What is considered “normal” bladder health?
Learning a physical therapy technique in class before the peeing incident in my light grey pants.
I grew up saying, “Oh, I just have a small bladder. That is why I have to pee every hour.” And I thought this was 100% true. My friends and family did not like taking road trips with me.
After taking my first pelvic floor course in 2011, I quickly learned, that is 100% NOT true. In that course, I learned that everyone’s bladder is the size of their own fist. It has the ability to expand 3 times that size when needed. I learned that I had to pee every hour, not because of the size of my bladder, but because my pelvic floor muscles were tight causing me to think my bladder was full to the maximum.
When I was in physical therapy school, I got out of my car one day while wearing light grey pants (see the picture above). I had to pee, so figured I would go when I got inside. Well instead, I completely and fully peed my pants right there in the parking lot. I had zero control. I was only 23 at the time. I figured that was normal because I was a woman and I had been told my whole life that I would pee my pants when I got older (I love that I thought 23 was older.)
The Truth
The truth about bladder health is that the bladder is a muscle and can expand and contract. It can get to 3 times the size of its resting position. You begin to feel the urge to urinate when the bladder is about 1/3 of the way full. During the day, your bladder should hold about 8-12 ounces of urine before needing to empty it. During the night, it can hold between 20-27 ounces of urine.
If you are drinking half of your body weight in ounces of water a day then ideally, you should be peeing every 2-4 hours and not waking up at night to pee if you are younger than 65 years old. This means that if a person weighs 150lbs, they should drink 75 ounces of WATER a day and pee every 2-4 hours.
If you read that and said, “NO WAY! I would be peeing all the time if I drank that much water!” Your bladder might be dehydrated causing you to need to pee more often. Since your bladder is a muscle, if it is dehydrated, then it cannot expand fully to allow you to pee less often. I challenge you to try to drink half of your body weight in ounces of water a day for 2 weeks and let us know if that increased or decreased your urgency.
If you are under 65 years old and have a healthy bladder you should not be waking up in the middle of the night because you need to pee. If you happen to wake up and pee, that is different than your bladder waking you up. If you are waking up in the middle of the night, how often are you peeing during the day? If you bladder doesn’t have a chance to fill up during the day, then how can we expect it to be able to expand at night? And, the opposite is also true…. if you hold your pee all day then at night when you muscles are relaxed, your bladder will want to pee more often.
If you are staying hydrated, then you should be peeing at least every 4 hours during the day. If you are not because you are busy, set an alarm to allow for optimal bladder health and make sure you are peeing at least every 4 hours during the day. You want to aim to pee every 2-4 hours during the day in order to let you bladder have optimal health so that you are not waking up in the middle of the night to pee. Make sure to drink all of your water needed for the day before dinner time. I know that it is dry here in Colorado, so if you need a couple of extra sips of water after dinner or to take bedtime medication, that is fine, but try to limit it to less than 4 ounces.
When you pee during the day, you should be peeing about 8-12 ounces. You can measure this with a urine hat or you can pee into a measuring cup. A less accurate, but easier way is to count using Mississippis as your pee comes out (e.g. 1 Mississippi, 2 Mississippi, 3 Mississippi…etc.) If your flow of urine is a typical flow stream, which is fairly strong, you should be peeing about 8-12 Mississippis. That is about 8-12 ounces. If you are a patient at Insight and you would like to actually measure your pee, come by our clinic and we’ll give you a urine hat.
The solution
If you find that you are not able to wait 2 hours before you need to pee next or you are waking up at night to pee, see a pelvic floor physical therapist. A pelvic floor physical therapist will assess your muscles and figure out what is causing you to pee more often. If you are unable to get into a pelvic floor therapist, or while you are waiting to see them, you can try this party trick.
You can try to decrease the urge to pee by doing calf raises. Calf raises help to “distract” the nerve to the bladder to decrease your urge to pee. Next time you have to pee, but you are not near a toilet or it hasn’t been 2 hours since you peed last, try some calf raises to see if that helps to decrease the urge.
In conclusion
The big take aways for bladder health are
Drink half of your body weight in ounces of water during the day
Pee every 2-4 hours
Count your Mississippis when you pee to make sure your bladder was actually full
Aim between 8-12 Mississippis during the day (The first pee of the morning will be more)
If you are younger than 65 and have a healthy bladder you should not be waking up in the middle of the night to pee
Do calf raises to help decrease your urge to pee
