When I pee I feel like I have to push?

Straining to Urinate?

The need to strain or push in order to urinate can be due to problems with the contractile force of the bladder or problems with obstruction of the bladder outlet and urethra. Failure to empty due to problems with the contractile force of the bladder may be due to nerve-related disorders such as spinal-cord injury, multiple sclerosis, diabetes, and the like. Failure to empty the bladder due to urethral problems is unusual in women. Some causes of obstruction of the bladder outlet in women include prior vaginal or urethral surgeries, rare strictures of the urethra, and, in rare instances, polyps or cancerous lesions.

Urinary symptoms should always be investigated to rule out some of these unusual but serious conditions. In the urologist’s office, an evaluation for these symptoms would typically include a detailed history, physical examination including a vaginal speculum examination, urinalysis, and an ultrasound measurement of bladder volume after voiding. The most important thing that this latter test would show is whether or not the bladder is completely empty. If the bladder empties completely it makes neurological problems unlikely. If the bladder retains a lot of urine, further studies with urodynamics, a bladder-pressure study that assesses the contractility of the bladder muscle, would be appropriate.

Q2. My husband has been taking oxycodone for pain management for eight weeks now. He is currently having trouble urinating. I understand this is from the medication, but what can he do to overcome the problem? Would drinking more liquid help?

— Irene, North Carolina

Oxycodone, as well as other narcotic pain medications, can lead to bladder problems. Your husband’s difficulty urinating may have resulted because the medication interacts with and blocks some of the nerve signals that cause the bladder to contract. If he cannot be switched to a nonnarcotic pain medicine, then additional evaluation is indicated to assess the severity of his urinary problems. Narcotic pain medicines can also lead to constipation, which, if severe, can prevent normal evacuation of the bladder.

It is important to know whether your husband has an underlying predisposition to bladder difficulties. If he has an enlarged prostate, for example, lower urinary tract symptoms that are caused by prostatic enlargement may be exacerbated by a narcotic pain medication. In such cases, additional medication to treat the underlying lower urinary tract symptoms related to prostatic enlargement might improve his situation. It is unlikely that increasing his fluid intake will resolve bladder-emptying problems — this could actually exacerbate them. Any evaluation of a man who has difficulty urinating would also seek other, less common problems, such as chronic prostatic infection, prostate cancer, bladder stones, and the like.

Learn more in the Everyday Health Pain Management Center.

Everything You Need to Know About Urinary Hesitancy

There are many possible causes of urinary hesitancy. In men, the condition is usually caused by a benign prostatic hyperplasia (BPH). In both men and women, it may also result from:

  • bladder muscle disorders
  • nerve damage
  • surgeries
  • infections
  • psychological issues
  • certain medications
  • a cancer tumor obstructing the urethra or urinary bladder

Enlarged prostate

If you’re male, you have a prostate gland. It surrounds your urethra. Your urethra is the tube that carries urine from your bladder to the outside of your body.

Many men develop a benign enlarged prostate as they get older. As it swells within the center of the prostate gland, it puts pressure on the prostatic urethra. This pressure makes it harder to start and maintain the flow of urine.

Nervous system disorders and nerve damage

Damaged or diseased nerves can also interfere with your flow of urine. Nerves can be damaged by:

  • accidents
  • stroke
  • childbirth
  • diabetes
  • brain or spinal cord infections

Multiple sclerosis (MS) and other nervous system disorders can also lead to nerve damage.

Surgery

Anesthesia administered during surgery can impair some of your nerves. This can result in urinary difficulties afterward. Surgery on your bladder, kidneys, or urethra can also create scar tissue that constricts your urethra. This can cause urinary hesitancy.

Infection

Prostatitis is common in men. It’s inflammation of the prostate gland that could be due to infection. It can cause the prostate to swell and put pressure on your urethra. This can result in urinary hesitancy.

Urinary tract infections (UTI) and sexually transmitted infections (STI) can also lead to problems with urine flow in both men and women.

Shy bladder syndrome (paruresis)

In rare cases, urinary hesitancy may be a sign of a psychological condition, known as shy bladder syndrome (paruresis). If you feel uncomfortable about urinating in the presence of others, you may find it hard to urinate in certain situations.

