Really, these two questions shouldn’t cause so much trouble – but they do
Other health and hygiene questions are easy: How often should you clean your teeth? Wash your body? Change your pants? Others are more debatable but fortunately probably not so important: pyjamas or naked? Knickers on or off at night (I hear Americans definitely do, Brits more variable)? Deodrant or au natural?
These two bladder questions – How much should you drink? and When should you wee? are full of issues
Frequently asked questions
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? Is it normal to wee in the night? Is it ok to have just a tiny wee before you go out the door? ………
So this article is a two-parter as one influences the other – first what’s the normal IN and then normal OUT ? Then based on that maths how do you know when to go for a wee? There will be an extra part 3 to consider what’s different when you are pregnant…..
What should go IN and how much should come OUT – the quick version
If you want to cut to the chase, get The Facts, here is a summary of government/other guidelines and generally agreed wisdom on the subject:
A Quick Summary of daily IN:
Fluid intake: normal fluid intake should be 1.5 to 2 litres in a 24 hour period.
This is ALL fluids added up together (tea, coffee, water, juices, alcohol). 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 and 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.
MOST IMPORTANT: It is NOT 2 litres of water on top of all your other drinks
1.5-2 litres equates to 6-8 standard 250ml mugs a day, or 4 x 500ml water bottles.
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.
And based on this volume IN
A quick summary of the daily OUT routine
- 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 much should you drink? – the long version
If you read this blog regularly, you will know that I Do Like a Bit of Detail and if you do too, I like you already and am very pleased to have you here.
If we talk through the look of a ‘normal’ day, in an untroubled bladder world, it will help your brain to understand how it all should work. If you have been having trouble regulating your bladder, suffering with mad dashes to the loo, uncomfortable and inconvenient urges and even bladder accidents, this will really help. Experience has shown me that if your brain ‘gets it’, you will instinctively make some useful changes and then often there is very little left to do to sort most of this particular problem out.
It is best to take an ‘organised approach’ to when to fill & empty the bladder
First to think about, normal fluid intake is maximum 2000ml ( = 2 litres = 4pints) per day. If you are not a particularly big person, rather go for 1500ml.
If you work on a standard mug or glass (of tea, coffee, water etc) being 250ml then people are often surprised to realise that this is no more than 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 2 litres IN gives you 5-6 wees out – then if you are drinking 4 litres a day, simple maths says that’s either going to be about 12 wees or 6 very very full bursting ones – highly likely to be accompanied by some unpleasant sensations or not quite making it! Cut back on the volume (to 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.
Not all drinks are equal
It can seem strange that we say 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 but 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) and/or 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.
Start to notice how long it takes for different drinks to pass through you and make your bladder uncomfortable. 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 and increase the balance of plain water and you will likely see a quick reduction in bladder urgency and increased capacity to hold. And 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?
Squeezy App (which also 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.
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) and when we sweat. If it is a hot day, we need extra fluid. If you are doing an extra sweaty activity, you need prepare with a little extra 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.
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.
How often should you Wee? – the long version
Based on drinking the recommended amount of 2 litres/24 hours (roughly one mug [250ml] roughly every 2 hours) then…………
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 and you would get a ‘I might need a wee‘ sensation 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 clock the time, do the maths (only an hour since I last had a wee), we 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, 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 and that can be very disabling.
Ignore the first message and wait for the next one
Normally, that first message quickly disappears and we would forget all about the bladder and be able to fill it further for a second hour (or so) till there is more like 300ml (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.
But 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.
If we ignore the middle message, and head into a third or even fourth hour, we 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 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. An emergency being unexpectedly stuck on a motorway, not quite frankly, just putting it off for one more paragraph, chore or advert break. And not just because you are too busy to remember to go for a wee!
So is there something wrong with your bladder – or is it poor human judgement?
So many times the problem is really that the human operator is not listening to the (rather good) system properly. Guilty??? You already know which way you tend to go… too early (friends and family tease you about always needing a wee) …or too late (lots of sweaty near misses or trouble at the front door)?!
Or, very common, is that you swing between too early and too late – you push your limits…push your limits…leave it…leave it…just one more thing and THEN you very nearly have an accident. Now you and your bladder are so nervous that you start doing lots of little wees as soon as you feel something, just to be safe…avoiding another 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…and there goes the cycle again.
what CAn you do to improve your bladder habits?
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 – 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 – to be honest it is too polite to be properly useful. A bit more interesting would mean it wasn’t so easily missed. But we can’t change nature and once you are familiar with that “oh this is what a comfortable wee feels like ” you will be able to spot it much better and 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, but 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 and either get only a tiny wee out or you feel the bladder contract and it can just empty itself partially or completely (urge incontinence). If after organising your fluid intake (as above) you still struggle with bladder control, keep a bladder diary (use Squeezy App) to monitor the pattern and discuss it with your GP. There is medication that can help ‘calm’ a bladder and 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 (over age 70 this naturally declines). Note if you have massive urine volumes at night even though you are not drinking and 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.
As with all the supported mums advice: if your symptoms aren’t getting better, or you feel you need some individualised help, ask your GP to check you and if appropriate refer you to a specialist physiotherapist.
And weird stuff
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 and then 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.
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, perhaps consider your bladder as a barometer to your stress levels? Rather than try to ‘fix’ the bladder…can you decrease the source of the stress?
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. Over age of 60 years 1-2 x to wee in the night is normal, as the hormones affecting the kidney processing of your urine change.
- aim to have your last drink 2 hours before bedtime so that the fluid has plenty of time to go through your system and you can have 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!
Waking up in the morning
Most people wake up with a very full bladder (picture that pint glass!) and need to make getting to the toilet their priority on waking.