We all can develop some toileting tendencies that over time, can be detrimental to the relationship between our bladder and our pelvic floor muscles. It becomes especially important to address any of these “bladder bad habits” when a woman has a pelvic floor condition such as stress urinary incontinence, urge urinary incontinence, pelvic organ prolapse (cystocele or urethrocele), overactive bladder, or interstitial cystitis (painful bladder syndrome), to name a few. Even if you aren’t currently experiencing any of these conditions, it never hurts to be proactive and address any counterproductive behaviors to ensure your bladder remains healthy and happy.
Bladder “bad habit” #1: Hovering over a toilet seat. I think as women, we are often guilty of doing this in public bathrooms or when traveling. The reason why we want to avoid hovering over the toilet seat is twofold. First, hovering disrupts the natural reflex that should be occurring between the pelvic floor muscles and the bladder. When the bladder is filling, the bladder muscle should be relaxed or “off” and the pelvic floor muscles are “on” to prevent leaks from occurring. When you get to a toilet, the bladder muscle turns “on” to empty the bladder, and the pelvic floor should relax or turn “off” to allow emptying to occur. If you are hovering, both muscle groups are “on” at the same time and working against each other.
Second, when you hover over the toilet seat, your pelvic floor muscles can’t fully relax because they are working as part of your core to support you in this semi-squatting position. If the pelvic floor muscles can’t fully relax, it is difficult for the bladder to fully empty, and this can put you at risk of developing urinary retention. If urinary retention is occurring, you may notice that you are having multiple little small voids less than an hour apart. Because the bladder wasn’t able to fully empty, now you are getting the urge to go again and you just went!
Bladder "bad habit" #2: “power peeing”! So as we mentioned above, in the normal emptying reflex, the bladder muscle is on and the pelvic floor muscles should be off to allow emptying to occur. Many of us women are just too busy to have time for peeing! Many women tell me that they sit down and try to hold their breath to bear down or use their abdominal muscles to try to increase their flow rate and just push the urine out faster. As much as I understand that we are all busy, we need to take time to just sit down, relax, and allow emptying to happen. Bearing down to get the urine out faster again disrupts that normal bladder/pelvic floor muscle reflex and can also put you at risk of pelvic organ prolapse. Holding your breath or bearing down using your abdominal muscles can really put a lot of excess strain on all the connective tissues that hold up our pelvic organs!
Bladder "bad habit" #3: Going “just in case”. So what I mean by this is minimizing the amount of times you urinate without feeling a true urge to go. For example, say you are going out shopping for the day or out for a drive and you don’t feel an urge to urinate but you decide to go “just in case” before you leave the house. Or say that every time before you leave for a run you decide to do the same thing. Or another common example is when a woman is waking up during the night to nurse her baby and she decides to urinate before she goes back to bed since she’s up anyway. Now the key here in all of these situations is there is no urge or sensation of needing to urinate, but she decides to go anyway.
Over time, this can train the bladder to associate certain situations with a signal or urge to you that you need to go, when in fact the bladder is not very full at all. The bladder starts to associate that it’s time to empty every night at 3am long after you are nursing for example, or every time you are getting ready to leave the house. It starts to give you a strong urge when it is only ¼ full instead of when it’s ¾ full. What I would suggest is wait until you have a true urge to urinate, and only go before leaving the house without an urge if you know that there won’t be any bathrooms available when you’re out and about.
Now that you know more about your bladder and its relationship to your pelvic floor, you can start to make some of these simple changes in your bathroom habits. Your pelvic floor and your bladder will thank you! Of course, if you want to learn more about your bladder, pelvic floor, or if you are dealing specifically with any of the conditions that I mentioned at the beginning of the blog, don’t hesitate to reach out to a pelvic floor PT for help!
So what got you into pelvic floor PT? This is a question that I get asked fairly often by clients as they get to know me. Honestly, I never envisioned myself as a pelvic floor PT and in fact, earlier in my career it was an area of PT that I had written off for myself without knowing much about it. But it’s funny how life works and how suddenly the thing I was sure I would never do became one of the things I am most passionate about.
A combination of life events, witnessing first-hand the vast gaps in women’s pelvic healthcare, and ignorant marketing commercials all fed into this little flame of passion within me that I can only describe as a call. A definite calling that even though I didn’t know much about pelvic floor PT, and no matter how much easier it would be to stay in my comfort zone, I needed to do everything I could to learn more and to let women know that they are not alone, they should not feel ashamed, and there IS help.
This is the wrapper from a Dove chocolate that I snagged when I was taking my first Herman and Wallace continuing education course to be trained to perform internal pelvic floor muscle evaluations and treat women with pelvic floor conditions. I knew I was in the exact right place at the exact right time when I opened up this wrapper and saw “It’s your call”.
Since having the opportunity to work with women with pelvic floor conditions, I have witnessed so many amazing life transformations. It is so rewarding to be able to empower a woman with knowledge about her body and to be able to see her take that and run with it. To be able to sometimes be one of the first people to say, you are NOT crazy and you are not the only one with this issue, and there are actually so many things we can do besides “just learning to live with it”.
So yeah, that’s what got me into pelvic floor PT and that’s what keeps me loving to do it.
Dr. Julie Berube is a pelvic floor physical therapist who is on a mission to revolutionize the standard of healthcare for women in Central New York and the Syracuse area.