For example, you may experience urinary hesitancy when using public bathrooms.

Medications

Certain medications can also cause problems with urination. For example, certain cold treatment medications, nasal decongestants, and anti-allergy medications can affect your urination.

Anticholinergics, which are used to treat stomach cramps, muscle spasms, and incontinence, can also cause urinary retention and hesitancy. Antidepressants may also affect your urinary habits.

Having to push to pee?

Otherwise at some point you may need a bladder prolapse repair to lift it up a bit (I had this done). Called an anterior repair.
Takes a bit of time to recover, but your kids are that bit older and don’t need lifting etc. In the meantime:
don’t ever lift anything weighing more than about 6kg (less if possible), so divide your shopping into smaller bags.
Don’t lift suitcases etc. Don’t turn mattresses or push the sofa around etc. Don’t carry a full load of wet washing to the line, break it up into smaller portions.
Try to minimise pushing as in hoovering, so if you have a hoover that you really need to exert a pushing motion, change your hoover to something that glides more easily. Or just don’t hoover! Don’t do exercise involving running, or jumping or pressing down on the pelvic floor. You might also find that clothes that are very tight around your tummy make it worse, like tight jeans. Constipation may have a knock on effect, as the full rectum may be distorting the shape of the bladder. Good luck with it.

Try these techniques to relieve common urinary symptoms without medication

Updated: September 17, 2019Published: November, 2013

For frequent urination or urgency in men, these methods really work. And you can always switch to medication later.

If you are a man over age 50, chances are you know—or will soon—someone taking a medication for an overgrown prostate gland. Better known as benign prostatic hyperplasia (BPH), this condition can cause bothersome problems like frequent urination at night, difficulty completely emptying the bladder, and the urgent need to urinate at inconvenient times.

BPH triggers noticeable problems in a third of men in their 60s and nearly half of those in their 80s. Drug therapy relieves symptoms, and for severe problems, surgery may be considered. But for men with milder symptoms that don’t interfere much with their daily lives, there’s another option: watchful waiting.

In watchful waiting, you and your doctor monitor your symptoms closely and then take action only when you feel it is necessary. In the meantime, simple changes in behavior can help to take the edge off urinary symptoms. This approach also avoids the costs and risks associated with more aggressive treatment.

“Watchful waiting is broadly available to men who have lower urinary tract symptoms that have been attributed to BPH, but who are not bothered enough to take on the small but finite risks of treatment, such as drugs or surgery,” says Dr. Michael J. Barry, a clinical professor of medicine at Harvard Medical School who helped to write national guidelines on how to treat BPH.

Do you have BPH?

IRRITATIVE SYMPTOMS
(Problems with bladder function)

  • Frequent urination during the day or night

  • Strong and sudden urge to urinate, sometimes with involuntary leaking of urine

OBSTRUCTIVE SYMPTOMS
(Problems with the flow of urine)

  • Difficulty starting urination

  • Straining to urinate

  • Incomplete bladder emptying

  • Weak or intermittent urine stream

  • Dribbling after urinating

What is BPH?

In many men, the prostate gland may begin to grow larger over time. The urethra—the tube that conveys urine from the bladder to outside the body—passes right through the prostate, so it doesn’t take much prostate growth to make urination difficult. As the bladder works against the restriction, its muscular walls thicken. This can cause problems like the need for more frequent visits to the bathroom and difficulty fully emptying the bladder.

For some men, the symptoms of BPH don’t demand immediate treatment. The question that should drive that decision is this: How much do your symptoms bother you? “Whether it is getting in the way of doing the things you want to do should be the primary driver of treatment,” Dr. Barry says.

How bothersome is it?

Doctors use the International Prostate Symptom Score (IPSS) to measure how frequent a man’s symptoms are. It’s a seven-item questionnaire about typical BPH symptoms that provides a score from 0 to 35. You can see the questionnaire at health.harvard.edu/IPSS.

