The bladder LOVES habits. Unfortunately many of us have trained it with bad habits. Here are some steps you can take toward creating better bladder habits:
- What is "normal" voiding (urination)? Approximately every 3-4 hours, or 5-7 times in a 24 hour period with no voiding in the middle of the night unless you are pregnant, breastfeeding or elderly.
- Don’t dehydrate yourself. Dehydration causes a host of problems, including concentrated urine which is more irritating to your bladder (leading to increased feelings of urgency even when your bladder is not full).
- Aim for at least 2/3 of your daily fluid intake from water (about a half ounce per pound of body weight is a good rule of thumb for many, increasing if you're pregnant, breastfeeding, or sweating)
- Eliminate “just-in-case” voiding. You may think it’s a good idea to “never pass up an opportunity to pee” but what this does is train your bladder to want to void at less than full and/or create triggers to needing to void such as every time I get to X place or X time
- Don't hover – semi-squatting over the toilet to avoid touching the seat does not allow your pelvic floor muscles to fully relax the way they are intended to while voiding. If you're in a public toilet and worried about germs, just take the extra few seconds to put down one of those covers or a couple strips of TP. Full squatting can actually be great, but our western toilets weren't designed for that - so leaning forward or elevating the feet can help some folks.
- Don’t rush it. Sit on the toilet for at least 8 full seconds (ideally closer to 15) and don’t strain or push to empty faster.
- Peeing in the shower is not the best idea. It can create a habit/trigger for your bladder for you to feel a sense of urgency every time you see or hear water.
- Blowing your nose while sitting on the toilet is also not the best idea – it trains your pelvic floor to relax while creating the pressure to blow out the nose/mouth (same reflex as for coughing and sneezing) In fact, creating the opposite habit is helpful: train yourself to pre-engage your pelvic floor muscles before blowing your nose, coughing, sneezing, lifting, etc.
- Avoid or reduce potential bladder irritants. These can be highly individual, but some common offenders include:
- If incontinence during sex is an issue, void before
- Prevent urinary tract infections (which can be a major underlying factor in urinary urgency, frequency and urge UI) Here are a few basic suggestions:
- Rule out chronic or recurring yeast infections or bacterial vaginosis as a possible trigger as well. There are some complex functional gut health and nutrition considerations, but you can try simply eating less sugar and move live probiotic foods to see if that helps. Also, the vagina is self-cleaning - it does not need anything more than water. Oh the French had it right with their bidets! Often over-washing (or using products containing irritants) is leading to irritation or recurrent infections due to wiping out your body's natural defense mechanisms.
- Take care of constipation to make room for your bladder, remove pressure from the pelvic floor, and reduce straining or bearing down on the pelvic floor. The functional nutrition considerations are complex and best ironed out with help. An easy thing to try is to elevate your feet to get into more of a squatting position as long as you don't have hip problems with that position. Have you ever tried a "Squatty Potty"? You can also just rest your feet on a footstool or yoga blocks by the toilet to put your pelvic floor muscles in a more poop friendly position.
- Orgasm – yes ladies, our new mantra is “an orgasm a day keeps the incontinence away"
- Learn proper posture, abdominal and pelvic floor engagement and timing – best with the help of a pelvic health PT
Not sure what your current bladder habits are like? There's an app for that. The Share May Flowers blog highlights a free app called BladderTrakHer which helps you get started on your bladder diary and retraining program. Track your habits for a few days and export them for your visit with your pelvic health PT!