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Problems with Urinating

By Dr. Brooke Meinema, DPT, FAFS

There can be a lot of issues when it comes to urinating – pain, symmetry, or difficulty starting the flow of urine. Not all issues are reasons for concern, but some of them can be very frustrating to deal with. Here are a few common concerns we hear about.

  • Asymmetrical stream
    • Some people report noticing their urine always sprays to one side (or just sprays and splatters in general). This can be caused by tension in the pelvic floor putting increased pressure on the urethra. If the tension on one side of the pelvic floor is tighter, that can create an uneven tug on the urethra causing your stream to go in one direction. This isn’t anything you should necessarily worry about, but if you’ve noticed this, it would be a good idea to start working on reducing the tension in your pelvic floor to allow for a more even stream as well as prevent any more issues from arising.
  • Difficulty initiating flow
    • It’s not uncommon to have a hard time initiating the flow of urine from time to time, but if this is a regular challenge for you, you may have high tone through your pelvic floor muscles. Our pelvic floor muscles work in combination with the muscles in our bladder; when the muscles in the pelvic floor relax, the muscles in the bladder are allowed to contract to push the urine out and vice versa. If the muscles in our pelvic floors are too tight and have a hard time relaxing, it can give mixed signals to the bladder making it difficult to initiate the stream of urine. Having to sit on a toilet and give your pelvic floor a pep talk every time you have to urinate should not be happening. Like with the asymmetrical stream, this population would benefit from working on reducing tension and tone in your pelvic floor muscles. Think pelvic and hip opening exercises and gentle relaxation approaches.
  • “Power peeing”
    • Forcefully urinating by bearing down is not a good habit to get into. Our bladders should be able to comfortably release urine without the need to “push the pee out”. Power peeing can lead to other issues with abdominal tension, pelvic strain, worsening pelvic organ prolapse symptoms, and worsening leaking symptoms.
  • Stop the flow while urinating to “test your pelvic floor strength”
    • I’ve heard a lot of people working on increasing their pelvic floor strength by stopping the flow of urine mid-stream. This is a mistake! This can create issues with your bladder knowing how to coordinate urinating. If you are telling your bladder mid-stream to stop, you may develop issues initiating the flow of urine or having your stream start and stop without you wanting it to. This also increases your risk of developing a UTI, which nobody wants! There are better ways to strengthen your pelvic floor.
  • Burning during urinating (without active infection)
    • Having symptoms of a UTI (burning, frequency, etc.) without the presence of an active infection can be a sign of pelvic floor dysfunction. If the muscles in the pelvic floor get too tight, it can compress the urethra which may lead to a burning sensation. Imagine it this way: if you try to blow forcefully through a straw, it might make your cheeks burn. The same principle applies to compression through the urethra. Reducing tension in the pelvic floor through manual work and pelvic opening stretches can alleviate these symptoms.

*If you are experiencing symptoms of a UTI, always get a urine sample tested to make sure there is an active infection.

  • Leaking when you stand up after finishing urinating
    • When we sit to urinate, the position of our bladder can sometimes allow for a small amount of urine to sit in a pocket of the bladder and not come out until we go to stand up. If you find yourself leaking a little bit after you finish urinating, you can try “double voiding” to prevent this. After finishing urinating, lean forward to allow the pelvis to tilt which changes the position of the bladder to encourage the last little bit of urine to empty.
  • Frequent urination
    • If you find yourself scoping out the nearest bathroom every time you go out and about, I’m talking to you about this one. There are many reasons you may experience this, but for so many people it comes down to habitual urination. First step: stop “just in case” peeing! This is when you go to the bathroom “just in case” so you don’t have to go later. This trains your bladder to feel the urge to empty at even the smallest amount. Also, your bladder is a muscle; it can get stronger just like every other muscle to help it have the strength to hold more urine without leaking. (Note: there are times when it is ok to “just in case pee”: before going to bed, after intercourse, and if you know you will not be able to access a bathroom for a very long time.) There are other potential causes for having to urinate frequently, and these are also treatable with the right help.

Not seeing your complaint or concern above? Reach out to one of our women’s health therapists to discuss what you need help with! We would be happy to hear about your symptoms and develop a plan for going forward.

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