We all have a bladder, but we never really learn the true ins and outs of caring for it. Even basic potty training teaches children when and how to use the potty, but has very little teaching about when and how to use their bladder’s. Believe it or not there are actually some healthy AND unhealthy habits we can adopt over time that really impact our bladder function and health.

Everyone has their own version of “normal” but in this blog we want to discuss some basic bladder habits that can really help you THRIVE! 

the bladder basics

1. Drink your daily recommended water intake (half your body weight in fluid ounces).
2. Quality matters! Focus on drinking mostly water based beverages throughout the day. Avoid those sugary drinks!
3. Avoid excess bladder stimulants. This includes caffeine, carbonation, artificial sweeteners, spicy foods, citrus and dehydration if you have a sensitive, overactive bladder or you struggle with leaking.
4. You should aim to urinate every 2-4 hours during waking hours if you are well hydrated and your bladder is well functioning. If you are going more frequently than this, have bladder accidents, or are unable to hold it this long, you may have urinary frequency and/or incontinence that should be addressed with a Women’s Health (WH) professional.
5. Get your beauty sleep. Waking up to urinate during the middle of the night is not necessarily normal unless you are pregnant or over the age of 65 (these populations still only have a recommended maximum of 1 time per night). If you are waking up to urinate more often than this, you may have urinary frequency and should seek consultation with a WH professional.
6. Stay hydrated! Don’t purposely dehydrate yourself to avoid accidents. An increased urine concentration will stimulate your bladder and make it worse!
7. Stop & breathe through urges. If you feel your body having a strong urge to urinate and that you might “pee your pants,” rather than panic, stop where you are and take 5 big diaphragmatic breaths and perform 5 quick flicks of your pelvic floor (kegals). This will help calm your nervous system and support your bladder so the urge calms. You can then walk calmly to the restroom while maintaining control over your bladder 🙂
8. Avoid “Just In Case Peeing.” This is a really common, bad habit that can lead to bladder leakage and frequency issues. Go when your body is actually telling you it needs to go and trust that bathrooms are readily accessible in most places.
9. Don’t hover when you pee. Sit your bottom all the way down on the toilet seat so your pelvic floor can completely relax and empty.
10. Slow down on the seat. Avoid peeing so quickly that you don’t allow your bladder to completely empty. This can lead to UTIs and other bladder issues.
11. Don’t Power Pee. Pushing urine out can be damaging to your pelvic floor and lead to issues such as leakage and prolapse. If you struggle with completely emptying your bladder, seek consultation with a Women’s Health professional.

Many people read this list and go “Wow, I had no idea all these things impacted my bladder health!” So we want to dive a little deeper into each of these areas. If you identified with any of the above statements…please read on!

gotta go…gotta go…gotta go!

Most bladders can hold up to 2 cups of fluid before needing to empty. Our bodies start to sense an urge when the bladder is about 40% full. This is the time that you start to think about seeking out a restroom in the near future. Many factors can influence when and how this urge is experienced and controlled. In a normal functioning bladder, you should sense this urge and calmly make your way to the bathroom within the next 30-60 minutes. You should NOT have to rush to the bathroom to avoid peeing your pants the moment you sense an urge to urinate. This is NOT a normal functioning bladder. Medications, medical procedures, pregnancy, scar tissue, birth and behavioral changes can greatly impact how we manage this urge and can often result in some form of dysfunction, such as urinary leaking or increased frequency. The good news is, that there are strategies to help improve the control and health of your bladder!

Unfortunately many women purposely don’t drink enough quality fluids throughout the day because they want to avoid accidents. Purposely (or un-purposely) dehydrating yourself actually increases the concentration of your urine, which stimulates your bladder and makes leaking worse! So please do not withhold water from your body. This will only make your bladder, along with the rest of your cells and body very unhappy.