Typically, men who score 8 and above are more likely to think their condition needs treatment, but it varies from man to man. “Above a score of 8 there is actually a spectrum of bother,” Dr. Barry says. “Two men can have the same symptom score, and one can tolerate it just fine but the other can’t.”

The IPSS test cuts through the subjectivity with this additional question: “If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?” If the answer is, “I could live with it,” then watchful waiting might be best for you.

But watchful waiting doesn’t mean “do nothing.” It should include strategies to lessen symptoms or make them easier to cope with. In one recent study, men who attended classes on such self-management techniques lowered their IPSS symptom scores by 6 points within three months. “Six points is a difference most men would perceive,” Dr. Barry says.

Living with BPH: A toolbox for managing urinary symptoms

BPH progresses slowly, so most men can decide for themselves if and when they would like to consider medication or surgery. Men with mild to moderate symptoms often find that the changes in fluid intake, medication use, and bladder habits listed below can noticeably relieve BPH’s bothersome effects.

MEDICATION USE: Alter use of medications that could worsen urinary symptoms.

  • Talk to your doctor or pharmacist about prescription or over-the-counter medications that may be contributing to your BPH symptoms. Antihistamines and decongestants can cause problems for some.
  • If you use medications that could make you urinate more, don’t take them right before driving, traveling, attending an event, or going to bed.
  • Don’t rely on ineffective dietary supplements. Saw palmetto and other herbal supplements have failed rigorous scientific testing so far.

FLUID RESTRICTION: Change how much fluid you drink and when to prevent bothersome bathroom visits.

  • Don’t drink liquids before driving, traveling, or attending events where finding a bathroom quickly could be difficult.
  • Avoid drinking caffeinated or alcoholic beverages after dinner or within two hours of your bedtime.

BLADDER HABITS: Change the timing and manner in which you empty your bladder to reduce symptoms or make them less disruptive.

  • Don’t hold it in; empty your bladder when you first get the urge.
  • When you are out in public, go to the bathroom and try to urinate when you get the chance, even if you don’t feel a need right then.
  • Take your time when urinating so you empty your bladder as much as possible.
  • Double void: After each time you urinate, try again right away.
  • Try urethral milking: To prevent post-void dribbling, gently squeeze the base of the penis after urinating and work your way outward to force urine out of the urethra.

BLADDER TRAINING

If you experience urinary urgency, progressively delay the time to when you urinate.

(Ask your doctor for detailed instructions.)

Be watchful—and informed

As you discuss watchful waiting with your physician, make sure you understand how your symptoms could change over time. In other words, what can you expect? What should you watch out for? Lower urinary tract symptoms from BPH generally worsen slowly over time, but not always. In one study of men with moderate symptoms who chose watchful waiting, 13% had milder urinary problems after four years of follow up, in 46% things stayed the same, and in 41% the symptoms progressed to severe or the men opted for surgery.

Many men also need to be reassured that the changes in urinary function they are noticing are not signs of something like prostate cancer. It’s a common fear, Dr. Barry says. “Many men will consult a doctor about the lower urinary symptoms less because they are bothered enough to do something about them, but more because they are concerned about what the symptoms could represent.”

Finally, mark your calendar for the next appointment, because watchful waiting means you should come back to check in. “The watchful part is checking in periodically with a doctor to make sure the symptoms haven’t changed and that there aren’t other things to be concerned about,” Dr. Barry says.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Urination Problems

Urination difficulty at a glance:

  • Having trouble urinating – also referred to as voiding difficulty – is caused by an underlying mechanical problem with the coordination between the urethra and the bladder muscle that allows urine to freely pass.
  • Urination problems include difficulty initiating urination and impaired bladder emptying, as well as urinary incontinence.
  • Urine voiding problems in women can be caused by a variety of conditions, including urinary retention, prolapsed bladder, urinary tract infections, and the effects of menopause and pregnancy.
  • Symptoms are painful urination, difficulty starting the urine stream, a sense of incomplete bladder voiding, and sometimes an inability to urinate—an emergency situation known as acute urinary retention that requires immediate treatment.
  • Treatments for voiding problems depend upon the underlying cause, but may include bladder muscle conditioning, medications, implant devices and surgery.

