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Pelvic Floor Therapy and Bladder Function Basics

Through Pelvic Floor Therapy patients learn to strengthen and relax their pelvic muscles in order to improve bladder function and decrease pelvic pain. The goal is to modify bladder function to extend the time between trips to the bathroom. This can be achieved by gradually increasing the time and logging it into a bladder diary. You can say the bladder needs to be under your control, and not vice versa! With that said perhaps we should outline some bladder basics:

What does the bladder do? 

• The bladder consists of two involuntary muscles. These muscles store urine as it is produced. As the bladder fills these muscles are stretched. This stretch ultimately sends a message to empty the bladder. 

• The bladder normally holds 600ml (roughly 2 ½ cups) when full. 

How often do I need to “go”?

• 6-8 times per day, or every 2-3 hours and before age 60 it is normal to need to empty the bladder 0-1 times per night. After age 60 voiding 1-2 times per night is considered normal. 

• Holding urine in for long periods (more than 4-5 hours) is not recommended. 

Best way to empty your bladder: 

• Emptying is a “low flow” system: sit on the toilet and relax. Bearing down can strain your pelvic floor. 

• Sit down! Do not squat over the toilet as your pelvic floor muscles cannot relax. 

Taking charge of your bladder: 

• Wait until you have a mild urge to empty. Try not to develop a “Just in case” habit. If you go to the bathroom before your bladder has the chance to fill, your bladder will adapt to this and you will feel the need to go more and more often.

• If you are going more frequently than every two hours, try and distract yourself at the first urge, but go to the bathroom on the second urge. Your physical therapist can help you fill out a bladder diary and guide you.

What should I drink? 

• A healthy intake of “good” fluids is 48-64oz a day (6-8 glasses or 1.5-2L) – water is best.

• Your therapist can provide you with a list of “bladder irritants,” which can increase urgency. You will soon discover what irritates your bladder. Caffeine and alcohol are common bladder irritants.

How do I know if I am drinking the proper amount? 

• Your urine should be light yellow in color and have no odor. 

• Colorless urine may indicate that you are drinking too much water. 

• Dark color or strong smelling urine may indicate that you are dehydrated. Concentrated urine may irritate your bladder. 

Is my bladder empty? 

Sometimes your bladder does not empty completely. If you believe this happens to you, discuss it with your doctor or physical therapist.  To make sure that you empty completely, try leaning forward and back, or from side to side. 

After emptying my bladder I sometimes dribble, why?

Sometimes your bladder does not empty completely. If you believe this happens to you, discuss it with your doctor or physical therapist.  

When you think you have fully emptied, wait and count to 30, to see if your bladder will empty more. Avoid straining or pushing out your urine. Focus on breathing and relaxing the muscles around the pelvis to avoid straining. 

“Double Checking” can be helpful so when think you have emptied your bladder, stand up and or walk around inside the bathroom for a moment.    Then sit on the toilet again for the second time to see if more urine empties.  

Tell me about Skin Care  

The skin of the vulva is more sensitive and delicate. Gently pat the area after going to the bathroom and always dry from front to back for good hygiene. If your skin is very irritated, you can also try:

  • Rinsing with water in a spray bottle after you empty your bladder
  • Use fragrance free moist wipes (baby wipes) instead of toilet paper
  • Wear cotton underwear to let the area “breathe.” You will want to avoid wearing tight thong underwear.
  • Avoid using fragrant soaps in the vulva

Reach me if I can answer any questions on physical therapy, serving you locally in New York City or anywhere online virtually through “telehealth“.

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Pelvic floor disorders impact 1 in 3 women and many are surprised to learn pelvic floor physical therapy doesn’t only deal with the pelvic floor. Because our pelvic floors connect to so many other muscles and joints, it can affect many other parts of the body as well. Hence that hip or lower back pain may actually be due to pelvic floor dysfunction.  The good news—pelvic floor dysfunction is not considered a normal part of aging and can be treated successfully. Subscribe and receive my tips along with insights on the latest advancements on physical therapy including pelvic health.

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