What is considered normal bladder function?
The adult bladder has a capacity of approximately 400-450ml of urine (some people will be less at 300ml and some people will be more - up to 800ml) This means that a person drinking 1.5-2L of fluids a day, should be going every 3-4 hours during the day and no more than once at night. In other words, 4-6 times during the day and 0-1 times during the night. (Note: pregnant women are likely to go more frequently, and the older we are, the more likely we are going to need to go to the toilet overnight, but no more than x2/night).
Before going to the toilet you should have a strong (but not urgent/rushing) sensation that your bladder is ready to empty. This sensation triggers the bladder muscle to contract and the urethral sphincter to relax. This is all under automatic/reflexive control, however, we can (and should always be able to) consciously override the urge if there is no toilet available. The pelvic floor muscles are part of this ability. These muscles (including the external urethral sphincter) are under our voluntary control. We can choose to contract them to help defer the urge to pass urine, then we can relax them when we’re on the toilet. If they are not strong enough, or have insufficient endurance to hold them for long enough for you to get to the toilet, then your ability to defer the urge will be compromised.
How we actually pass urine is also just as important as how much and how often we go. When ready to go, the urine should come out promptly, in a strong continuous flow. You should achieve complete emptying of the bladder without pain, blood in the urine or straining/effort.
If this does not sound like you, please keep reading!
Healthy Bladder Habits for Everyone:
Sometimes it is the small things that can make a real difference. These are some easy habits to improve control of your bladder:
Keep up your fluids
Aim to drink 1.5-2L of fluids per day, unless advised otherwise by your doctor. Fluids include all liquids (including juices, teas, coffees, soup) not just water. If you are exercising/physically active and/or live in a warmer climate and/or breastfeeding, you are likely to need more fluids.
Avoid bladder irritants
Some foods and liquids can irritate the bladder causing a ‘diuretic’ effect (increases frequency of toileting) and/or contribute to bladder urgency. Such irritants include caffeine, alcohol and artificial sweeteners. Take a note over the period of a week to see if your bladder is triggered by these irritants (not everyone is bothered by them) and if you are, limit or avoid them completely. This will help to calm your bladder down.
Good bowel habits
One of the most important factors for a healthy bladder is a healthy bowel. The bladder and bowel co-exist in very close proximity to each other within the pelvic cavity and if the rectum (the storage zone at the end of the bowel) is full, it can annoy the bladder, causing sensations of urgency and frequency.
Constipation causes the rectum to be full for long periods and become quite distended. Bearing down when passing a bowel motion can over stretch the pelvic floor muscles and the tissues that support the pelvic organs, which can contribute to causing a prolapse.
Read here for more information on Healthy Bowel Habits.
Good toilet position
Don’t hover over the toilet ladies! Sitting on the toilet encourages the pelvic floor muscles to relax and allow the bladder to fully empty.
When you sit on the toilet, make sure you sit, relax your tummy and lean your torso slightly forward
Don’t rush or strain. Allow the urine to come out without any effort to squeeze it out.
Just-in-case trips to the toilet
It is okay to go just-in-case sometimes, for example, just before bed or before a long car ride. However, getting into a habit of going just-in-case can become a bad habit and encourage the bladder to empty without being full and can lead to more frequent urination.
Know your pelvic floor muscles
Pelvic floor muscles can be completely normal and aid your continence and bladder function
They can also be weak and lengthened, weak and tight, or strong short and tight. Any of these dysfunctions can affect the bladder and contribute to urgency and frequency
If you have bladder symptoms, we highly recommend that you have a proper pelvic floor check with a Pelvic Health Physio to determine whether the muscles are tight or not. If you start a pelvic floor muscle retraining programme (Kegels) and your pelvic floor muscles are already tight, you may actually make your symptoms worse.
Common symptoms of bladder dysfunction:
These are some common bladder symptoms we see in our clinic that we can help with:
Urinary leakage (day or night)
Difficulty controlling the bladder
Urgency or rushing to the toilet
Going too frequently to the toilet
Pain before, during or after urinating
Searching for toilets outside of the house
Feeling like the bladder is not completely empty after using the toilet
Straining to empty the bladder
Urine doesn’t come out straight away or stop/starts during toileting
Decreased or absent sensation of the bladder filling
You are not alone if you are experiencing any of the above symptoms, they are all relatively common.
At Beaches Pelvic Physio, our friendly pelvic health physiotherapists will talk to you about your symptoms, then assess you and do any testing necessary. From these results a plan is made in conjunction with you to get you back in the driver’s seat managing your bladder well.
If you have any questions, or if you’d like to make an appointment, please don’t hesitate to contact us on: 02 8964 5579 / 0435 150136, email us at: hello@beachespelvic.physio, or
We look forward to meeting you soon.