Experiencing these symptoms? Learn about your treatment options

Contact us at 720-505-5063 or Request an Appointment

Causes of urination problems

Incomplete bladder voiding often goes unnoticed until it reaches its end stage, known as overflow incontinence. Overflow incontinence can be caused by nerve damage (from diabetes or multiple sclerosis) or by a blockage in the urinary tract, such as a kidney stone, or a urinary tract tumor that constricts the urethra.

Some common causes of voiding difficulty include:

  • Urinary retention, partial or complete, which has three main causes.
    1. A hypotonic bladder, also called a lazy or neurogenic bladder, which causes the bladder to not contract properly and completely empty the bladder.
    2. Vaginal prolapse, in which vaginal structures can press the urethra and block the passage of urine.
    3. Dysfunctional voiding occurs when the muscles around the urethra do not relax properly during urination to allow a free flow. Spinal cord injuries, a herniated disc, infectious neurological processes, and pelvic surgery or fractures can also cause incomplete voiding of the bladder.
  • A prolapsed bladder, also called a fallen bladder: When the vaginal wall supporting the bladder weakens (often due to age), the bladder can prolapse, or descend into the vagina. Common causes are stress from childbirth, heavy lifting, straining during bowel movements, long-term constipation, and the menopausal lack of estrogen – a hormone that strengthens vaginal muscles. Obesity can also contribute to a prolapsed bladder.
  • Urinary infections, which result from bacterial infection in the kidneys, ureters (tubes that carry urine to the bladder), bladder or urethra (the tube that releases urine from the bladder outside the body). Infections can be caused by sexual intercourse, partial blockage of the urinary passage, catheters, or stool contacting the vagina.

Symptoms of urination problems

When a woman has difficulty urinating, it is a sign of one of the underlying conditions described above. Each condition has its own set of specific symptoms.

Urinary retention

Symptoms of urinary retention include having difficulty urinating, having the sense that the bladder has not completely emptied, trouble beginning the flow of urine, recurrent urinary infections, and a weak, slow or intermittent urine stream.

Overflow incontinence

In addition to voiding difficulty, overflow incontinence symptoms can be a sudden release of urine, a feeling of bladder fullness after urination, a urine stream that stops and restarts, and urine leakage while sleeping.

Urinary infections

Symptoms of urinary infections include difficulty voiding, a burning sensation or cramps in the lower back or abdomen, frequent urination or having an urgent need to urinate, urine that looks cloudy or has a strong odor, and a burning sensation during urination.

Prolapsed bladder

Women with prolapsed bladders often note a lump of tissue in the vagina, which may subside when they lie down. Other symptoms include difficulty emptying the bladder, a feeling of incomplete voiding, and pain or pressure in the pelvis. Symptoms of a prolapsed bladder may increase after being on your feet for a long time, or while lifting or straining.

Treatment of urination problems

Treatment for urination problems depends on the underlying cause. For example, urinary infections are most often treated with a course of antibiotics, such as penicillin or amoxicillin.

A prolapsed bladder, depending on its grade and other factors, may respond to estrogen replacement therapy (topical or oral) in conjunction with other treatments. A removable diaphragm-like device called a pessary may be worn in the vagina to hold the bladder in place. In other cases, surgery may be performed to secure the bladder in its correct position.

Symptoms of urinary retention can also be treated with a pessary. Medication may also be a treatment option for this condition.

Clean intermittent self-catheterization is another treatment option for urinary retention. A woman inserts a small tube through her urethra to drain the remaining urine from the bladder after urination.

InterStim ™ Therapy is a urinary retention treatment that involves the implantation of a small device the size of a deck of cards under the skin of the upper buttocks to gently stimulate the sacral nerve to help the bladder function properly.

Urination problems may also be treated by pelvic floor therapy, in which a physical therapist may use biofeedback, functional electrical stimulation, and bladder training techniques to help the nerves and muscles involved in emptying the bladder work better.

Contact us to request an appointment with one of our Urogynecologists to learn more about your treatment options.

What Causes Urinary Retention and How Is It Treated?

