Do you find yourself in a pattern of needing to pee every 30min or so? Are you the woman who goes to the bathroom “just in case”? Do you pee “just in case” there won’t be a bathroom on the road ahead? Does this sound familiar:” There’s a long drive ahead, let’s go pee just in case”. Have you realised that you often pee before getting into bed but then also go again a few minutes later, “just in case”, before falling asleep because you don’t want to wake up at night?
By doing this you train your bladder to empty more frequently without having filled up all the way- thus leading to an over trained and overactive bladder.
How does the bladder work?
Your kidneys filter blood and produce urine which is sent to your bladder via your ureters. Your ureters connect the kidneys to the bladder. Your bladder is made up of a thick muscle- the Detrusor muscle. You do not have control over this muscle. The function of the bladder is to store urine until the point of fullness, the detrusor muscle then contracts in order for the urine to pass through the sphincters and urethra and the urine then exits the body. The urethra has 2 sphincters (ring of muscle to keep openings such as the urethra and anus closed when needed), the internal and external sphincters. There are pelvic floor muscles looping around the urethral opening and external sphincter, the pelvic floor muscles also support the bladder. The pelvic floor muscles are responsible for maintaining urethral closure pressure to prevent you from leaking urine. Pelvic floor muscle dysfunction can lead to leaking.
The bladder is constantly filling with urine. During the filling phase the detrusor muscle is relaxed to allow entry of urine (think of a balloon filling with water, the balloon edges have to relax and expand to allow entry of water). The sphincters and pelvic floor muscles stay slightly contracted and closed to hold urine in. This all depends on pressure; the closure pressure of the sphincters is much greater than the pressure from the bladder above- as the bladder muscle is relaxed during filling. This is why you are able to control the 1st small urge to pee and why you don’t leak any urine (or you shouldn’t if your pelvic floor is functioning optimally) because the bladder is not full yet. The detrusor muscle has receptors that respond when the muscle stretches while filling and they send signals to the brain when you have to pee. The signals are sent when the detrusor muscle contracts, it usually contracts and sends signals twice.
The first signal is sent when the bladder has filled to about 150ml, more or less halfway, this is the first urge to go. The bladder is not completely full and therefore it is not necessary to pee yet, the brain sees this as an inappropriate time to go and sends signals back to the bladder to shut off contractions and to keep filling. During the first urge you also usually reason to yourself that you have maybe not consumed enough fluid since the previous void so therefore you can wait, or maybe there isn’t a bathroom close by and the urge is not big enough. You are able to hold it, your pelvic floor muscles function well and you don’t leak. It is important to be able to shut the first urge off.
The second urge to go occurs when the bladder has filled to about 300ml, more or less full. The bladder has stretched more and contracts to send signals to the brain. This can then be seen as an appropriate time to pee, you can then decide to ignore the urge, like above, because there is no bathroom available. Or, you can find a bathroom and empty your bladder- with calm and ease, not being rushed. This happens when you sit comfortably in order for your internal and external sphincters as well as your pelvic floor muscles to relax. When this happens, the full bladder will contract more and the pressure is then much greater in the bladder than the closure pressure. Your bladder then empties in one steady stream.
When you ignore the second urge and can’t a find a bathroom a little while later, you will get another urge, much stronger than before, and won’t be able to control the urge as the closure pressure of the sphincters and pelvic floor muscles are being over ridden by the pressure from the bladder as it had time to fill beyond 300-400ml and is running out of space. This is when you are basically running to the bathroom and almost pee your pants- sometimes a drop does escape. You should never ignore the second appropriate urge as this can put pressure on your bladder and pelvic floor and can lead to accidents.
How am I supposed to know which urge is the appropriate time to go?
There are a few things to consider. Like, the number/milliliter of fluids you consumed, the type of fluids and foods, the time frame in which the fluids were consumed etc.
The bladder usually takes about 3-4 hours to fill, this means you can more or less expect to get the urge to pee around that time, assuming you didn’t drink an abnormal amount of fluid in a short time. Generally, you need to pee about 6-8 times a day, and 1 time at night (2 times at night is acceptable for older women). These numbers can vary when you don’t drink enough fluids or if you sweat a lot or if you drank a lot before bed. So always take these things into consideration.
*If you are urinating 150ml or less- you are peeing too soon and not allowing your bladder to fill up enough, therefore overtraining your bladder. This will affect your ability to go longer between urinations in the future as your bladder muscle isn’t getting trained to stretch and fill enough. This is usually a urination stream that is less than 10 sec in duration.
*If you are urinating more than 400ml- you are waiting/holding too long to go and overfilling your bladder putting strain on the detrusor, sphincters and pelvic floor. This is usually a urination stream that is more than 15sec in duration.
The normal amount of urine to empty is about 300-400ml, every 3-4 hours, with a steady continuous urination stream of about10-15 sec in duration. Your bladder should empty fully with ease. You should be producing about 1.5l of urine daily. The best way to stay hydrated is by drinking small amounts of water in evenly timed intervals throughout the whole day. Listen to your body and drink water when you are thirsty.
Bladder irritants:
There are bladder stimulants and irritants to take into consideration though. Alcohol, coffee, other caffeinated drinks, fizzy drinks, chilli, citrus, sweeteners and smoking can lead to you peeing more often in shorter intervals with small urine volumes. These do not affect everyone the same way, so pay attention to your symptoms when consuming these things if you want to make sense of the reason you are voiding too often.
Bladder triggers:
Your bladder can develop habitual triggers that can set off the urgency for your need to pee. It is not the same for everyone. You may be absolutely fine, have a small easily suppressible urge or sometimes a very specific trigger can set of the urge. Some might leak urine with these triggers.
Common triggers: Hearing running water, arriving home from work, putting your key in the door, before pulling your pants down in the bathroom, driving into the driveway at home or work, washing dishes, after swimming. Try to suppress the urge from a trigger, especially if your bladder hasn’t had enough time to fill up enough. Pelvic floor physiotherapy can help you with this through bladder training and techniques to suppress urges from triggers, especially if you are prone to leak during the trigger activation.
-Some women develop leaking symptoms with bladder dysfunction which can be because of over training your bladder. The pelvic floor can then be affected. Sometimes bladder symptoms can even be because of a dysfunctional pelvic floor, for example not being able to empty your bladder fully and then leaking due to an overactive or tight pelvic floor.
Consult with a pelvic floor physiotherapist if you are struggling with any of the following symptoms: frequent urination, urgency to get to the toilet, leaking accidents, difficulty with initiating a urine stream, straining to pee, having to pee again after standing up from the toilet.
