Two tricky questions…

Other health and hygiene questions are easy.  How often should you clean your teeth?   Wash your hair?  Change your pants? But these two bladder questions – How much should you drink? and When should you wee? are full of issues, myths & legends. This article helps you understand the UK guidelines, understand why how much you drink influences when you will wee – and offers tips & tricks to for a happy bladder!

Bladders & drinks FAQs

• Does how much you drink cover just water or all your drinks? 
• Are tea and coffee drinks? 
• What about the milk in your cereal? 
• Is it different if you are taller/smaller, fatter/thinner or breastfeeding? 
• Is it better  to have a few big drinks or sip from a bottle all day? 
• Should we wee when we first feel it or when we are busting? 
• Is it ok to hang on……..but how long is hanging on for too long? 
• Am I normal if I wee in the night?   
• Is it ok to have just a tiny wee before you go out the door?   ………

Phew….see what I mean about a tricky subject?!

How much water should you drink: official guidelines

Your body needs water or other fluids to work properly and to avoid dehydration. That’s why it’s important to drink enough fluids. In climates such as the UK’s, we should drink about 1.2 litres (six to eight glasses) of fluid every day to stop us getting dehyrated. In hotter climates, the body needs more than this. We also get some fluid from the food we eat.

NHS Choices

Extra (practical & useful) tips & info:

Normal fluid intake should be 1.2 to MAX 2 litres in a 24 hour period.

 It is NOT 1.2 litres of water on top of all your other drinks

• This is ALL fluids added up together (tea, coffee, water, juices, alcohol).
• 1.5-2 litres equates to 6-8 standard 250ml mugs a day, or 4 x 500ml water bottles.
• Don’t count the milk in your cereal. But if you have soup for lunch, jelly to follow and smoothies to drink you might want to be aware of their impact on the total volume.   
• If you are breastfeeding or doing sweaty exercise you may need an extra glass here & there to replace lost fluid. But unless you sweat profusely or produce gallons of breast milk – this is not nearly as much as you think. 
• Drinks should be evenly spaced at approx 2 hour intervals. With the last proper drink 2 hours before bedtime (ideally non-caffeine), just sips thereafter. 

How to be nice to your bladder: filling tips

Let’s talk through the look of a ‘normal’ day, in an untroubled happy bladder world. It will help your brain understand how it should all work. 

If you have been suffering with mad dashes to the loo, uncomfortable and inconvenient urges and bladder accidents, these habits will really help. 

# 1 . Take an ‘organised approach’ to when to fill & empty the bladder

A standard mug or glass (of tea, coffee, water etc) is 250ml. Many people are often surprised to realise that you therefore need no more than 6-8 mugs/glasses in 24 hours.

The bladder prefers regular and spaced filling intervals rather than droughts or floods. Though the bottled­ water companies would like to persuade us differently, it is not normal to be constantly sipping water.  A drink every couple of hours should rather nicely lead to needing a wee every couple of hours. 

• If you look at your wee when it comes out it should be pale yellow.  If it looks like water you are drinking too much, if it is dark yellow you are not drinking enough.
• Drink every half an hour ? Guess what…you are going to need to wee every half an hour…
• If 1.2 litres IN gives you 5-6 wees out. Then if you are drinking 3 litres a day, simple maths says that’s about 12 standard wees. Or 6 very very full bursting ones. Those bursting wees are highly likely to be accompanied by some unpleasant sensations or not quite making it!  Cut back on the volume (to 1.2 litres a day) and you could get an instantly happier bladder. 
• Monitor your fluid intake carefully for a few days. Your ‘bladder’ problem could be merely operator error at the filling end.

# 2 Not all drinks are equal

It can seem strange that we say 1.2 litres of FLUID and don’t distinguish water from other drinks.  Tea and coffee are, however, just water with flavoring.  Think how you pour the water out of the kettle?

