The bladder AKA our storage tank for urine, is responsible for the filling and emptying of our liquid waste. This organ works in harmony with our brain and pelvic floor to control when/where we empty.  

Now we each have unique bladder habits and a healthy bladder can look different from one person to the next. It is important to use this information as a guide and seek help from a pelvic PT if you have questions!

Let’s break down how the brain-bladder-pelvic floor muscles coordinate, bladder norms, common dysfunctions of the bladder, and healthy bladder habits!   

As simple as peeing may seem it is a highly coordinated process beginning in your central nervous system (brain and spinal cord). As your bladder muscle fills (detrusor muscle) it stretches. Then, your pelvic floor muscles, helping with the sphincteric function of the urethra, contract (keeping urine from coming out). 

Brain-Bladder-Pelvic floor Connection

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1^st : Once pressure in the bladder increases to a level perceived to be “full”, a signal gets sent through our spinal cord to get permission to urinate from the brain.   

2^nd: If it’s not a good time to go (maybe you are in a class or shopping) then your brain tells those pelvic muscles to stay CONTRACTED and tells the bladder muscle to RELAX 

OR  

If the time is right, it tells the pelvic sphincter muscles to RELAX and the bladder muscle to CONTRACT.  

So basically, the bladder muscles and pelvic floor muscles work on opposition when one contracts the other relaxes.  

Our urinary urge and frequency is an orchestrated process between our brain-bladder-and pelvic floor muscles. Our bladder is also one of the most neuro-dense organs in the body, meaning we can REALLY be aware of it filling and emptying. It also is very influenced by our nervous system and can learn our behavioral habits. Have you ever noticed how hearing water can make you feel like you need to pee? Or have you been so nervous before a big presentation or sporting event you felt like you needed to pee? This is our autonomic nervous systems influence on our bladder habits. It is so important to realize your bladder triggers so you can be in control of it, not the other way around.

“I was so scared I peed my pants” Is an old saying basically emphasizing our nervous systems influence on the bladder!

Bladder Norms  

Now that we know how the bladder works let’s talk bladder norms.  

• Emptying every 2-4 hours 
• Using the bathroom every 5-8x/day  
• <65YO 0-1x/night >65YO 1x/night  
• Stream of urine of ~10secs ( counting, 1 Mississippi and 2 Mississippi…) 

Bladder Conditions  

• Overactive bladder: where you feel a strong urge to urinate >8x/day.  
• Urge incontinence: Leakage or loss of urine with urges to urinate. 
• Stress incontinence: Leakage or loss of urine with coughing, laughing, sneezing, and exercising.  
• Mixed incontinence: When you have symptoms of both urge and stress incontinence. 
• Dysuria: Painful or difficult urination  
• Frequent UTI’s: 3 episodes of UTI in previous 12 months  
• Interstitial Cystitis: An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes.    

Bladder Health Tip and Tricks 

-Avoid “speed pee” (rushing your urine stream): When we “speed pee” we push or strain causing confusion and dysfunction to the pelvic floor muscles (telling them to contract when we want them to relax). Over time this can cause pelvic floor dysfunction and disrupt your normal urinary cycle.

-Avoid “just-in-case peeing”: Our bladder learns our behaviors. If we always urinate before leaving the house eventually you may feel the need to urinate whenever you prepare to leave your home.

-Avoid hovering to urinate, just sit and relax: When we hover, we have to use our muscle to help hold us up. This makes it more difficult for the pelvic floor to RELAX to let the most urine come out. Thats why sometimes after hovering to urinate you may feel like you have not completely emptied. You may dribble urine or you may get a small burning sensation after emptying.

-Avoid peeing in the shower: Again, our bladder learns our behaviors so if we pee in the shower you may end up getting the urge to urinate every-time you shower/get in water.   

-Avoid blowing your nose on the toilet (we can create a lot of pressure doing that!!): Yes we can create more pressure inside of our own bodies than running or jumping. Too much inta-abdominal pressure can put you at a higher risk of things like pelvic organ prolapse. While urinating our pelvic floor relaxes. If we then blow our nose, the pelvic floor has a difficult time supporting the organs above.

-Breathe with urinating, try leaning elbows onto knees and just breathing, avoid straining or pushing to pee  

-Sip vs. Chug water (we can only absorb so much water per second, try drinking water slowly): We can irritate our bladder if we do not drink enough water (ideally~64oz/day) but we can also cause urinary urgency if we drink water too quickly.

-Common bladder irritants (things that make you have to pee): Caffeine, alcohol, and carbonation!

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Reach out with any questions!!!