A guide to peeing: How often you should go and other helpful tips

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A guide to peeing: How often you should go and other helpful tips

Holding your urine, going too often or hovering over the toilet may seem like “innocuous little things,” experts say, but in the long term those habits could lead to a host of urinary, bladder and pelvic floor problems.

For more than two decades, Alicia Jeffrey-Thomas was a self-described “Olympic-level hoverer.”


“I don’t think I sat on a toilet in public until I was, like, 25,” Jeffrey-Thomas said. But all that changed, she said, when she learned more about the pelvic floor — a group of muscles that provide support for internal organs, including the bladder, rectum, uterus and prostate — during physical therapy school. She stopped hovering and noticed that “things got a lot better.” Now, Jeffrey-Thomas, a pelvic floor physical therapist at Greater Boston Urology, imparts this lesson, among others, to her patients.

Hovering is one of several common urination habits — such as holding your urine or going too often — that Jeffrey-Thomas and other experts say may seem like “innocuous little things,” but in the long term could lead to a host of urinary, bladder and pelvic floor problems.

“We’re the sum of our habits over time,” Jeffrey-Thomas said. “Having good habits and establishing them early on can be protective in a lot of ways.”


Here are some dos and dont’s experts recommend keeping in mind.


Don’t: Go too infrequently or too often

When it comes to urinating, avoid extremes, experts said. “Going 12 hours between urinating is not normal; going every 15 minutes is not normal,” said Stephen Freedland, a professor of urology at Cedars-Sinai Medical Center.


Habitually holding your urine and overfilling your bladder can cause the organ to become overstretched over time and work less effectively, Freedland said. You may also find that it’s more difficult to relax when you do finally go, said Doreen Chung, a urologist and associate professor at New York-Presbyterian/Columbia University Irving Medical Center. People who hold urine (a more common habit among women) may struggle to empty their bladders, leading to recurrent urinary tract infections and, in some cases, pelvic pain.


Similarly, constantly rushing to the toilet at the slightest sensation of needing to go or urinating “just in case” before you feel any urge can have long-term negative effects on the bladder, Jeffrey-Thomas said. Going to the restroom just in case, for instance, can train your bladder to become more sensitive to less urine, she said. “A lot of times when they actually go to try to empty their bladder, there’s not a whole lot there, but the intensity of the urge is as if they’re about to have a minute-long pee.”


Freedland added that urinating too frequently and never allowing the bladder to fill up completely can cause the bladder muscle to become contracted. “After years and years of this pattern, the bladder will not fill up as much when you do need it to fill up,” he said.


Ideally, experts said adults should be urinating about every three to four hours while they’re awake, though the frequency may change depending on how much and what you’re drinking or eating, or whether you’re pregnant.


Children should be trying to go every two hours, and it’s important to establish healthy urination habits as early as toilet training years, said Candace Granberg, a pediatric urologist and surgeon-in-chief at the Mayo Clinic Children’s Center.


Do: Take your time and relax

“Straining to urinate is always a risk factor for developing pelvic floor dysfunction,” said Amin Herati, a urologist and director of men’s infertility and men’s health at Johns Hopkins.


While it’s common to try to “force every last drop” of urine out of your bladder as quickly as possible, “that’s not actually allowing that normal reflex of your pelvic floor relaxing and your bladder contracting to empty,” Jeffrey-Thomas said. “You’re kind of just creating a lot of intra-abdominal pressure to make things happen.”


Bearing down, she said, can affect the pelvic floor muscles and potentially contribute to pelvic organ prolapse, which is when your organs drop out of their normal position because the pelvic floor can no longer support them.


The key, Chung said, “is to relax and not be in a hurry.” She suggested sitting on the toilet for at least one to two minutes and actively urinating for as long as you need.


On average, it shouldn’t take longer than 30 seconds to urinate, Freedland said. “Once you get going and it takes you a minute to empty your bladder, that’s a problem. That’s not normal.”

How you position your body can also help, experts said.


“In this country, unfortunately, we have toilets that are too high,” Granberg said. “When you’re not seated low enough, then your hips are too high for your pelvic floor muscles to relax. The perfect position is almost in a full squat where the hips are below the knees, because that will relax the pelvic floor muscles, which will allow the sphincters to relax, which allows you to empty your bladder and empty your rectum.”


This is why hovering over the toilet isn’t ideal, Jeffrey-Thomas said. During urination, “the pelvic floor’s job is just to get out of the way so that the urine can flow through,” she said. But in the hovered squat position, the pelvic floor muscles aren’t fully relaxed, causing people to have to push more.


Putting your feet on a stool can help get your knees above your hips, experts said. Jeffrey-Thomas also recommended leaning forward while keeping your spine straight and hinging at the hips. Other relaxation tactics to try include doing pelvic tilts (leaning front to back or side to side) or drawing little circles with your hips while you’re sitting on the toilet.


Do: Pay attention to what and how you’re drinking

Caffeinated beverages such as coffee and tea as well as alcohol and carbonated drinks can be triggers for urinary urgency and frequency, experts said. Make sure you’re drinking enough plain water, but avoid over-hydrating.