So they will hydrate you but…you might want to think how the ‘flavoring’ could affect you:

• Caffeine is a known bladder irritant. Some people notice that they react worse to ‘real’ coffee than instant (or vice versa).  Adding fat (milk or cream or on trend is butter!) slows the absorbtion of caffeine.
• Tea can be ‘light’ by design (eg Earl or Lady Grey). Or light in the making; a few leaves gently steeped is very different from squashing the teabag to death in a mug.  The ‘builders’ tea’ version has extra caffeine and tannins – that’s what stains the mug.

• Alcohol is a diuretic (for every glass in, you will get one and half out…think hangover…dry mouth, dehydration, headache…).   
• You may notice your bladder reacts to certain types of alcohol (spirits, wine, fizz) differently.  Find your tipple of choice and note what to avoid when there isn’t a handy toilet!
• Fizzy water and de-caf coffee can also be irritating for some people. It is thought that it is something about the manufacturing process.
• Watch out for ‘sneaky’ ingredients.  Fruit teas are high in sugar. Green tea has caffeine (and is also a diruetic – hence drunk on ‘diets’). Many hot chocolates are high in sugar & can contain caffeine.

#3 Take more notice of how drinks affect you

Start to notice how long it takes for different drinks to pass through you and make your bladder uncomfortable. 

Squeezy App (which reminds you to do your pelvic floor exercises) has a bladder diary you can use to monitor your fluid intake and trips to the loo or download a chart here.

• You may find you are not as ‘tolerant’ of your favorite drink as you used to be. 
• Don’t feel you have to go cold turkey. Just cut down a bit on the likely culprits. Then increase the balance of plain water. You will likely see a quick reduction in bladder urgency and increased capacity to hold. 
• Pick your moments. It doesn’t mean you can’t drink your favorite double strength cappaccino…but maybe not just before a long car journey or the cinema?

#4 Sweating? Breastfeeding?  When you might need extra fluid

Hot days & exercise:   We don’t just lose fluid from our bodies when we wee.  It also escapes from our body in our breath (think how you can steam up a mirror). Also when we sweat.  If it is a hot day, we need extra fluid.  If you are doing an extra sweaty activity, drink a little extra before and be sure to re-hydrate after.  “Guesstimate” the amount that you might have glowed away. As well as the drink you were probably due about then anyway. But don’t over do it.

Breastfeeding: It is important to have some extra fluid each time you feed…but again don’t over do the drinking or you will just be weeing more. To estimate the amount you need to re-hydrate – think about the milk volume that you produce when you express? Probably about  200-400ml?  So an extra glass/mug of fluid is all you need back again. You don’t need to down a pint of water – your poor bladder will just fill to bursting really quickly and not love you for it.

When should you have a wee?

A quick summary of the daily OUT routine. IF you are drinking 1.2 litres fluids in 24 hours (which is one 250ml mug roughly every 2 hours)

• One wee in the middle of the night is considered normal 
• On waking up expect a BIG wee  (400-600ml) – you could possibly fill a pint glass
• Then through the day expect 5-6 average wees (200-400ml) – each one could fill a big mug
• You do not need to wait until you are bursting to empty your bladder.
• Aim to empty when your bladder holds a good mug-full. Little ‘yogurt pot’ wees should be avoided.

How to be nice to your bladder: emptying tips

# 1 The first sensation is usually too early

 After 45 minutes to an hour your bladder would normally hold about 120ml (a yogurt pot) of urine. Then you would get a ‘I might need a wee‘ sensation. This happens as the walls of the bladder (it’s a muscle) stretch for the first time.  

Our brains should know to recognise this as an ‘irritating-stretching-message’ not a ‘need-a-wee-now’ message.  Subconsciously we should

• clock the time,
• do the maths (only an hour since I last had  a wee)
• tighten our pelvic floor muscles in a slow steady way,
• distract ourselves with the job in hand

and within 2-3 minutes the feeling of wanting a wee completely disappears – like we never needed one in the first place – we go on with our activities, almost forgetting that we have a bladder.

This is the bladder’s normal first response.

That first annoying signal isn’t particularly useful. It’s just a very early warning signal. Like your petrol gauge alerting you when you still have 60 miles in the tank.   You don’t need a wee when there is only a yogurt pot worth in the bladder, even if the bladder feels a bit scratchy about it.  Just ignore it and it will go away.

