Do you suffer from urinary urgency and/or frequency?
According to the International Continence Society, normal void frequency is 5–7 times per day. This norm will change according to hydration, exercise, and heat levels.
For example, singers will often drink more water during the day and performances to stay hydrated, so their normal voiding frequency will be higher.
The problem with frequency
If you have quick access to a bathroom, you might use it at your first urge. Your bladder will become trained to expect to void more frequently despite whether the bladder is full.
Why is this a problem?
Over time, your sense of bladder capacity may decrease. Your sense of urgency with 10 seconds of urine in your bladder might become the same amount of urgency at 5 seconds.
This may not seem like a problem if you are always close to a bathroom, but could lead to issues down the road, such as urge urinary incontinence. Urge urinary incontinence can develop over time, starting with a few drops as you get to the toilet to ultimately needing to wear pads.
Just-in-case voids, or JIC, should be avoided when possible. If you are leaving the house to go grocery shop and you know there is a bathroom there, you can wait until you really need to go.
For the times where you may be prohibited from using the bathroom—like waiting in a plane on the tarmac (yes, this once happened to me!)—then JIC is better than holding for an indefinite period of time.
Diet can play a role in urinary urgency and frequency. Certain foods and beverages have been shown to irritate the bladder lining.
Men and women with interstitial cystitis will often avoid these irritants because it will elicit a pain response and significant urinary frequency.
- black and green tea
- red and blue food dye
If you love all (or many; who admits that they love red or blue food dye?) the things on this list, start with the items you will miss the least and find substitutes.
For example, if a patient says she drinks two cups of coffee, three cups of seltzer, and a glass of wine every day, she might want to substitute still water for seltzer and see if that helps.
Some clients will report being able to tolerate a latte but not coffee with cream. The milk or milk substitute in a latte is a higher ratio to the acid and caffeine in the espresso shot so it may not irritate their bladder as much as coffee with a splash of cream.
Urgency, frequency, and urge incontinence can also become worse during times of high stress and hormonal fluctuation.
Also, seasonal allergies can affect bladder function since some anti-histamines might cause increased bladder sensitivity.
Strategies to suppress the urge
Besides paying attention to bladder irritants, there are other strategies you can implement to suppress the urge. First, see if you have a “true urge.”
- Did you just walk by a waterfall?
- Did you wash your hands and notice a sudden urge to go?
- Did you just read an email that caused a nervous stress response?
These experiences can induce the urge to go even if your bladder isn’t full.
When you feel the urge, stop and notice. Take five deep breaths into the belly and imagine the pelvic floor muscles releasing. Did the urge change? Sometimes it does!
Then, when the second urge to urinate arrives, go at that point. Overtime you can retrain your brain to wait until your bladder has filled up more before heading to the bathroom.*
- Doing a few pelvic floor muscle contractions. A Kegal will remind the bladder that it is not the time to void.
- Crossing your legs will pull in the adductors, which are helper muscles to the pelvic floor.
- Distraction techniques like mantras or counting backwards can also be helpful to defer the urge.
Dear [bladder] diary
Bladder diaries are useful to get a baseline. Sometimes people don’t realize how often they are going to the bathroom until they chart it.
Looking at the pattern of urgency and bladder irritants can often become more clear when looking at bladder diaries. The NIH has a bladder diary that you can access.
Treat yourself to a full void!
I understand the chasing-toddlers-around phase when you can barely sit down to go to the bathroom. Sometimes that becomes a habit, so make sure you take the time to fully void. Here are some tips to make sure you empty:
- Take five breaths after you finish urinating and see if more urine comes out.
- Rock side to side and front to back a few times to see if more urine comes out.
- With toilet paper ready to catch drops, stand up and sit back down and see if more urine comes out.
- Don’t hover over the toilet in a squat.
- Don’t push the urine stream or at the end of voiding to get a little more out. This confuses the coordination between the pelvic floor muscles and detrusor muscle around the bladder.
- Stopping the flow mid-stream is not a good idea! This also confuses the coordination between the pelvic floor muscles and detrusor muscle around the bladder.
Of course, you should always check with your medical provider to make sure you do not have a urinary tract infection or other medical condition that is causing the urinary urgency. Tightness in the pelvic floor and hip muscles, specifically the obturator internus muscle, can also feel like urinary urgency. A pelvic health physical therapist can help with this!
*In the presence of an infection it is recommended to urinate upon first urge. Please be sure to check with your provider to make sure urinary urgency and frequency are not signs of an infection!