“When it comes to drinking water, it’s also important how you drink your water, more so than it is how much you’re drinking in a day,” Jeffrey-Thomas said. Instead of “chugging massive amounts of fluid all at once,” try to pace your intake. She suggested drinking a few ounces of water every hour and using time marked water bottles to help keep track.


For people whose sleep is being disrupted because they wake up multiple times during the night to urinate, Freedland suggested limiting or cutting off fluids after dinner, particularly diuretics such as caffeine or alcohol.


Don’t: Forget about your bowel

“Forgetting about poop can be the No. 1 thing that contributes to bladder problems,” Granberg said.


“If you have poop taking up real estate in your pelvis, it’s going to push on the bladder, and it can cause an overactive bladder,” she continued. “It can also push the bladder out of the way so that you’re unable to urinate altogether, or you’re just not able to empty all the way.”

In addition to optimizing your fluid intake and developing a healthy urination schedule, Granberg said people should aim to have a soft stool daily. “Common things being common, those three things alone will help fix almost all bladder issues,” she said.


Do: Listen to your body

Although many urinary and bladder problems can often be improved with behavior changes, experts emphasized that it’s important to pay attention to signs from your body that may be signaling something is amiss.


Bladder symptoms can be the result of underlying health conditions, such as diabetes, neurological disorders or prostate issues.


“We always encourage people to be proactive rather than reactive,” Herati, the Johns Hopkins urologist said. If, for example, you start noticing that you’re urinating much more frequently, going to your doctor for a urinalysis may provide answers. “There are a lot of other conditions that can predispose somebody to urinary frequency beyond obstruction or voiding habits,” he said.


It is possible, experts said, for people who urinate too frequently to retrain their bladders. There are strategies to help calm down the intense urge, including medications, and pelvic floor physical therapy may also be beneficial, Jeffrey-Thomas said. But people with overstretched bladders as a result of years of holding their urine may have a more complicated recovery, Freedland said.


“Once the damage is done, so to speak, we can prevent further damage — the bladder can heal to a certain degree — but only to a certain degree,” he said.


Experts encourage keeping track of your bathroom habits and regularly talking to your health-care provider about them. “I ask people about how often they urinate during the day all the time, and you’d be surprised how many people can’t actually answer,” Chung said.


By Allyson Chiu, featured on The Washington Post.
Tips below featured from a pelvic physiotherapy clinic:

How Can You Train Your Bladder?

What is Normal?

It would be typical to urinate 5-8 times each day, and not at all through night unless you’re over 65. Each time you use the toilet you should have a good stream that lasts at least 8 seconds, which would be more than 200ml of urine.


What is “Overactive” Bladder?

The bladder can become irritable or “overactive”, making you pee more often. This could be due to habit, if you often empty the bladder before it is full. If your bladder never fills up, it doesn’t ever expand and can become smaller over time. But this can be reversed! You can use your pelvic floor muscles to train your bladder to hold more urine before you need to pee.

It is important that you first get checked by your family doctor, as there can be medical reasons for experiencing urinary frequency or urgency. If there is no underlying medical issue, you can get some help from a pelvic health physiotherapist who has advanced training in working with pelvic floor muscles and other structures in that area.


What to Do?

If you feel you need to urinate more than every 2 hours, try not to go with the first urge you feel.


When You Do Feel the Urge to Pee

  • be still (standing or sitting) and tighten up through your pelvic floor muscles
  • try to distract your brain at the same time with something else

Doing this can help settle down the urge to urinate. If after a minute or two you still need to go, try to walk to the toilet slowly. If the urge to pee has settled down, try to delay going until you feel an urge again. Over time you are trying to lengthen the time between visits to the toilet.


Incomplete Emptying

When you first sit down on the toilet, your brain recognizes that you are in the appropriate place to pee, and it will signal your pelvic floor muscles to relax. This automatic release through your pelvic floor makes your bladder contract, and that is what starts the flow of urine. Your job is to keep those muscles relaxed and take a few deep breaths. Once the stream of urine is done, keep your muscles relaxed and take another breath or two, just giving it 5-10 more seconds before you get up and move. Do this every single time you go to urinate, and over time your brain should learn that you are going to keep your pelvic floor muscles relaxed enough to empty more completely.


Fluid Intake

It is important to drink enough through the day so that your urine does not become too concentrated. Your goal would be to drink about 2L of fluid each day. Try to limit any fluid intake after dinner so that you don’t have to get up through the night to pee.


Caffeine can irritate the bladder in some people. It is found in coffee, tea, colas and chocolate. If you feel that caffeine makes you urinate more often, see how things change if you replace these drinks with decaffeinated versions. If you notice a significant reduction in how often you are having to pee, it would be beneficial to reduce caffeine over the long term.


Drinks that do not irritate the bladder are:

  • water
  • milk
  • decaffeinated tea and coffee
  • diluted cranberry juice


(taken from: https://elevation-physio.com/pelvic-health-2/urinary-frequency-and-urgency/)