Most of us don’t think much about going to the bathroom — we just go when we need to. But when bladder and bowel issues pop up, the bathroom suddenly takes up a lot more mental space. From constipation to urinary leakage to pain when using the bathroom, these issues can feel frustrating and embarrassing. But trust me — you’re not alone.
As a pelvic floor physical therapist, I see patients for bladder and bowel control issues all the time! It’s common, but you don’t have to suffer through it forever. Your pelvic floor plays a key role in healthy bathroom habits, and there are lots of steps you can take to rehab your pelvic floor and enjoy stress-free bathroom trips in the future.
Urinary incontinence affects up to 3 in 4 women by the time they reach their 70s, and it frequently occurs during pregnancy and postpartum, too! There are two kinds of urinary incontinence, and they stem from different causes. Stress incontinence is often caused by pelvic floor weakness, uneven intra-abdominal pressure, or poor muscular coordination, while urge incontinence is often caused by an overactive bladder or nerve damage. Pelvic floor issues can also cause pelvic organ prolapse (POP), which is a main cause of fecal incontinence. (Pssst: want to learn more about these conditions? Click the hyperlinks above to read a full blog post by yours truly on each topic.)
Bladder and bowel health is important for your physical health and your overall quality of life! Here’s how to know if you have a healthy bladder and bowels.
When your bladder is healthy, you’ll pee anywhere between 5-8 times per day (every 2-4 hours while you’re awake. These bathroom trips should be free from irritating symptoms like burning, itching, stinging, or leakage.
With our modern western diet, one bowel movement per day is normal. (Many other diets around the world allow for 3+ bowel movements per day — gee, thanks, processed American foods.) Whether you’re passing urine or stool, you shouldn’t need to strain.
The final sign of a healthy system? No fecal smearing after wiping. Fecal smearing occurs when you wipe and wipe and there still seems to be stool left over on the paper towel. It can be a sign of constipation, often accompanied by less than one bowel movement per day, or a sign of poor muscle tone around your rectum!
If you read those last few paragraphs and thought, “oh no!”, don’t freak out. Most of us don’t think about our bathroom habits, but a few simple tweaks can greatly improve your bladder and bowel function over time. Let’s break some bad habits, y’all!
Blowing your nose causes additional stress and pressure on the pelvic floor. When you’re sitting on a toilet, your pelvic floor is in a vulnerable and relaxed state, without any support underneath it. This is purposeful — it needs to be relaxed to allow stool and urine to flow. However, when you reach for the tissues, the additional stress of blowing your nose on the toilet can cause more pressure on your pelvic floor than it can handle. Too much pelvic floor pressure can lead to a host of issues, including pelvic organ prolapse, hemorrhoids, and other dysfunctions that come from poor intra-abdominal pressure management.
The fix: Thankfully, this one’s easy: stop blowing your nose on the toilet! If you absolutely can’t wait to stand up or leave the bathroom first, then only blow after you’ve finished peeing or pooping, gently lifting your pelvic floor up and in as you blow.
Have you ever been told by your mom to pee before you leave the house, even though you might not need to go? So many of us have picked up this habit, but it actually trains our bladders to empty before they give signals to our brains that they need to be emptied. For most women, the bladder can hold up to 500ml of urine but many feel the need to urinate around 200-350 ml.
If you’re in the habit of peeing just in case, you’re likely emptying your bladder before you even reach the 200-350ml mark, training the nerves in your bladder to signal to your brain to empty your bladder earlier and earlier. “Just in case” peeing leads to an overactive bladder and urge incontinence. Remember, 5-8 times per day is plenty for a healthy bladder.
The fix: If you have trained your bladder to feel the urgency to empty everytime you leave the house or walk in the door, you’ll have to retrain it — along with your brain. Stop and take 5 deep breaths when you leave or come home, seeing if you can wait 5, 10, or even 15 minutes before heading to the bathroom. If you still have the urge after, then go ahead and pee – not trying to torture you here! But bumping up that time slowly will help you retrain your body to practice healthy urinary habits.
When you urinate, your pelvic floor muscles should relax to open the urethral sphincter and allow urine to pass. This happens naturally — you don’t need to push out your urine. When you do, you are increasing pressure on your pelvic floor (just like blowing your nose above), which can lead to the same issues.
The fix: Try taking some big diaphragmatic breaths as you pee, allowing the urine to simply flow. This is a habit that might take time to correct, so just be mindful of whether you’re pushing or not whenever you sit down to go to the bathroom.
It’s not always convenient to go to the bathroom, I know, but “holding it in” is one of the leading causes of constipation. The hierarchy of bladder/bowel health should be bowels, you, bladder – meaning your bowels control you, but you control your bladder. When you feel like it’s time to poop, go!
The fix: Respect the hierarchy. This means when you feel the urge to poop, don’t wait longer than 5 minutes to get yourself to the bathroom if at all possible. You don’t want to cause constipation from holding it in, especially since we’re already prone to this from eating processed foods in our diet.
As you’re probably realizing, many of our bad bathroom habits lead to the same issues. Holding your breath or straining excessively when passing stool can cause increased pressure on your pelvic floor, much like power peeing or blowing your nose.
The fix: If you feel like you need to bear down to pass stool, inhale and then exhale as you bear down gently. Otherwise, simply diaphragmatically breathe and let it occur naturally. If you’re having difficulty pooping without strain, try using a squatty potty to better align the rectum for easier passage of stool.
This is the opposite of “just in case” peeing — instead of going when you don’t need to go, you don’t go when you should! I typically see this with teachers or medical providers, who will hold in their bladder all day or avoid drinking water at work. I understand! It’s hard to fit in bathroom breaks working 12+ hour shifts in the ER or during a constant parade of little ones. But holding back urine for longer than 2-3 hours (or not hydrating properly) can lead to yeast infections, which you definitely want to avoid.
The fix: Try to prioritize peeing every 2-3 hours, whenever you feel the need, to avoid potential leakage from a bladder that is too full. And remember to stay hydrated, even on the job!
This is a habit a lot of parents find themselves doing, because it’s their only time alone without a toddler pulling on their pants leg or asking a thousand questions. But once again, sitting on the toilet puts your pelvic floor in a vulnerable and relaxed state, which can cause dysfunction over time. Sitting too long on the toilet also causes increased pressure on your rectum and anus, which can contribute to hemorrhoids.
The fix: This one might be the simplest of all: get up when you’re done in the bathroom! If you need to stand by the sink and watch videos on your phone for a few, have at it. But try not to increase the pressure on your pelvic floor while you decrease other stressors.
I get it: you don’t want to sit directly on a public toilet seat. But when you squat, your pelvic floor muscles can’t fully relax to allow the healthy passage of urine. This leads to excessive pressure on the pelvic floor and can even lead to an uneven stream (and no one wants pee dripping down their leg!) because maybe one side of the pelvic relaxed, but not the other.
The fix: Sit fully on the toilet, but cover the seat with toilet paper beforehand if you want to avoid germs! Allow your pelvic floor to relax, and take deep breaths to further relax it as you pee.
These tips will help you practice good bathroom habits and give you a healthier pelvic floor, which pays off big time outside the bathroom too! Reducing or eliminating bladder and bowel dysfunction symptoms improves your whole quality of life — and that’s what I want for every in-person patient and every blog reader alike.
If these at-home tips and tricks don’t resolve the problem, find a pelvic floor physical therapist in your area. Pelvic floor PTs are well-trained in diagnosing and treating bladder and bowel problems, and they would love to help you find some relief. I hope you enjoy the benefits of a healthier pelvic floor very soon!
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