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The bladder owner’s manual: What your bladder wants you to know

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We have owner’s manuals for many things in life: our cars, our smartphones, even our toaster ovens. We know so much about these gadgets, yet how well do we know our own bodies?

Take the bladder. After more than 20 years as a physical therapist specializing in female pelvic health — which includes treating women dealing with a variety of bladder and bowel issues — it has become apparent to me that many women know more about their electronic devices than they do about their bladders. And often, women have been taught by their mothers and grandmothers, who meant well but weren’t experts either.

Let’s start with the basics. The bladder is a hollow muscle, just like the heart. Its job is to store urine, which is created by the kidneys and flows slowly into the bladder. An average adult female bladder holds about 2 cups of urine, and we typically start feeling the first urge to urinate when it’s 1 cup full. A certain level of stretching of the bladder muscle triggers messages that let the brain know it’s time to start planning for a bathroom visit. This doesn’t mean we need to run to the bathroom, but it alerts us that we may need to plan for a pee stop in the next 30 minutes or so.

With a moderately strong urge, we can typically walk calmly to a bathroom, sit down, relax and effortlessly empty our bladder through a strong stream of urine. It should not be necessary to push to get the urine out. The urine should be light yellow (fluorescent if you’ve taken your B vitamins and pinkish after eating red beets) and have minimal to no odor (unless you’re one of the people whose urine smells bad after eating asparagus).

Now let me clarify some common misperceptions.

  1. Never pass up a bathroom.

If we empty our bladder every time we pass a bathroom and we don’t wait until there is an urge, we may create an overly sensitive or even smaller bladder that expects to be emptied very frequently. This can be quite cumbersome.

  1. I’m a nurse (or doctor, teacher) and I don’t have time to pee, so it’s OK that I trained myself to go only a few times a day.

On the other hand, ignoring the urge for many hours can do the opposite and make us less sensitive to that feeling of needing to “go.” This can also create an overextended bladder, which may eventually result in a bladder that doesn’t fully empty. That’s sometimes called teachers’ or nurses’ bladder. An average adult should pee about 5 to 7 times during the daytime. People under 65 typically don’t need to pee at all at night, though 1 to 2 times during the night might be normal in older adults.

  1. When it comes to drinking water, more is better.

Drinking excessive amounts of water not only dilutes our electrolytes but can also overtax our bladder and increase risk for urinary leaking. The recommended fluid intake depends on various factors such as the climate we live in, our activity level, how much we sweat, our body weight and more. A guideline I share with my patients is this: body weight in pounds divided by two equals the number of ounces of fluid to consume per day. Alcoholic or caffeinated beverages don’t count.

  1. Never sit down on a public toilet seat because you might get an infection.

Some people are so fearful of contracting an infection by sitting on a public toilet that instead they hover over the seat. Although this does create some nice strengthening of the legs, the drawback is that the muscles of the pelvic floor can’t fully relax, which may result in the bladder not emptying well. Unless the toilet is absolutely disgusting, it’s better to use a toilet seat cover (you can even purchase them and have them handy in your purse) and allow yourself to sit down.

  1. After you’ve had a baby, it’s typical to pee your pants while sneezing.

Women often believe they can expect to leak urine when sneezing, coughing or jumping once they’ve had a baby. Although many women do experience this, especially in the first few weeks after vaginal delivery, it is not necessarily typical and can be treated successfully in most cases by strengthening the pelvic floor muscles. Pelvic health physical therapists are experts in evaluating and treating women with postpartum urinary leaking.

If you’re experiencing bladder symptoms that bother you, talk to your primary care physician or make an appointment with a physical therapist specializing in female pelvic health.

Pauline Lucas, PT, DPT, WCS

Pauline Lucas is an integrative physical therapist specializing in women’s health at Mayo Clinic in Scottsdale, Arizona. Her mission is to empower women by helping them understand how to honor their unique bodies through evidence-informed lifestyle practices. Find her on Facebook @phoenixyogaandmeditation or on her YouTube channel, Dr. Pauline Lucas.

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