1 (Small)

“I should go, just in case…”

Stop ?peeing just in case…

While the idea of going to the bathroom “just in case” (JIC) sounds good in theory, doing so frequently over time causes an increase in the communication signalling between the brain – bladder reflex. This type of increase gives the bladder a sense of being full prematurely, triggering the brain to alert us that it’s time to go to the bathroom prematurely. Put this cycle on repeat and you quickly find yourself going to the bathroom A LOT, and preoccupied with when/where you’ll need to go next! You may also notice how you only get one type of signal – “you need to go now!” – regardless of how much volume has actually accumulated vs the incremental warnings that should increase in intensity overtime as the bladder becomes more full. The good news is, just as this reflex was trained to become overactive, it can often be trained back to a more realistic frequency with more reliable signalling.

Special note: Overactive bladder as pregnancy progresses and also due to the increased hydration needs for breastfeeding periods do not fully apply to the references below. More research is needed to determine what are more typical voiding frequencies for these unique periods. However, noticing if you’re choosing to void because you need to vs JIC is still helpful so that you can support your brain – bladder reflex and avoid adding to communication interruptions.

A few fun facts about the bladder:

  1. It has the capacity to hold 16 oz which is quite a significant amount! It’s also designed to accumulate this volume over a 3-4hr period.
  2. Healthy urine voiding for a 24hr period is 5-7x, plus 1x overnight if needed = total of 8x
  3. Typical signalling from the bladder to the brain is designed to respond as follows: mild signal at 5-8oz, normal signal at 10-13oz, and strong signal at 14-16oz. This is intended to give us time to plan around what we’re doing in anticipation that a trip to the bathroom will need to happen soon.
  4. Overnight, the brain releases antidiuretic hormone (ADH) when we enter REM cycle sleep to help slow kidney production and prevent voiding from needing to occur so that rest can remain uninterrupted.

Some ways to help retrain an overactive brain – bladder reflex:

  1. Note how much fluid intake you are consuming and if you’re bulk drinking or sipping overtime. The former can result in filling the bladder more quickly, depending on the volume, which also makes it more challenging for the reflex to alert you gradually over time of when you need to go.
  2. Be aware of the volume of bladder irritant foods/beverages you consume as they also contribute to overactive signalling. Common examples include: Coffee, tea and carbonated drinks (even those without caffeine), beverages with artificial sugars, alcohol, citrus fruits and juices, spicy foods, tomato-based products, and chocolate.
  3. Note the time you first go to the bathroom when you wake to start your day, and if you get a signal to void less than 2hrs, ask yourself the following questions: have I consumed enough fluid since my bathroom break for my bladder to be full yet (aka 16oz)?
    1. If you answered yes, go to the bathroom and assess if the urgency signal was appropriate for the amount of urine released to help you better assess the reliability of the signal. We’re training bladder volume tolerance AND reliability of the signal (mild, normal, or strong).
    2. If you answered no, can you give yourself 10-15min to wait and see if the urge dissipates…if your bladder isn’t truly full, the urge will often resolve…cue training! Also, performing 5-10 kegels in this case and waiting a few minutes can also be effective as contractions of the pelvic floor signal the brain – bladder reflex that it’s likely not an appropriate time to void. See if you can hold it for 2hrs.
    3. Then repeat the 2hr window test again each time you void throughout the day. The more often you can do this successfully, the faster the brain – bladder relearns to fill more fully and with more reliable signaling. As 2hrs becomes easier, try 2.5hrs and so on till you reach 3-4hr comfortably.
  4. For overnight support, minimize late night fluid consumption approximately 90min before bed and void just before sleeping. If you wake in the night and feel the urge to go, try performing 5-10 kegels and/or giving yourself 10-15min of waiting time to see if the urge dissipates like I suggested for daytime voids and see if you can fall back asleep.
  5. This type of retraining can happen quickly. I’ve had patients suffer from overactive signalling for years, and be able to significantly improve their brain – bladder signalling in as little as 1 to 3weeks.

As always, these tips are general recommendations and are not a substitute for seeking individualized care from a qualified provider. If you’re suffering with overactive bladder symptoms, know that pelvic floor physical therapists are trained to support these challenges, and help unpack the WHY, so you can get back to living your life more fully, and with wayyyy less bathroom breaks 😉