My Physical Therapist Helped Me Break Up With John

“Gotta go, gotta go, gotta go right now?” Frequent urination is a real problem for millions of Americans. It can interfere with so many aspects of life, like school, travel, shopping, work and sleep! Urinary frequency can have many causes, and the good news is that it is typically easy to remedy. Oftentimes the culprit is something as easy as looking at what is in your glass or on your plate!

How Often Should I Use the Restroom?

Let’s take a look at “normal” urination and bladder function. Typically a person with a normal voiding pattern will urinate between 4-8 times per day, and 0-1 times at night (1-2 times at night if you are over 65).³ A normal-sized bladder usually will be able to hold urine for 2-5 hours and approximately two cups of fluid.⁴ Your bladder will fill more quickly in the presence of caffeine, alcohol, certain medications and carbonation.

Medical, Physical or Behavioral?

If you feel the constant need to run to the bathroom, it is important to find the cause. Problems can be medical, physical or behavioral. Let’s look at a few medical causes: First and foremost, if you have a fever, confusion, blood in your urine, pain with urination, or difficulty voiding, it’s time to visit your doctor to rule out infection or stones. Patients that complain of thirst and report urinating large amounts of fluid could be demonstrating signs of diabetes. Interstitial cystitis, chronic constipation, neurological dysfunction, radiation therapy, and use of blood pressure medications are also culprits. Previous surgeries, scar tissue, yeast infections, and hormonal changes can play a part in frequent voiding. All of these issues should be considered by your physician.

Physically, prostate issues can slow or interrupt the stream of urine, which can lead to incomplete bladder emptying and therefore frequent urination. Tight pelvic floor muscles can also cause urinary hesitancy, intermittent urine stream and difficulty passing urine. The pelvic floor is a sling-like hammock of muscles that supports all the pelvic organs, including the bladder, rectum and uterus. This group of muscles controls the opening and closure of three things; the urethra, vagina and rectum. Pelvic floor dysfunction is easily treated by a men’s or women’s health physical therapist. Obesity also can create undue pressure on the bladder. Of course, pregnant mommies can attest to frequent trips to the bathroom due to hormonal changes, as well as the weight of that little babe on the bladder.

Many times, the cause of urinary frequency is behavioral and can be remedied. This is where a physical therapist can really help. By keeping a simple bladder diary for a couple of days, we can assess what foods and/or drinks may be triggering your bladder. A good way to remember these triggers is to think of the three “A’s” and the 4 “C’s.” Artificial sweeteners, alcohol, and acidic foods (tomatoes, lemons, oranges, vinegar) are bladder irritants for many. The four “C’s” include citrus, cranberry, carbonation, and caffeine (including coffee, soda, tea, and sadly, chocolate… sorry)¹. When your bladder is irritated, it wants to rid itself of the irritant so it will begin to contract. Keeping track of the foods and drinks you consume can help identify what may be an issue for your bladder. Some other interesting triggers include onions, spicy foods, aged cheeses, gluten, processed foods and MSG. Everyone is different.

Consider this example of a behavioral cause: you run to the bathroom every time you get a little twinge of an urge, your bladder gets used to being emptied when it really is not full. Remember, a normal bladder should be able to hold urine for about two hours. So if you are voiding every hour, your bladder is not full. Your brain and bladder start to think that every hour is “normal,” so you will be triggered to go before it is actually time. This is easily remedied for most people by bladder re-training, as instructed by your physical therapist. Please note, there are a few exceptions to this rule for those with other medical problems.

Urinary frequency can be caused by overactive bladder, or urinary urgency. Some people have to dart to the restroom as soon as they get home, even if they just went not very long ago. Others have to go if they hear or touch water. Other patients tell me that every time they go to a certain store they are triggered to go. This is called urinary urgency and can also be re-trained with your physical therapist. Unfortunately, some patients report these symptoms to their doctor and are prescribed overactive bladder medication, which can dry out not only the bladder, but also the bowels, eyes, mouth and brain.

Breaking Up with John

Many people believe that drinking less fluid will alleviate those frequent trips to see John. However, the bladder is sensitive and does not like concentrated urine. It likes diluted urine. If your urine is yellow and concentrated, the bladder will want to expel it because it is irritating. Your bladder is much more willing to tolerate and hold urine that is diluted. Drink plenty of water and keep the urinary tract healthy and flushed. With a little investigating, you may be able to easily remedy urinary frequency.

You may want to start drafting your “Dear John” letter, because you may be seeing a lot less of him in the near future. Call Athletico Physical Therapy today to schedule a free assessment by a men’s or women’s health physical therapist to discuss how take charge of your urinary frequency!

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The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References:
1. Prendegast S, Rummer E. Pelvic Pain Explained. Lanham: Rowmann and Littlefield; 2016.
2. Wilson L, Brown JS, Shin GP et al.: Annual direct cost of urinary incontninence. Obstet Gynecol, 2001, 98: 398-406.
3. “Nocturia or Frequent Urination at Night.” National Sleep Foundation, www.sleepfoundation.org/articles/nocturia-or-frequent-urination-night.
4. “How Much Urine Can a Healthy Bladder Hold?” LiveScience, Purch, 4 Dec. 2012, www.livescience.com/32330-how-much-urine-can-a-healthy-bladder-hold.html.