How to Keep Your Urinary System Healthy: Bladder Basics, Tips & Tricks
Why learn about your bladder?
Most people don’t think about their bladder or their pee habits - when they gotta go, they go! However, there are some not-so-helpful habits that many people pick up, not knowing that they may be doing their pelvic floor a disservice down the road.
In this blog, we’re going to talk about how a “normal bladder” functions, how the nervous system affects the bladder, common bladder problems that people have, bladder tips and tricks, and healthy bladder habits.
So are you ready to learn how to keep your urinary system healthy and possibly reduce problems in the future? Your pelvic floor with thank you for it!
Bladder Basics
What is a “normal bladder”?
The average adult bladder can hold 10-13.5 oz. or about 2 cups of urine. People typically feel the urge to urinate when the bladder is about half full. Normal void intervals are between 2-4 hours, 4-8 times/day, and at night going 0-1 time. The bladder wall stretches and expands to accommodate filling, and as it fills, the stretch receptors in the wall of the bladder send signals to the nervous system. When the bladder is about half full the nervous system triggers a contraction of the bladder wall muscle (detrusor). At the same time, the urethral sphincters relax, allowing urine to flow out.
How does the nervous system impact the bladder?
The sympathetic nervous system (fight or flight) regulates the bladder by closing the internal urethral sphincter, allowing bladder filling without leakage. This may contribute to why it can be difficult for some people to empty their bladder when their sympathetic nervous system is amped up - when they are nervous or anxious or other people are present (aka “pee fright”). The parasympathetic nervous system (rest and digest) regulates the bladder by stimulating the detrusor muscle to contract, which relaxes the internal urethral sphincter, allowing the bladder to empty.
Common bladder problems that people may have:
Stress Urinary Incontinence - bladder leakage during physical activity or increased abdominal pressure, such as coughing, sneezing, jumping, laughing, running, bending, lifting, straining, etc.
Urge Urinary Incontinence - a sudden, intense urge to urinate which results in bladder leakage before reaching the toilet
Urinary Urgency - a sudden, strong, and difficult-to-delay urge to urinate
Urinary Frequency - the need to urinate more often than usual, during the day, night, or both
Over-Active Bladder - the combination of symptoms consisting of urgency, with or without urge urinary incontinence, urinary frequency, and nocturia, if there is no proven infection or other obvious pathological condition
Nocturia - waking frequently at night to urinate
Interstitial Cystitis (IC)/Painful Bladder Syndrom (PBS)/Bladder Pain Syndrom (BPS): a chronic condition that causes bladder pain, discomfort, or pressure
Other bladder dysfunctions: bladder hesitancy (trouble initiating the urine flow), incomplete emptying, post-void dribble (involuntary loss of a small amount of urine after peeing), and slow urine stream or a urine stream that starts and stops
This is just a general list. I will address these conditions in detail in future blog posts, as they are complex and multi-faceted, so more to come - I promise! For now, and most importantly, if you are having bothersome bladder symptoms, make an appointment with a local physical therapist who specializes in pelvic health.
How to Keep Your Urinary System Healthy: Basic Bladder Info., Tips, & Tricks
1) Don’t “hover” over the toilet! Squatting over a toilet makes it hard to empty or difficult to fully empty without straining because your pelvic floor muscles can’t fully relax. It also makes the toilet seat gross for the next person. Instead, sit down on the seat in a comfortable position, feet flat, lean slightly forward, and rest your forearms on your thighs. Relax your pelvic floor muscles and urethral sphincters to initiate urine flow. If you have concerns about cleanliness in public restrooms (probably another person hovering!), cover the toilet seat or wipe it down before sitting.
2) Don’t push or strain while urinating to finish faster (“power peeing”) or to “get the last bit out”. Your bladder wall is a muscle that pushes the pee out for you. Additional pushing and straining, over time, can cause issues such as pelvic floor muscle weakness, bladder leakage, or pelvic organ prolapse. Just relax the muscles to empty.
3) Don’t limit fluids: this can make your urine more acidic and irritating, so staying hydrated is important.
4) Avoid “just in case” (JIC) trips to the bathroom. This is fine before a long road trip but you shouldn’t get in the habit of going to the bathroom before leaving the house to run errands, when you see a bathroom, immediately upon coming home, multiple times before bed, etc. This sets up a problem of unnecessary bladder confusion where your bladder gets triggered by the environment and situation rather than fullness. This can lead to less stretchiness in the bladder - you won’t be able to hold as much and will feel the urge earlier. It can also make it hard to empty - a partially full bladder doesn’t contract as well as a full bladder.
