Gotta pee right now?! Are you crossing your legs or running to the bathroom? When’s the last time you went? How much have you drank? What did you drink? Why might you be feeling this urge?
If we’re never taught the norms of how our urinary system works, how our bladder fills and how fluids and foods can affect it, it’s hard to know if you should give in to an urge to urinate or not. Some people may feel like they rarely get urges to go, while others may feel like they are constantly getting urges to go.
Compare a hunger cue to a bathroom cue
I sometimes relate understanding bladder urges to getting in tune with hunger cues. When deciding when to eat, we often try to balance listening to what our bodies are telling us (internal hunger cues) with external thinking. For example: “When’s the last time we ate/drank? What did we eat/drink? When will our next chance to eat/drink be? Why am I getting a hunger cue (is it real hunger vs. a trigger: taste/stress/emotional/etc.)?” When we evaluate internal and external cues we can better decide if we want to give into it or ignore it.
Internal urinary urge cues:
How full your bladder is
How concentrated the urine in your bladder is (is it irritating the bladder and causing an urge sooner than it’s full)
Pressure on your bladder: internally from baby growing, pushing, kicking or external from tight clothing, belts
External thinking related to bladder awareness:
Volume: Most bladders (not pregnant) can hold up to 1.5-2 cups during the day and up to 4 cups at night
Urge sensation: Most urges begin to start when your bladder is about 60-70% full
Frequency: Taking into consideration bladder volume and quality hydration, most people will void every 2-4 hours, or roughly 6-8x per day (more when you’re pregnant)
Hydration: What did you drink and how much? Certainly larger volumes of fluid (more than 2 cups between voids) or bladder irritants – basically anything that isn’t water has the potential to irritate your bladder lining, making you feel an urge sooner (more concentrated urine) – coffee, soda, tea, alcohol, carbonated beverages, spicy foods and more
Urge triggers? Is there something external happening that might cause your urge to be sooner or more intense than the actual fullness of your bladder? Common urge triggers are running water, being in water, arriving home, key in the door, seeing the toilet/bathroom, leaving the house and a “just in case” urge
All this is to say we drink fluids, we pee, sometimes we urinate when a bathroom or break is available and sometimes we do it because there’s an urge. But how often do we actually think about balancing between internal cues and the external thought processing to decide if we should or shouldn’t go?
Try to balance the timing of your voids (2-4 hours) with good hydration habits (steady intake of water throughout your day ~6-8oz between voids) and what your body is telling you (urge sensation). You’re definitely going to pee more frequently when you’re pregnant, but hopefully some of this information will still be helpful during pregnancy and definitely postpartum in retraining your bladder’s awareness of filling and urges. Remember, it’s a balance between internal cues and thinking.
This information is meant to help increase your awareness of what is happening and why. What happens if you experience really strong urges and are running to the bathroom to make it in time? Consider trying some urge suppressions.
Count backwards from 100 by 7s
Wiggle your toes (toes and bladder are near each other in the brain)
List off groceries, to-do list, trees, birds, countries
Go through the ABCs with a theme/categories
The idea is to decrease the intensity of the urge or stop it completely briefly and then decide if it feels like an appropriate time to go. If it feels like “yes, this urge makes sense, my bladder is probably pretty full,” then once the urge intensity has decreased, go ahead and CALMLY head to the bathroom. If it feels like a trigger causing the urge and not actual fullness or irritation then go ahead and suppress the urge and continue on with what you were doing, trusting that when the bladder fills more you will once again get the urge and/or reference the clock for a rough time frame of when you might want to go.
Sometimes intense or frequent urges may be accompanied by pain or by leakage. Pelvic floor physical therapy can help with this. If your urge is accompanied by pain, you may want to work with a pelvic PT and a medical provider such as urologist or urogynecologist to rule out any underlying diagnoses or infections. If your urge is associated with leakage a pelvic PT can help you understand if the leakage relates to a tight pelvic floor that needs help relaxing or a weak pelvic floor that needs strengthening, or a combination that needs help with coordination and timing.
There are a lot of details and specifics and it’s always a good idea to check with a pelvic floor PT for an individualized approach. You can see any of us virtually for a session to discuss urinary urgency, frequency, leakage and more.
Jen Torborg, PT, DPT, CMTPT, is a pelvic floor physical therapist and author of three Amazon bestselling books: Your Best Pregnancy Ever, Your Best Body after Baby, and Your Pelvic Health. Jen treats clients in Ashland and Bayfield, Wisconsin through Orthopedic & Spine Therapy.
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