, I find the timing your pee method, while less scientific and accurate will give you a rough guide and means you don't have to carry a measuring jug everywhere with you.
And we're back to bladder irritants again, remember that sometimes the need to pee can also be due to bladder irritants. I LOVE coffee, but when I drink coffee it goes right through me. So I make sure I always have a glass of water with my coffee to lessen the irritant effect on my bladder and I choose carefully when to drink coffee.... For example, I won't drink coffee right before I take my little hound 🐾🐾 out for a two hour walk, I'll have the coffee when we get back home.
This sudden urge to urinate and inability to hold urine when you do dash to the toilet is called "Urge Incontinence" or "Over Active Bladder". It can be tricky to deal with as dealing with this form of incontinence is often as much about retraining the bladder/brain connection as it is about strengthening the pelvic floor. I find that the following tips are useful
Reduce or ideally avoid bladder irritants until your symptoms have improved. Some people find that they would rather give up some bladder irritants permanently while others restrict their consumption of bladder irritants.
Use distraction techniques when you need to pee. If you find that you are peeing for less than 8 seconds or more frequently than every 3 hours try to distract yourself when you get the sensation that you need to pee. Often simply distracting the brain will allow you to go a little longer between pees, even if this just extend the time before you HAVE to pee by 15 minutes you will gradually be able to reset your bladder stretch receptors by repeating this process.
A great distraction technique which also strengthens your pelvic floor at the same time is to slowly engage and release your pelvic floor 4 or 5 times. This is especially useful if you sit on a solid surface as the pressure on your perineum helps to quieten the bladder/brain noise.
Strengthening your pelvic floor. The muscles that help with urge incontinence are the slow twitch or endurance muscle fibres. however I would always recommend women (and men) always train both the fast and the slow twitch muscle fibres.
Nice recommends the 10:10:3 this refers to a daily practice of
engage the pelvic floor and hold that engagement for 10 seconds.
engage and release the pelvic floor quickly 10 times.
repeat 1. and 2. 3 times a day.
This is a simple bare minimum protocol but effective
It’s also worth mentioning here that if you find you can go hours and hours without needing to pee it may be worth looking at increasing your fluid intake. Ironically not drinking enough and keeping the bladder empty can also be a bladder irritant. Ideally we should be sipping fluids through out the day to maintain an even level of hydration rather than chugging large amounts when our mouths feel like the bottom of a budgie cage and we are starting to hallucinate an oasis in the corner of the office next to the photocopier. I carry a large water bottle around with me, this encourages me to sip water throughout the day. I empty it when I am traveling so its not heavy and just refill it from the tap when I get to work or home.
If you are peeing more than once every couple of hours, (if your not pregnant*) and it is concerning you I would recommend you see a pelvic floor physiotherapist or join an Adore Your Pelvic Floor class so you can learn the skills to take control of your bladder function again.
*Pregnant women will tend to pee more often as the weight of the baby pushes down on the bladder meaning it is being squashed and will not be able to fill.
If you are interested in training with me, I'd love to hear from you so feel free to contact me directly. I teach Adore Your Pelvic Floor group classes as well as offering One-2-One coaching in Edinburgh and the Lothians in Scotland as well as offering online training.
To find an Adore Your Pelvic Floor Coach in your area: https://adoreyourpelvicfloor.co.uk/courses/adore-your-floor-course/
If you are interested in training to be an Adore Your Floor Coach: https://adoreyourpelvicfloor.co.uk/courses/teacher-education-classes/
This Blog is not meant to be used as a treatment programme. While I hope you find the information I have shared interesting it is based on what I have found useful in my teaching over the years and the best and most current research. However, you should always seek the guidance of medical professionals in treating any condition. As a Pilates teacher I am not qualified to diagnose any condition. I would recommend seeking the advice of a good Physiotherapist or your General Practitioner. I would also recommend training with a Pilates Teacher who has completed a in depth training in the field. Pilates courses can vary vastly from short online trainings to three or four year in-depth full time apprenticeships. don’t be afraid to ask questions about your teachers training and experience. If you would like to train with me as a Pilates Teacher or as a Pelvic Floor Coach or find an Adore Your Pelvic Floor programme in your area. Get in touch I'd Love 💗 to hear from you.