It’s advice you might carry with you your whole life, but it is contrary to what any doctor treating urinary incontinence or frequent urination would tell you.
The bladder is a hollow reservoir for urine, which flows from the kidneys at about 1ml a minute via the ureters. The ureters have walls of muscle arranged in spiral and longitudinal layers. Every 10 to 60 seconds, waves of synchronised muscle contractions progress down the ureters, pushing urine into the bladder.
The bladder has a capacity of about 500ml and, like the ureter, has various bands of muscle in its wall – spiral, longitudinal and circular. When the bladder empties, the muscles contract in a specific sequence, starting at the top and working down. This wrings virtually all of the urine from the bladder.
You get your first urge to pass water with a volume of 150ml, but usually this can be ignored. But it’s harder to dismiss the marked sense of fullness that normally happens around 400ml.
The desire to urinate comes from sensors in the walls of the bladder that pick up the internal pressure. This pressure arises from having a full bladder, or from having something pushing on a not-so-full bladder (as in pregnancy, when the baby’s head pushes on the bladder).
Mental stress such as excitement or anger can tighten the muscle wall, leading to increased pressure and, once again, the desire to urinate.
If you get into the habit of going to the loo before your bladder is full, you can develop a problem known as “detrusor instability” or “unstable bladder”.
By passing urine in case you need to go later, you can reset the bladder sensors, which then fire off messages to the brain that you need to wee even though the bladder is only partly full. This can lead to your feeling the urge to go to the toilet frequently, but having
only a very small volume of urine to pass. By going to the toilet yet again, you perpetuate the cycle.
Along with the sensation of needing to pass urine, you can also develop inconvenient and embarassing urinary incontinence. The first steps to manage this condition are easy. See a GP and get a urine specimen tested to rule out infection and confirm the existence of an unstable bladder.
Avoid constipation and diuresis from drinks (such as coffee, tea and alcohol) and medications. Then sit back and literally hold on.
Just like five-year-olds physically holding their groin when they feel they are busting to do a wee, you have to cross your legs, sit down and try to ignore the first desire to pass urine. Wait for it to pass, without rushing to the toilet.
The idea is to gradually increase the time between each urination, and retrain your
bladder back to registering that it is full only when it is actually holding more than 300ml. This means you get bladder control back, and the bladder stops wrongly sensing fullness.
For most people, this is enough to shift them back to relatively normal bladder habits, full-night sleeps and being able to throw away their maps of public toilets.
Author: Rowell Bulan, M.D.
The Silent Disability: Urinary Incontinence