There are many factors which can cause changes to your bladder habits. Childbirth, prolapse, constipation, endometriosis, medications, menopause, surgery and even the food we take in can cause our bladder to be a diva. When we refer to our bladders being a “diva”, I am describing the out of the norm signals the bladder shares like urgency, frequency, pain and leakage.
Any change in your bladder’s health is an important signal that your body is telling you something! Understanding how your bladder’s personality affects you can be somewhat difficult to diagnose as there can be layered personalities and issues. Doctors often dismiss bladder issues as a “normal'' part of childbirth or just getting older, but prolonged issues (over three months) can point to something else.
Long-term changes in your bladder function and habits could point to a prolapse, bladder retention issues, or the need for collagen or estrogen support.
The Myers & Briggs Personalities of the Bladder
The Urgent Bladder: Urge incontinence is leakage which is accompanied by a sudden urge to urinate. Normally, when your brain signals the need to use the bathroom, your pelvic floor muscles tense to keep the pee in and support you while you walk to the bathroom. Feeling a sudden urge to urinate, followed by leakage occurs when your brain’s signaling gets mixed up or irritable causing the bladder to contract. As soon as you feel the urge to pee, the bladder contracts and the pelvic muscles relax thus causing leakage. Stress, neurological changes including Multiple Sclerosis or Parkinsons, lumbar nerve pathology and even foods and beverages like alcohol and coffee are a huge factor that mixes the messages between your brain, your bladder, and your pelvic floor.
Self Check for the Urgent:
How much time do you have to reach the toilet before you have leakage? When an urge occurs, remember “Mind over bladder”. You are in control and with coordinated pelvic muscles you can walk gracefully to the bathroom before leakage occurs.
Are you using a safety blanket? Using pads or panty liners to catch any leakage is helpful to protect your clothing, however can also be a safety blanket. Monitor how many liners/pads you use each day. If you change your fluid intake, food or start pelvic therapy, you can bet you will slowly use less and less.
How does your urine flow? You will know your bladder is holding properly if you urinate over 6-8 counts. Try it! Start to count your stream as soon as it starts. Over 8 counts show you really had to go! The stream should flow easily and without pushing or straining.
The Annoying Bladder: At some point in life, women tend to get into a routine and “go just in case”. Whether during pregnancy, waking up with babies or even recurrent UTIs that cause you to go more. The constant urge to go is called urgency. But every adventure to the bathroom is called frequency. This is one of the most frustrating issues our clients share. They feel they need to pee all the time or are self proclaimed small bladder owners. This is not always true. The bladder can naturally hold 1 ½ to 2 cups of fluid before having to empty! Yes, you most likely do not have a small bladder, but may be the owner of a Diva bladder!
Self Check for the Frequent:
How often are you traveling to the restroom? The average trip to the restroom to void is 6 to 8 times during a 24 hour period. As we get older, our bladder capacity can get smaller and we may need to pass urine more frequently but usually not more than every 2 hours.
Are you consistently taking in water or guzzling it in small periods of time? The fluid you intake takes about 2-3 hours to filter throughout the body, kidneys and store house of the bladder. Your Starbucks, due to pH changes related to caffeine, may feel hasten the process, but it truly takes more time to process.
Do you hit the loo before you leave the house? Avoid going to the toilet “just in case” (more often than every 2 hours). It is usually not necessary to go when you feel the first urge. Try to go only when your bladder is full.
Do you consistently ignore the urge to go? Waiting more than 4 hours between eliminations may be convenient and sometimes an occupational hazard for teachers and healthcare providers, but not healthy for your bladder. We often see more night time frequency in women who delay voiding throughout the day, ultimately disrupting beauty sleep and peace.
The Fit Leaky Bladder: The technical term for leakage is urinary incontinence, any kind of involuntary leakage that happens when you don’t want it to. Let’s focus on stress incontinence. The physical pressure inside your core can overwhelm the pelvic floor muscles and the bladder, causing leakage. Energetic jumping, allergies, or coughing can cause so much pressure that your pelvic floor can’t hold against the abdominal pressure causing the bladder’s urethra to slightly open. Postpartum healing can be a huge factor for leakage with exercise...read how here.
Self Check for the Fit, but Leaky:
When you cough or laugh, do you leak? The overwhelming pressure from a cough or laugh can be like someone squeezing an untied water balloon. Next time you cough or laugh, gently lean forward to bring your nose over the toes. This will decrease the amount of forces pressing directly on the bladder.
When you exercise, do you wear black pants or avoid specific movements? Like many women, no one likes double unders (jumping jacks) or hopping. If a movement in crossfit or the gym causes you to feel leaky, try exhaling through your mouth slowly when you move. This will minimize pressure in the belly and provide more support around the urethra sphincter muscles.
Do you need to squeeze your knees when you sneeze? Any compensation to assist the pelvic muscles to hold against leakage is a sign you need pelvic therapy! Your body is intelligent and knows what to do, but many times this can cause overactivity of the pelvic muscles potentially leading to pelvic pain.
The Constantly Dribbling Bladder: The sneaky leakage some women experience is not related to exercise, movement or bladder health. The muscles and supporting structures around the urethra can be relaxed causing a small, but constant dribbling throughout the day. Leakage related to changes in estrogen and the support around the urethra is common in childbearing years, and it often peaks again at menopause. Lowered estrogen changes the ability of the pelvic floor muscles to contract and relax efficiently.
Self Check for the Dribbler:
Are you experiencing a pressure sensation in your perineum with standing or movement? Pressure in the perineum could signal a pelvic organ prolapse. With POP, the pelvic organs themselves are not actually damaged, it is simply the supporting structures like fascia and connective tissue that are stretched and/or injured.
Do you feel dry down there when wearing tight undies or during intimacy? Any decrease in estrogen, especially in the perinatal period and perimenopause can cause the mucosal tissue of the vulva to be sensitive to touch and/or vaginal penetration.
Have you had your hormones checked? Changes to your menstrual cycle, recent pregnancy or are on the brink of menopause, asking your PCP or your OBGYN for a hormone lab panel is a great way to see if you need hormonal and or nutritional support. Do not forget to test your thyroid as well as the hormones!
Although you may feel like you are the only one with a Diva-like bladder, many women around the world have faced the same obstacle. About one in three women will experience urinary incontinence at some point between the ages of 15 years old to 65. This may be common, but not normal. Good news you CAN have less leakage, gain control of your bladder again and no longer need to stop in every Wawa restroom on the way to the shore. We want you to be able to jump, run, laugh, pick up the baby and do whatever we want to do, without leaking. But it’s not just about doing a Kegel. It’s about creating a well-behaved bladder from the beginning.
Download this Bladder Guide to Understanding Your Bladder Health. Simple tips and tricks learned at pelvic therapy can be life changing!
Dr. Amanda Heritage, PT, DPT, PRPC is the owner of Breathe Life Physical Therapy & Wellness, LLC located in Collingswood, NJ. She has been practicing physical therapy for 11 years with a strong focus on pelvic health. She enjoys encouraging women and men about pelvic therapy as a treatment option for those suffering with pelvic pain, incontinence or constipation.