Let’s talk about normal frequency. How often should you go?

urinary frequency

Urinary Frequency

Take your body weight and divide it in half. This is the number of fluid oz of water you should be drinking per day…yes, every day! For example, a 150 lb woman should be drinking 75 fluid ounces of water per day (150/2 = 75).

The recommended 6-8 cups of water per day is a rough estimate to start with, but the weight calculation is a much more accurate picture of what your body needs. And no, drinking diet coke doesn’t count. We want quality, water based beverages here! You may also want to consider what kinds of water based beverages you are consuming. You must also consider the quality. Many people realize that a double shot vanilla latte is probably doesn’t count towards your fluid daily intake (there is very little water content by the time you add all the “good stuff”). But many don’t realize that there can be hidden additives such as sugar, juice and caffeine to many off the shelf water products these days. Be sure to check the label.

For those who struggle with urinary leakage and/or urgency and frequency, consuming bladder irritants can make these conditions worse. See the bladder irritants section below for more information on this.

Based on your recommended fluid intake, you should be visiting the restroom about every 2-4 hours during daytime, waking hours. Most people will not need to use the restroom in the middle of the night, however a visit to the potty once per night is considered to be acceptable for most individuals (especially over 65 yo or during pregnancy). If you are urinating more often than this during either daytime or nighttime hours, you may have something called urinary frequency. 

Urinary frequency can be triggered by many factors, such as medications, medical procedures, pregnancy and often poor behavioral changes (such as “just in case peeing”). Bladder stimulants such as caffeine, citrus fruits and juices, diuretics, spicy foods, and carbonation can also irritate the bladder and cause it to hyperfunction…leading to have to urinate more frequently and urgently. 

Urinary frequency is unfortunately a very common experience for many women and children. Society doesn’t typically view this condition as a major issue, but letting it go un-recognized or treated for too long can easily increase the symptoms enough to start impeding on your quality of life. I would argue it’s a little inconvenient to have to visit the restroom every hour (or less!). This is especially true for busy mothers with young kids or individuals who work in settings that limit their “as needed” restroom visits (teachers, clinicians, public speakers, etc). The good news is that urinary frequency can greatly improve through behavioral training and identifying triggers.

bladder stimulants

Bladder Stimulants

Some people can be significantly impacted by bladder stimulants while others may not be. If you are, this may be contributing to your bladder leakage, urgency and/or frequency issues and may be helpful to consider.

Top Bladder Stimulants:

1. Caffeine – coffee, tea, soda
2. Carbonation – even water!
3. Citrus – lemons, limes, grapefruit, oranges
4. Spicy Foods & Condiments
5. Artificial Sweeteners
6. Food Sensitivities – gluten, dairy, soy, legumes, etc.

Although Tea and coffee are water based beverages, they are also bladder stimulants. This means they can also be bladder irritants – making you have to go more often and experience more intense urges. If you struggle with bladder leakage, urgency or frequency issues, you may want to either avoid these substances altogether OR just team them up with a cup of water. For example, while you are drinking your cup of morning joe, also drink a cup of water with it. Yes this mean more fluid intake and likely a trip to the bathroom, but this will help soothe your bladder and avoid intense urges and unwanted accidents.

stop that urge!

Bladder Urgency

If you find you have very sudden, aggressive urges to use the bathroom and have a hard time holding it, this is the section for you! Many people feel a sudden urge, panic inside and then RUSH off to the restroom as quickly as possible (sometimes even running!). Although this sounds like a great solution in the moment, it can actually increase your likelihood of an accident before you make it to the toilet.

Our nervous system is an amazing thing, when we use it properly. Many times the “bladder brain loop” gets discombobulated and instead of the brain telling the bladder when and where it can relieve itself, we allow our bladders to start telling us when we can go. This poses a big problem, because we don’t want our bladder in charge of our bladder control. We want our brain and nervous system in charge of our bladder control!

