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  • Christine MacMillan, PT

The Urgent Bladder

Updated: Aug 21, 2019

Most people have an unremarkable relationship with their bladder; they don’t spend much time thinking about their bladder or their bladder’s wants and needs. Their bladder just exists in the background of their daily life, doing it’s job dutifully. There is a respectful dialogue happening throughout the day:


Bladder: “just a head’s up, we’re gonna need to pee in the next 30-40 minutes, if that works for you?”

You: “thanks for the head’s up! I’ll let you know when it’s convenient for me to make a pit stop – it might be a good half hour, so your patience is appreciated.” *fist bump*


For other people, their relationship with their bladder is a little more complicated. Many feel like their bladder runs the show, dictating when they need to use the bathroom, with no room for negotiation. In many cases the urge to pee comes on intensely and out of nowhere – and delaying a trip to the bathroom can sometimes lead to bladder leakage (aka incontinence).


Bladder: “LISTEN, THERE’S NO TIME FOR QUESTIONS; IT’S GO-TIME”.

You: “Ok but –“

Bladder: “I SAID NO QUESTIONS!!!!!!!”

YOU: “Ok ok there’s a bathroom 30 feet away, I’m running!”

Bladder: “Too late. I emptied the tank.”


“Urinary urgency” affects a ton of people – men and women, young and old. For some people it is experienced as an overwhelming need to pee that they can control until they get to the toilet, if they go straight away. For others, urgency will lead to leakage within seconds. Some people only experience urgency when their bladder is full. Other people experience urgency at all times of day, even with a relatively empty bladder.


Some people find urgency is “triggered” by specific, predictable events like the sound of running water, or walking past a bathroom, or unlocking the front door as they arrive home from work. Other people report no rhyme or reason to when their urgency strikes. The common thread is that unlike a “normal” bladder, the urgent bladder is next to impossible to ignore.


So what exactly is “normal” when it comes to bladder function? Well, adults should be able to delay going to the washroom for at least 30 minutes from the onset of an urge to pee. You should be able to go 2-3 hours between voids (for a total of 5-7 pees within 24 hours – no more than once per night), and it should take roughly 8-10 “mississipi’s” to empty your bladder fully (i.e. counting one-mississippi, two-mississippi, three-mississippi…). A lot of the time when I tell people this, their eyes widen in disbelief as they think about how many times they pee before noon, alone! And how many of those pees are only 2 or 3 “mississippi’s” long.


So where does urgency come from? Why do some people have it, and others don’t? Well there are a few possible contributors:


1. Bladder Irritants – Some fluids are inherently more irritating to the inside of the bladder than others. Examples of common bladder irritants include caffeine, artificial sweeteners, citrus and carbonated beverages (to name a few). For some people, the presence of these liquids inside the bladder contributes to their feelings of urgency.


2. Not enough water – I meet very few people who drink the recommended eight glasses of water per day. Water keeps us hydrated, and dilutes the urine inside the bladder, making it gentler on the bladder lining. Insufficient water intake can contribute to the irritation within the bladder which can lead to feelings of urinary urgency. Some signs you’re not drinking enough water include foul-smelling urine, or urine that has a dark yellow colour to it. Urine should be almost clear if you have sufficient water intake.


Excessive tension in the pelvic floor muscles can contribute to Urinary Urgency and Urge Incontinence. Learning to release this tension is crucial in treating the Urgent Bladder!
Muscles of the Pelvic Floor

3. Pelvic Floor Muscle Tension –The muscles of the pelvic floor sit directly underneath the bladder and the bladder neck, which means that changes to these muscles can lead to bladder symptoms. Excessive tension in the pelvic floor can be irritating to the bladder, leading to feelings of urgency – even if there is actually very little urine inside the bladder. Most people don’t realize that the pelvis is one of the most common places to hold tension when we are stressed (similar to clenching your jaw or holding tension in your neck). Pelvic floor tension is incredibly common among men and women with higher levels of stress and anxiety, whether it’s a stressful job or relationship, or the chaotic life of a parent of young kids. Many people report they developed urinary urgency at a time that was stressful or difficult, and it rings a lot of bells for them when we discuss the connection between mental stress, physical muscular tension, and bladder dysfunction. Everything is connected!


Treating the urgent bladder requires looking at the “big picture” of who you are and how your body is working. Often people assume something is wrong with their bladder, when in reality the majority of the dysfunction is happening in the muscles of the pelvic floor. The good news: muscles are super easy to change! With guidance from a Pelvic Health Physiotherapist, you can regain control of your urgent bladder and change that bladder dialogue for good. Continue reading 6 Things You Can Do To Treat The Urgent Bladder, or visit www.thepelvicfloorpt.com for more information.

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