 If circumstances are justified,  it’s ok to have a “just-in-case” or “safety wee“.  Say you’re  about to go on a a long car journey. Or about to have a swim or a shower. Or go to bed.  Then it makes sense to get rid of even the 120ml so that you have a long run ahead of you.  But you need to justify to yourself why you didn’t just ignore the feeling.   Otherwise it can quickly become a habit to have a wee every time you get a bit of sensation. That can be very disabling.

#2 . Ignore the first message and wait for the next one

Normally, that first message quickly disappears. We forget all about the bladder. We can fill it for a second hour (or so) till there is more like 300ml. Think a large ‘Cath Kidston’ mug-worth. Then you should get a dullish, polite “you need a wee” sensation that sends us off for a comfortable-but-not-urgent wee. 

This is when you should go.  There is still a bit of room in the bladder. If you have to stand in a queue, find your front door keys, answer the phone.  There is a bit of give and it is not too heavy if you need a cough or a sneeze.

# 3. But do not leave it for a third or fourth message…

But do we go when we should go??  Of course not……Many people (and especially busy, distracted mums)  leave it TOO LATE.  

You can ignore the middle message, and head into a third or even fourth hour. You can fill to nearly a pint (shift workers, teachers and nurses can often hold even more). BUT filling to your max tends to be accompanied by a sudden, very uncomfortable and urgent “need for a wee” message. The type that makes you sweat, your eyes water and comes with a strong sense of panic. Panic that you might not make it (and indeed you might not). 

These maximum capacity wees are intended for first thing in the morning or an emergency.  BTW an emergency is being unexpectedly stuck on a motorway. NOT just putting it off for …one more paragraph, one more chore or an advert break.   And not just because you are too busy to remember to go for a wee!

#4 . Is there really something wrong with your bladder – or is it poor human judgement?

So many times the problem is really operator error. The human operator is not listening to the (rather good) system properly.  Guilty???  Which are you? Tend to go too early (friends and family tease you about always needing a wee)? Or tend to leave it too late (lots of sweaty near misses or trouble at the front door)?!

Or, not uncommon are you swinging between too early and too late? Do you push your limits…push your limits…leave it…leave it…just one more thing and THEN you very nearly have an accident?!  The problem is this makes your bladder very nervous. You start doing lots of little wees as soon as you feel something, just to be safe. You keep weeing early to avoid another bad experience? But then you think…this is silly… I need to train my bladder. So you start again, filling and filling, past the ‘right’ signal, on up and up …nearly bursting.. having an accident. And then you get nervous and go early again….a real viscious cycle.

What can you do to improve your bladder habits?

Homework this week. When you are heading to the toilet for a wee, try to predict the size of the wee you are going to have. Use the simple categories of:

• yogurt pot
• big mug
• or pint class

( aka: small, medium and large).

I’m prepared to take a reasonably large bet that as soon as you start taking a bit more notice of what’s going in at the top and what the wees feel like at the different size points, you will quickly  tune in to the bladder sensations and interpret the messages better.

The hardest one to spot and get in tune with is the ‘middle’ one. It can almost be too polite to be properly useful.  A bit more interesting would mean it wasn’t so easily missed!  But we can’t change nature. Once you are familiar with the feeling of a “comfortable-size wee” you will be able to spot when to have a wee more easily. This will help stop the cycle of under or over-filling.

Exceptions – when to seek more help

If you thought you were going to have an enormous wee but only get a tiny one – or a tiny one but get far more – you may find your body is not well tuned to the sensations.  Sometimes the nerves stay confused after the pressures of pregnancy and childbirth and need retraining.   

If you do not feel that you get the ‘right’ sensations guiding you towards having a wee at that middle point and you leave it too late before the bladder suddenly decides for you, or you get unexpected leakage, then I would suggest you use the clock as a guide for a while (but all the while trying to tune in to any sensations you are getting).