How does this problem start? This is what we do with kids because they don’t have a fully mature bladder, they can’t hold it for long, and we want to prevent accidents. But after about the age of five, we need to start training people to only go when they have the urge to go. Look, there are public bathrooms almost everywhere now, and for the most part, they are a lot cleaner than when I grew up in the 80’s! So thinking “I better go now because I won’t be able to go later when I need to” doesn’t pan out.
5) But don’t wait too long! If it has been more than four hours, you probably should go. We don’t want to over-stretch the bladder because over time this can negatively impact the bladder’s stretch receptors and lead to a decreased ability to empty efficiently. This may cause you to want to push and strain, which we already discussed was not a good idea. It may also cause someone to limit their fluids (you will drink less to avoid increasing the urge), causing the urine to become more acidic and irritating, and possibly risk developing a urinary tract infection. Excessive holding can also cause your pelvic floor muscles to be in a constant state of tension, leading to other problems.
6) Avoid using wipes! They all have some form of chemicals in them that can be irritating to the sensitive vulvar skin. They are also bad for the environment, so it is best to skip this.
Healthy Bladder Habits
🤜Try to drink roughly the same amount every day and sip throughout the day rather than chugging large amounts sporadically. How much should you drink? Some people recommend drinking half of your body weight (in ounces) of water every day. You may need more or less depending on your activity level, how much you exercise and sweat, etc.
🤜If you wake in the middle of the night to pee, try to determine if it is actually due to a full bladder or if you have just trained your bladder to contract because you woke up. If you do wake with a full bladder, especially if you wake to pee multiple times, consider limiting your fluid intake to about 2 hours before bed.
🤜If you have trouble initiating the urine flow, feel you have incomplete bladder emptying, or have a slow urine stream, try some of these techniques:
Do diaphragmatic breathing for 30 seconds.
Pelvic tilts: try tilting your pelvis forward (increase low back curve) and back (rounding back or slouch/slump). Repeat 10-15 times with deep belly breathing.
Inhale air through your belly while raising your arms overhead, exhale as if blowing out birthday candles, and lean forward as if to touch the floor. Repeat 5-10 times. Then, relax the pelvic floor to let go of any remaining urine. Do not push or force “the last bit out”.
Try walking around a bit before going to the bathroom.
Turn on the bathroom faucet or imagine water flowing (like a waterfall).
Try some inner thigh stretches, squat stretches, or marching with high knees before sitting on the toilet.
For those with a penis, try sitting down to pee rather than standing up.
Try squeezing your pelvic floor muscles first (do a “kegel”) and then relax the muscles completely as you inhale deeply, inhale, bringing the breath down into your pelvic floor muscles.
🤜Tips for relaxing the pelvic floor muscles to allow the urine to come out:
Imagine a marble falling out of your vagina/rectum
Think of a waterfall or water flowing
Imagine your pelvic floor muscles are an elevator and let your muscles go all the way down to the ground floor
🤜Other Things to keep in mind:
Pregnancy and breastfeeding throw most of these bladder habits out the window. It is common to have urinary frequency, peeing during the night, drinking more fluids, etc. If your bladder symptoms are bothersome, or you have bladder leakage, or any other pelvic symptoms while pregnant or postpartum, I highly encourage seeing a pelvic floor physical therapist to get your individual needs met.
Is it bad to do a kegel while you are peeing? No, but I wouldn’t make this an ongoing habit. The pelvic floor muscles need to be relaxed to allow the bladder to empty (it can’t empty if the muscles are squeezing and the gate’s closed off) but it’s the micturition reflex that triggers the bladder to contract and empty. Trying to “stop the pee flow” when you are halfway empty once or twice is not a bad idea if you are trying to figure out how to control the muscles that close off the urethra, as we often teach people who have stress urinary incontinence. Doing this at the end of the flow isn’t great because there won’t be enough stretch left in the bladder to start the flow again. So, is it bad? No. Would I recommend doing it all of the time? No, but it can be a learning tool.
Did you learn anything new? If so, share this blog post with your friends and family. We all want happy, healthy bladders! 🙌
Do you need help with your bladder problems and want to work with me? If you live in the greater Minneapolis, Minnesota area, my clinic is in Edina, MN - let’s work together! Contact me to learn more.
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Disclaimer: The information in this blog post is for general purposes only and is not intended to be used as medical advice, diagnosis, or treatment. Refer to your medical provider for all questions and concerns regarding your individual care.
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