Have you ever wondered if you go to the bathroom too many times in a day? What about scheduling your day around bathroom breaks? You may be too scared or embarrassed to ask your friends or even your doctor! So, we just assume we are normal, right? Wrong! It was not until I was educated about normal bladder habits that I now know what “normal” is. By the end of this blog I am hoping you too will understand what are normal bladder habits.
Normal bladder voiding is known as micturition. It is the process of emptying the bladder through complex reflexes in response to increased pressure in the bladder. The bladder is a vessel that should be able to hold 400-600 cc’s of urine. Normal bladder emptying should occur every 3-4 hours for an average of 4-8 times per day. The first sensation of bladder filling occurs at 40 % capacity. This should be easy to disregard. The first desire to void should occur at 60 % capacity. However, if this desire occurs at an inconvenient time you should be able to delay the urge to empty your bladder. If it is convenient, you should be able to calmly walk to a nearby restroom without fear of any leakage. A strong desire to void without leakage occurs at 90 % capacity.
This perception of bladder fullness can be affected by one’s emotions or poor bladder habits. Poor bladder habits consist of delaying bladder emptying too long, hovering over the toilet, poor diet, and pushing while voiding. Typical positioning during bladder emptying is seated, leaning forward, relaxing your lower abdomen, and mouth open. This aids in relaxing the pelvic floor muscles to allow a steady stream of urine output. The bell curve indicates the normal flow of urine. It should start slow gradually increase and then slowly decrease at the end. This flow rate may be altered with hovering or pushing. Hovering does not allow the pelvic floor muscles to relax making it more difficult for urine output. Listen to see where you may be on the curve!
The number one cause of increased bladder frequency is what we call, “just in case toileting.” Do you go to the bathroom before you leave your home “just in case” without the urge to go? This also applies to children. So, listen to them when they say they don’t have to go. When the urge is not present but you go “just in case,” it alters the complex reflex system required for normal filling and emptying. Your bladder becomes confused and will start to send premature or erroneous signals to the brain that the bladder is full when it is really not. For example, instead of having the strong urge at 60% volume it could occur at 40% volume. Over time this can lead to multiple problems. Incontinence or urinary frequency are common results. Incontinence where you are unable to hold your urine without leaking. Urinary frequency is going to the bathroom every hour.
Are you guilt of any of these? Not sure how to fix it if you are? Either speak to your physician or find a local physical therapist that specializes with pelvic physical therapy. Everyone should be conscious of their bladder health. It can potentially be an easy fix and make a great deal of difference in your overall health.
Emily Bickers, PT, DPT, OCS
As a native of Floyds Knobs, Indiana, Emily grew up just across the Ohio River from Louisville. While earning her bachelor’s of science in Biology at Indiana University Southeast, Emily played basketball and volleyball. In 2014 she earned her Doctorate of Physical Therapy at the University of Evansville and then returned home to follow her passion for Women’s Health and sports rehab working with collegiate athletes and “weekend warriors”. In 2015, Emily became a Board Certified Orthopaedic Certified Specialist (OCS), a certification from the Federation of the State Board of Physical Therapy (FSBPT). In 2016, Emily transitioned her focus to pelvic pain and dysfunction in male and female patients while continuing to incorporate her orthopedic skills into her patients’ care.
Emily continues her education by working towards becoming a Board Certified Women’s Health Specialist (WCS). She is a member of the Indiana Physical Therapy Association (INAPTA), the American Physical Therapy Association (APTA), Section on Women’s Health (SOWH), and of the Orthopaedic Section of the APTA.
Emily is married with a miniature dachshund, Millie. In her spare time, she enjoys traveling, trying new restaurants, and running. She is also an active parishioner and Eucharistic minister at St. Mary’s Catholic Church.