Start with an hour, then have a wee, noticing how small they are at this stage. Then, once you are comfortable with this, don’t stick here too long or your bladder will get into an annoying ‘habit’ of thinking this is all you can do. Move up in 15 minute increments as feels comfortable and ‘safe’ to do.   Remember the goal is just 2-3 hours of holding  – no need for more. 

There are also medical conditions of the bladder

• Overactive Bladder (OAB), often colloquially termed ‘irritable bladder’ is a pathology with symptoms of frequency, urgency and urge incontinence.  Commonly you feel a strong urge to wee but only a small wee comes out. Or you feel the bladder suddenly contract and leak, partially or completely (called urge incontinence).  If you have tried the tips above, but you still struggle with bladder control, keep a bladder diary to discuss the pattern with your GP.  There is medication that can help ‘calm’ a bladder. Or working with a physiotherapist on your pelvic floor muscles will also improve your control.
• You can have a low grade bladder infection and not necessarily realise this.  Watch for cloudy urine, funny smells, feeling off colour.  The dipstix test at the GP is not that reliable – you may need to send your urine off for testing
• You may not be making the hormones that suppress night time bladder production. If you have massive urine volumes at night, even though you are not drinking, discuss this with your GP.
• Paradoxically – wearing a pad to prevent leakage can irritate the bladder tube and increase urge and leaks.  Try going without a pad or wearing knickers with an inbuilt pad to see if this is the case.
• a CHANGE in bladder habits can also be an indicator of several other medical conditions.

If your symptoms aren’t getting better, ask your GP to check you and if appropriate refer you to a specialist physiotherapist.

Weird stuff affects bladders

Ever have one of those  days where you seem to need to wee and wee and wee?  Not necessarily unpleasantly but  you think “where is it all coming from????”

The body constantly re-adjusts our fluid balance – and sometimes does this really dramatically.  You see it best by watching how tight/loose your rings are.  Notice this week how sometimes you can slide your rings about easily but other times they are stuck on tight.  The body holds fluid when it is hot and dumps it as it gets colder.  We also have circadian rhythms that affect fluid in and out. Most people wee more in the mornings and less in the afternoon.

Stress affects bladders

When we are ‘stressed’ (anxious, worried, cross, running late) our system is releasing adrenalin.  Adrenalin triggers our Fight, Flight or Freeze response.  If a tiger walked in your door right now – your hairs would stand on end, your heart would beat faster…and you would wet yourself.  Likely bowels too.  I think it’s supposed to be so that you can run faster.

Fortunately,  you are unlikely to encounter seriously stressful moments too often but we experience mild ‘stress’  all the time.  When you are feeling anxious, worried, cross, running late , the brain ‘drips’ adrenalin into your system to help you cope.  But with that comes bladder (or bowel) irritation.  Think of standing in a queue to do an exam, or waiting to give a presentation at work…that strong need to wee…and then even to wee again.

So if  you are having a day needing lots of wees, ask if you are stressed? Your bladder could be used as a barometer to your stress levels?  Rather than try to ‘fix’ the bladder…can you decrease the source of the stress?

Peaceful sleep & your bladder

It is normal to get up for one wee in the night  (assuming sleeping for 6-8 hours).  Annoying…but perfectly normal. Nicer if you don’t have to but some bodies just do. 

• But don’t be hard on the grandparents. Over the age of 60 it is normal to wee once or twice in the night. Hormone changes of aging affect the way the kidneys process urine.

• aim to have your last drink 2 hours before bedtime. Then the fluid has plenty of time to go through your system with a good wee before getting into bed. 
• Best to avoid caffeine late. 
• Beware, sneaky sources of caffeine like Green Tea & some hot chocolate mixes
• alcohol is a diuretic ie more volume comes out than went in (just think hangover….dry mouth….)

if you do have a late night drink (party!)) then don’t berate your bladder for needing a 2am wee!

That first morning wee…

 If you don’t wake in the night most people wake up with a very full bladder. You will need to make getting to the toilet your priority on waking.  

====    Mums go first!   ====

I appreciate that this was a LONG blog post – but I couldn’t leave anything out. I hope it has been helpful. Do let me know if this has helped you?