When you have a sudden urge to urinate, before you fully panic and run off to the restroom…

1. STOP right where you are
2. Take 1-5 deep and slow diaphragmatic breaths (breathing and expanding from your rib cage and lung space).
3. Do 5-10 quick flicks of your pelvic floor (kegals) – trying to activate your pelvic floor as quick as you can (for a proper kegal you should aim to close your vaginal and rectal openings and lift them up and inside your body).

This technique should significantly calm your urge to urinate, giving you enough time to SLOWLY and CALMLY make your way to the restroom without any loss of bladder control. If you find that the urge is still there or comes back along your journey, simply stop and repeat the process. This is a great technique to start trying within your own home so you can get used to it without fear of an accident in public.

just in case peeing

As we mentioned above, you should avoid visiting the restroom “just in case.” This bad habit actually starts to teach your bladder that it can and should go to the bathroom frequently, rather than waiting for your nervous system to inform you that your bladder is ready to go as it is approaching full. Just in case peeing can actually lead to Urinary Frequency, Urgency and even Leaking. Now I know what you all may be thinking, “you have got to be kidding me? I’ve been doing this for years!” Most people have been “just in case peeing” their entire lives. We learn this poor strategy as young children, which ultimately translates into our adulthood. Now, there can be some flexibility in the rule. For example, if you are about to hop on a 3 hour plane ride with your 5 year old child, it may be reasonable for both of you to visit the restroom before you board the plane. Or if you’re going to your childs 2 hour soccer game and there are not any accessible restrooms at the field. Then you may want to go to the restroom before you leave the house. However, you should avoid this tendency as often as possible if you know you will have access to a restroom. Most places in this day and age have public restrooms available if and when you need them. Learn to find trust in this accessibility!

sitting on the seat

While sitting down on the toilet seat there are a few general rules that everyone should know and abide by whether you are pooping or peeing.

1. Sit all the way down on the toilet seat. That’s right…ABSOLUTELY NO HOVERING over the top! It is completely false that you can contract viruses, bacteria or diseases by sitting down on a public toilet seat. If it makes you feel more comfortable simply place a toilet seat cover or some extra toilet paper over the seat itself to act as a barrier. Simple as that!
2. Take your time. We all live very busy lives, and its common to carry this trend over into your bathroom habits as well. I caution you not to! Be sure to sit down, relax, breathe and allow nature to work its magic. If you struggle initiating peeing or pooping, give it a few moments (or minutes) of time and try and use diaphragmatic breathing to relax your mind and pelvic floor. If that doesn’t work, you may consider consulting with a WH specialist to further evaluate the hold up.
3. Don’t Power Pee. Never push urine out of your body by bearing down and holding your breath. This can be very detrimental to your pelvic floor muscles and abdominal wall and can lead to more pelvic floor dysfunction, such as leaking and prolapse issues. Again, it goes back to take your time on the toilet 🙂
4. Get in a squat position. This is the position our bodies were designed to go to the bathroom. A true bathroom squat is one with your feet supported, knees above your hips, knees and feet wider than hip width and slightly turned out, and torso slightly bent forward (forearms on your thighs). This is the optimal peeing and pooping position! We best relax our pelvic floor muscles in this position and allow a clear path for things to exit the body when we want them to. A squatty potty is a great resource to have in your home for all of your family members to enjoy. If you are traveling or don’t have a squatty potty available, a tipped over suitcase or trash can under your feet can be a great, quick alternative on the go.

in summary

Hopefully you found this Bladder Basics segment enlightening and helpful. Spread the word – tell a friend, your mother, your kids. These are important life skills that many of us simply don’t learn in our childhood potty training or health classes. For more specific questions and concerns for how to address urinary leakage, urgency, frequency or pelvic floor dysfunction, be sure to consult with a Womens’ & Pelvic Health Physical Therapist. They can more specifically help you overcome these obstacles and gain control over your bladder again!

You can find more information on the bladder in our Common Bladder Issues blog post. Check it out!