March Knowledge Drop
Each month for our newsletter, the Lady Blurb, we'll share answers to some pelvic health questions you've submitted. The questions below were taken directly from you! To submit a question for next month, comment below or email us at contact@ladybirdpt.com.
**The answers to these questions are not meant to be used as medical advice. These answers are not meant to take the place of a skilled physical therapist or discussion with your medical provider. If you are experiencing concerning symptoms, please contact your physician.**
This month, we’re answering:
Can holding your pee make bladder symptoms worse?
What does a pelvic floor need to be happy?
What can you do to manage a strong, sudden urge to pee?
Can holding your pee make bladder symptoms worse?
I was chatting with a patient this week who told me that the urge to pee often interrupts her work flow and she will frequently hold her urine to the point of pain. She asked me if this could be making her bladder symptoms worse.
TLDR: yes. Don’t hold your pee!
In a healthy adult, occasionally holding in pee will not cause problems, but there may be some unwanted effects if it becomes a habit.
A healthy, happy bladder can hold about 2 cups of liquid. The bladder sends the first signal up to the brain when it’s about half way full, and then continues to signal the brain with increasing frequency as it becomes more and more full. The cells in the wall of the bladder are specially designed to sense pressure, and tell our brain when it’s time to empty. Ignoring this signal regularly decreases the sensitivity of these cells over time.
When we hold urine for prolonged periods of time it puts excess strain on both the walls of the bladder and on our pelvic floor muscles. Over time this can cause tension throughout these tissues and make it more difficult for these muscles to do their job (maintaining bowel, bladder and sexual function among other things!). Pelvic floor muscles that are tight or tense may present as weak, since the first symptoms to arise are often leaking and decreased bladder control.
Holding on to urine can also overstretch the bladder and lead to voiding dysfunction, or a lack of coordination between the bladder muscle and the urethra. This may make it difficult or impossible for the bladder to contract and release pee normally. Abnormal urination is also very often accompanied by abnormal bowel voiding, (think leakage or constipation) which can be both painful and emotionally distressing.
We also need to think about what is happening inside the bladder. Although there is a popular myth that urine is sterile, urine does naturally contain bacteria. Holding onto urine for too long gives that bacteria a chance to multiply and can lead to infection in the bladder, kidneys or urethra.
Just remember, when you’ve “got to go” you “ought to go”.
What does a pelvic floor need to be happy?
Have you heard that kegels aren’t enough but you’re still not sure why? Your pelvic floor needs a heck of a lot more than strength to be happy! So what does it really need?
Strength: Strength is important for any muscle! A muscle needs to be strong enough to do the job asked of it and your pelvic floor is no different.
Length: Strength without length leads to tightness in a muscle, and a tight muscle can’t function properly. Appropriate tissue length is just as important as strength!
Coordination: Coordination is what let’s you access the strength you possess. It’s the mind-body that causes a muscle to contract or relax when you tell it to.
A deficit in any one of these categories can lead to common pelvic floor symptoms like:
Urinary incontinence
Urinary urgency
Pain with sex
Tailbone pain… and many more!
A happy muscle is strong, flexible and coordinated. A muscle that's lacking in strength, length or coordination can start to do funky things, leading to symptoms!
Here's an example of what I'm talking about - think about your bicep. If I want to take a drink of water, my bicep needs to be strong enough to lift my 40oz insulated water bottle to my face. It also needs to be long enough so that I can easily straighten my arm to reach for my water bottle. And lastly, my brain has to be able to tell my bicep where my face is so I can bring the straw to my mouth instead of tossing it over my shoulder.
If I don't have enough strength, I can't life it off the table. If I don't have enough length, I can't reach the bottle in the first place. And if I don't have coordination, I won't be able to position the straw.
A muscle needs all three to do their job, and your pelvic floor is no different. A big part of a pelvic floor PTs job is figuring out which of your muscles are missing strength, length and/or coordination and then creating a program that helps you restore what's missing. What you do to address your symptoms will depend on what your body needs more of!
What can you do to manage a strong, sudden urge to pee?
Urgency drills are something you can do when you get hit with a strong sudden urge to pee. These can help you manage your symptoms and buy you some more time to avoid leakage on the way to the bathroom!
A strong sudden urge can be triggered by running water, parking your car at home, occurring right as you get to the bathroom, or intermittently throughout the day for seemingly no reason. To manage the urge and buy yourself a little more time to make it to the restroom, try an urgency drill.
When the strong, sudden urge sets on, follow these steps for an urge drill:
Pause wherever you are and try to relax your body.
Do 5 quick pelvic floor contractions (kegels).
Followed by 5 deep belly breaths.
Followed by 5 heel raises.
If this calms your urge, calmly walk to the bathroom and empty your bladder. If it doesn’t, go through steps 1-3 a few times! Allow your mind to be distracted during this time.
The deep breaths are important for relaxing your pelvic floor. If you feel like you kegel and then you get stuck in that contracted state, take out the contractions altogether and just try deep belly breathing.
Working with a pelvic floor physical therapist can help address sexual dysfunction, bowel and bladder concerns and help you prepare for pregnancy, birth and postpartum recovery. Contact us here to learn more about setting up an appointment with us, today!
This post was written by Dr. Liz Cote, PT, DPT, OCS and Dr. Rebecca Maidanasky, PT, DPT.