Peeing all the time? Physiotherapy can help!

Symptoms of urinary urgency or frequency are very common and can be incredibly disruptive to your life. It is not a good feeling to have to run your life by where your next bathroom is.

A physiotherapist with advanced training to treat pelvic floor dysfunction can help! There are several factors that you need to look at:

1. Consider your pelvic floor: the pelvic floor muscles work like every other muscle in the body, they’re just inside. It is important to make sure you can properly engage those muscles and also relax the muscles easily. These muscles can be  involved with issues with urinary urgency and frequency or pelvic-area pain.

2. Measure things: sometimes certain tools can be used to get a big-picture sense of what is going on, and can help your Physio design the plan that will help you fastest. These can include tests like:

  • Bladder diary- provides a picture of your bladder and bowel habits, how much and what you drink to figure out any patterns. Constipation is important to address as it can impact bladder function as well as pelvic pain.
  • DASS (Depression, Anxiety and Stress Scale)
  • PCS (Pain Catastrophization Scale)

4. Look at everything:  a thorough physiotherapy assessment includes looking at how you breathe, your posture, how you move, your lower back, and overall strength—not just the pelvic floor itself. The pelvic floor muscles are very important with urinating, having a bowel movement, and sexual function.  There are many reasons for the onset of overactive pelvic floor muscles, and it is important to get to the driver or source of this in order to move symptoms forward.

5. Diet modification– caffeine, alcohol, carbonated beverages, tomato products, citrus fruits and juices and cranberry juice are several irritants that can contribute to intense discomfort. Sometimes they need to be stopped for a period of time to help symptoms.

6. Breathing– HOW you are breathing matters! Purposeful deep breathing can calm your nervous system, and can be one of the easiest, yet most effective, interventions to learn.

7. Help improve sleep– three out of four people who have ongoing pelvic pain have difficulty staying asleep, and that is worse if you have to get up in the night to pee. Going to sleep at the same time every day, staying warm, and no screens right before bed can all be helpful.

8. Manual therapy– different treatment techniques will be helpful for different people—one thing does not work for everyone, of course! Your Physio will likely want to work with stretching or strengthening different muscles (pelvic floor and others), and techniques for your nerves and connective tissue With the pelvic floor, it is possible to be both too tight and too weak, and lengthening must be addressed first.

9. Exercise: exercises that are fun, non-irritating and novel will help to change the brain to look at pain differently.

All of these things can help change pain, frequency or urgency issues to help get better, faster!

How Normal is it to Pee in the Night?

I always hesitate to use the word “normal”, as there are so many factors that go into how often you pee.  If you typically get up once in the night, then that is probably normal for you.  If your sleep is disrupted because you’re getting up more frequently, then possibly something needs to change during the day while you’re awake.

  1. Are you drinking too much after dinner?  Assuming you’ve been drinking fluids through the day and your kidneys are working properly, stopping all fluid intake 2-3 hours before bed will reduce waking up at night.
  2. Are you drinking alcohol or caffeine?  Both are diuretics, meaning they make the body produce more urine. Enough said.
  3. Are you pregnant?  There is a pregnancy hormone called human chorionic gonadotropin (hCG), which will increase blood flow to the kidneys and uterus—this will put pressure on the bladder.
  4. Do you take medications for high plod pressure, muscle relaxants or sedatives? Some of these drugs can make you pee more.
  5. Are you over 60?  As you age, the bladder tends to not hold as much, so if you’re drinking the same amount as when you’re younger, then you may have to pee more often. As well, menopausal women can have changes in the urethral tissue—the tube from the bladder that urine flows out—that make the urge to pee more prominent in the brain, so women may want to keep less in the bladder and empty more often.
  6. Do you have a UTI or prostate issue? If peeing in the night is also associated with burning or urgency, it could be due to a UTI or enlarged prostate.  A larger prostate can lead to thickening of the bladder tissue, and the prostate can make the urethra smaller, so the bladder holds less and is less elastic, and then has to push against the obstruction of the prostate. This equals more peeing, day and night.

When should you get it checked?

If you are up a few times in the night, try to keep a bladder diary for two 24 hour periods and see if there is a pattern—track how much you take in, what you are drinking, how often you pee, and how long is the flow of pee in seconds.  If you’re peeing more than 8 times in any 24 hour period, that is likely too much. If frequent peeing is also associated with increased thirst, weight loss or increased appetite, you should get checked by your family doctor. If you notice the frequency of peeing in the night getting worse, if you see blood in your urine, it is painful to pee, or if you’re going to pee often but only in small amounts, then get checked by your doctor.

Really, the pelvic floor?

If you’re peeing often, or have real urgency to pee through the day or night, then sometimes the brain and the pelvic floor can be the cause. If other things, like UTI or prostate issues, have been ruled out, sometimes having a pelvic floor that is too tight or too weak (or both) can be an issue.  The pelvic floor is often ignored by most until they have a problem.  At Elevation Physiotherapy & Wellness, we are your pelvic floor specialists who can help with bladder frequency and urgency due to pelvic floor issues—there is much that can be done, let’s start now!