Bladder Urgency & Frequency: Why You Feel Like You Have To Pee All The Time
Many people plan their day around the bathroom. You may be someone who knows where all the cleanest public restrooms are in your area. You may be that person who feels anxious in traffic, meetings, travelling, or exercise classes. You may even be that person who pees every time they leave the house. Bladder urgency and frequency are very common symptoms that can wreak havoc on your schedule and your nervous system. But most importantly, these are symptoms you don’t need to live with. The bladder can be trained to control for urgency and frequency. Here, I explain what they symptoms mean, how they commonly develop, and what you can do to resolve them.
What Are Urgency & Frequency?
Frequency
Frequency is urinating more often than normal during the day. It’s normal to empty the bladder every 2-4hrs during the hours you are awake. This means that on average, people should be peeing 5-8x/day. For someone who’s emptying the bladder every hour (or more), they may find they urinate 10+ times a day.
Urgency
Urgency is a sudden, strong sensation to empty the bladder. It’s like going from 0-100mph with little warning. Urgency may also make you feel as if you won’t make it to the bathroom in time, and many people with urgency do in fact experience bladder leakage on their way to the toilet.
Common symptoms associated with urgency & frequency include:
nighttime urination
bladder leakage
bladder pressure
feeling like you “always have to go.”
How The Bladder is Supposed to Work
Think of your bladder as a balloon. It receives urine from the kidneys and is designed to fill gradually over time. This filling results in a stretch to the bladder. The stretching of the bladder creates a signal that travels along the nerves to your brain where it gets interpreted as an urge to pee. Your brain can then send a signal back down the nerve pathway that tells your bladder to hold it in or empty. As you can probably see, the nerves between the brain and bladder form a connection is very important and acts like a highway of information. It’s important here to make the distinction that an urge is a normal sensation to pee, while urgency is abnormal.
If your bladder is only about 1/3 full, the urge will be minimal and you may decide to wait and not need to pee right off. As time passes and the bladder fills and stretches more, the urge sensation will be stronger and more pressing. Your bladder is designed to be a storage organ, not an alarm system.
We can’t talk about the bladder without touching upon the Pelvic Floor muscles as well. When the bladder is storing urine it is relaxed, while your pelvic floor muscles are active to keep the sphincters closed. This means your pelvic floor is actually working (without you noticing) to keep the urine in the bladder. When you urinate, the bladder muscle (known as the detrusor muscle) contracts and your pelvic floor muscles relax to allow urine to pass through. This act should be passive, requiring no effort on your part. As you can see, the bladder muscle and the pelvic floor muscles can’t both work at the same time. It is a coordinated partnership in which one relaxes while the other contracts and vice versa. Your brain is very much involved in coordinating this function.
Common Habits That Cause Urgency & Frequency
If you experience urgency and frequency, you may think there is an inherent problem with the bladder organ itself. In some cases, this may be true, but many times it is our own habits that unknowingly create these symptoms over time.
“Just In Case” peeing
Many people, during childhood, are often told by their mothers to pee before leaving the house - even if they don’t feel the need to. This develops a habit for many individuals that can confuse the bladder-brain connection. When you empty the bladder “just in case” and without first receiving a signal that your bladder is full, you can actually retrain your bladder to prematurely send a signal to the brain that it’s time to pee. This often results in your brain learning to signal you to pee when your bladder really isn’t full. In these cases, people who often report that they “have a small bladder.” In reality, their bladder capacity is usually normal but they simply aren’t using their capacity.
Withholding Liquid to Avoid the Bathroom
Many people intentionally limit liquids, in an effort to diminish frequent trips to the bathroom or urgency. This often backfires and leads to worsening symptoms. Withholding liquids makes someone dehydrated and the urine become very concentrated. Concentrated urine irritates the lining of the bladder, making your bladder want to rid it of urine. Additionally, a lack of hydration will contribute to constipation and constipation will always worsen bladder symptoms.
Hovering Ove the Toilet
As I mentioned above, when the bladder works to empty, the pelvic floor muscles must relax. Hovering over the toilet, rather than sitting, doesn’t allow for complete relaxation of these muscles and therefore can lead to incomplete emptying. Those who stand to urinate can also experience incomplete emptying from poor pelvic floor relaxation. For these individuals, it may be helpful to either sit or stand with one hand placed on the wall behind the toilet/urinal to lean into.
Pushing or Straining to Urinate
Peeing should be a passive act, meaning all you should need to do is relax your body. When someone pushes to empty the bladder, they typically end up either straining the muscles or inadvertently contracting their muscles. This can lean do confusion for the muscles and further difficulty relaxing during urination. People often resort to pushing when they either are rushing to get back to a task or they feel as though their bladder doesn’t empty well enough without pushing.
What is Bladder Retraining?
Many of the above common habits end up training the bladder to signal prematurely the need to empty and/or cause the bladder to empty less efficiently, which leads to urgency and frequency. The good news is that Pelvic Floor Therapy can help with retraining for optimal function.
Bladder retraining consists of various strategies to help with:
Improving bladder capacity
Reducing unnecessary bladder signals
Re-establishing ideal bladder habits
Bladder retraining involves:
Timed voiding
Urge suppression strategies
Fluid management
Nervous system regulation
Pelvic floor coordination
Bladder retraining is just one component of treatment for bladder frequency and urgency. Biomechanics, strength and mobility, both within and outside of the pelvis, are oftentimes included in a comprehensive treatment approach. Bladder retraining is not about ignoring your body - it’s about helping your bladder communicate more appropriately. It’s about aligning proper function between your bladder, your pelvic floor muscles, your habits, and how you brain receives and relays information. Start by taking a look at your own habits on a daily basis and see if you can identify any changes that you can make to improve symptoms. As always, I recommend working with a pelvic floor therapist to identify your personal triggers and treatment plan options for optimal success. It’s never too late to improve your quality of life!
✨If you’ve been struggling with any symptoms of pelvic floor dysfunction, I’d love for you to consider working with us and getting you relief. We have both in-person and virtual options available, for your convenience.
