Looking for some more fine grained information on bladder training
August 5, 2022 4:20 AM   Subscribe

I have a tight pelvis (CPPS) as far as I can tell. I'm working on that, but part of the treatment that has been recommended has been retraining my bladder. I've found protocols online, but have questions for those who are more knowledgeable! Also some general bladder questions

First off, I know you're not my doctor. I live in a country where physical therapy is still very nascent...while I'd love to have a great PT I could chat with about this, at the moment I do not. That said, by all accounts, bladder training seems pretty safe to do on one's own, assuming they have ruled out other more serious health issues (which I have to the best of my knowledge, though I welcome suggestions on diagnostics to look into-where I live diagnostics are pretty cheap, even if the quality of doctors is not the best). I'm working on the CPPS separately and thus far have had ok results, but it'll be a long term thing.

First the more general questions...I should say that on the bladder front, simply workign on loosening my pelvic floor has had pretty amazing results. I've always had an overactive bladder and it has definitely gotten worse, but working to loosen my pelvis (breathing exercises, reverse kegels, "dropping" my pelvis in my daily life) has helped significantly. That said, somethign odd has happened...I can go quite a long time (3-4 hours, which is crazy compared to how I use to be) without peeing, but for much of that I might have a low key "...don't you need to pee?" type feeling. It's ignorable, but I guess in the past I would just...go pee, even if there wasn't that much (thus the overactive bladder). Thus far I've just been ignoring it and hoping it'll get better as my brain learns to adjust. Is that justified?

To add onto that, the other day I had a particularly weird experience...I had the feeling mentioned above. I knew I didn't need to pee, but sort of had that low grade "you need to pee, don't you?" feeling for ~2 hours. Then it just...went away. Which freaked me out! I mean, it's great on the one hand, but just a totally new feeling for someone used to peeing a lot, you know? Any clue what might have been going on there?

So after having someone recommend bladder training, it seemed more principled than just "hold it as long as I can until I can't no mo'"...is that justified? I guess I'm not sure what can go wrong if you just hold it until you get that "ok I REALLY need to go feeling", unless of course you're holding it for extremely long periods of time (to my knowledge, going every 3-4 hours seems good, holding it a lot longer than that is bad). But I became afraid...what if I lost the ability to know when I actually need to pee? Will I do other damage? These would be great questions for a knowledgeable PT, eh? *sigh*

So I've been looking into bladder training, and the protocol seems very reasonable. They all seem the same (happy for a rec of a nice detailed protocol if you have one!), but this is the one I was pointed to: https://www.health.harvard.edu/healthbeat/training-your-bladder

The protocol itself is pretty simple, but this is where my compulsive self got into a bunch of questions about the minutia of the protocol...the main jist has to do with how to handle cases where you are forced to deviate from the protocol not because you have to go (it speaks to that), but rather because of other factors.

For the case of these questions, we will say that the protocol is on a 2 hour interval, you've gone at 12pm, so the next time you should go is at 2pm. However, for whatever reason you know you won't be near a toilet at 2pm, but you may be near one at 230pm. What should you do? Do you go before-hand? Do you try and make it until you go after? And after that, do you still aim for 4pm? I guess part of these protocols that is a little odd to me is that it seems that, essentially based on when you wake up, you set your pee times for the rest of the day...instead of saying, after each time you pee, wait 2 hours (or whatever your current interval is) until the next one. The harvard protocol speaks to what to do in the case that you biologically have to go before your proper time, but not to do in the above cases...eg what if you are foced by circumstance to wait longer than the appointed time? Or must go earlier?

A related question is bowel movements...I guess you can try and target having bowel movements at the same time as your next pee, but of course that is not always possible...and so biologically you will end up peeing off schedule when you might not really need to. Like if you end up having to take a bowel movement at 1pm in the above example...do you still pee at 2pm? I guess so?

Beyond fine grained questions about timing...when does bladder training "end"? And what does the end-game look like? Like let's say you get to the point where you can go 4 hours between urinating, like a clock. At that point, do you still schedule your peeing? Or do you just shifting to "going when you need to," keeping an eye out to vacuate every 3-4 hours?

Lastly, I welcome any wisdom/protocols/avenues for exploration when it comes to training one's bladder to be less overactive. I have other related to things to work on (like the aforementioned tight pelvis), but I welcome it. While the above seems to all be helpign during the day, I also wake up at night to pee and I don't think this well help with that...
posted by damedeshou to Health & Fitness (2 answers total) 2 users marked this as a favorite
I'm not an expert but - since the goal of bladder training is to be able to wait longer between pees, then holding it slightly longer sometimes due to being busy is probably good, and peeing early sometimes to make space for life activities is probably fine.

It sounds to me like you think about pee a lot so maybe it'd be helpful to share my own pee schedule as a baseline, and some pee thoughts.

I have a big bladder (held my pees as a child because my school had gross bathrooms) and I pee less often than many of my friends. I'm also probably a bit chronically dehydrated but not a horrible amount. I usually pee every 3-4 hours, but can hold it for longer if I'm busy, and I go more often if it's convenient and the bathroom is clean and nearby. It's definitely not like a clock or on a set schedule. I don't schedule pee or really think of it at all, I just feel the need to pee, non-urgent, and then within 15 minutes I make time to pee.

It's totally possible to feel the "I have some pee" feeling and then it goes away. It just happened to me as I'm typing this, in fact. To it means, "there is pee in me, but not an urgent amount." If I'm out of my house and have delayed a pee, I might feel a somewhat urgent need to pee but generally I could still hold it for 15-30 minutes if I needed to.

The fact that you feel a lot of pee urgency makes me wonder if you might have a low-grade UTI? It adds to the urgency feeling. Maybe get checked for that periodically? If you're drinking a lot of water and peeing a lot you may be flushing out your bladder to a level that the bacterial count is low, maybe even too low to register on a test, but your bladder could still be mildly inflamed in there and it's causing urgency (this is not medical advice, just logic - I once tested positive for a mild UTI and wanted to avoid antibiotics at that time for other reasons, so I chased it away by drinking tons of water and peeing a ton... you might be just on the threshhold of feeling it but it not registering on a test).

Peeing in the middle of the night is very normal for adults. Between the ages of about 20-30 I never did, now I do every night.

The only time I think about pee is that I make a point of peeing every time I leave a place with a clean bathroom, whether I want to pee or not, because I want to be able to avoid dirty bathrooms. So if I'm going to the mall, I always pee before I leave my house.

I pee 5-6 times a day: when I wake up, around lunch, 1-2 "extra pees" a day before I leave my home just to make sure I won't have to pee in an undesirable bathroom, once in the evening, once right before bed, and once in the middle of the night. If I drink a lot, especially coffee or beer, it might add 1-2 pees to that day.

I think it's more normal to pee "X hours after drinking a glass of water" rather than to pee "at Xpm on the dot". Your body is less like a clock, more like a conveyer belt.
posted by nouvelle-personne at 9:12 AM on August 5

If you experience urinary frequency or incontinence, even mild constipation may be a cause. Most Americans don't eat nearly enough fiber, no idea about your country, but in my experience, especially as a post-menopausal person who bladder became so volatile after most of my estrogen abandoned me, eating more soluble & insoluble fiber makes all the difference.
posted by theora55 at 9:52 AM on August 5 [1 favorite]

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