Acute

Acute urinary retention is a medical emergency, and your doctor will quickly place a catheter into your bladder to let out the urine. This is the quickest and easiest procedure.

If this method can’t be done or doesn’t work, a small tunnel can be made in the skin over your bladder and through the bladder wall. A suprapubic catheter can be inserted this way.

Your doctor will use local anesthesia. Emptying your bladder will make you feel better right away and help prevent complications. Your doctor will then diagnose and treat the cause.

Chronic

Chronic urinary retention is treated if you develop symptoms that affect your quality of life or if you are experiencing urinary tract complications.

Catheterization

You’ll probably need catheterization to release the urine from your bladder unless the cause of your urinary retention can be fixed right away.

Doctors try to avoid keeping a urethral or suprapubic catheter in place for a long period of time because these can lead to a variety of complications. When done intermittently, a catheter often needs to be placed several times a day. You’ll be taught how to insert the catheter to minimize getting bacteria into your bladder.

Urethral dilation and stents

This procedure can be used to widen a urethral stricture in order to allow more urine to flow through. Tubes of increasing width are inserted into your urethra. This slowly opens the stricture. Another way to do this is to insert a tube with a balloon into your urethra and inflate the balloon in the stricture.

Sometimes a stent, a small tube that widens as it opens, is inserted at the stricture. This opens the stricture and increases urine flow. The stent may remain in your urethra permanently to keep your urethra open.

Cystoscope

A lighted, flexible tubular scope called a cystoscope can be inserted through your urethra into your bladder. There, it can be used to find and remove stones or foreign objects from your bladder, bladder outlet, or urethra.

Medication

There are several medications that your doctor might prescribe to help your urinary retention:

  • antibiotics or other medications for urinary tract infection, prostatitis, or cystitis
  • medications that make your urethral sphincter and prostate relax so urine can flow through the urethra better
  • medications that make your prostate smaller to relieve obstruction in men with noncancerous prostate enlargement

Behavior modification

There are some things you can do to learn to control your bladder or make it less likely that you’ll retain urine:

  • Manage the amount and timing of drinking fluids.
  • Strengthen the muscles in your pelvis.
  • Use bladder retraining exercises and techniques.

If medication and other therapies haven’t worked to relieve symptoms, surgery may be an option. In men, most surgical procedures are done by inserting an instrument through the urethra. The surgeon then uses an attached tool or laser to fix the problem. These are outpatient procedures, which means they don’t require you to stay in the hospital. Many of them are less invasive to help reduce pain and aid in a faster recovery. Several options for treatment include:

  • minimally invasive procedures done through the urethra that involve the use of small needles and heat waves
  • transurethral resection of the prostate (TURP) to remove extra prostate tissue that’s blocking the urethra
  • urethrotomy to open a stricture in your urethra
  • removal of the prostate

Other surgical procedures may be needed depending on the cause of the urinary retention. Certain conditions may require laparoscopic (using small incisions for lighted cameras and instruments) or open surgical procedures (using larger surgical incisions):

  • to remove part or all of your prostate because of cancer
  • to remove an enlarged or abnormal uterus
  • to fix a cystocele or rectocele by lifting your bladder or rectum back to its normal place
  • to remove cancer in your bladder or urethra
  • to remove other tumors or cancer of your pelvic organs

Urinary hesitancy: Causes in men and women

Share on PinterestBeing given an anesthetic during surgery may cause urinary hesitancy in both men and women.

There is a wide range of possible causes of urinary hesitancy. Some affect both men and women, while others only affect one sex.

Some of the most common causes include:

  • nerve damage from accidents, strokes, diabetes, or brain damage
  • anesthesia from surgery
  • urinary tract infections
  • kidney or bladder stones
  • surgery on any part of the urinary tract
  • medications, such as decongestants
  • sexually transmitted infections
  • cancerous tumor causing a blockage
  • psychological conditions
  • bladder muscle disorders
  • voiding dysfunction

Typical causes for men

One common cause of urinary hesitancy in men is a benign, enlarged prostate. This is the most common cause in older men, but an enlarged prostate can affect younger men as well.

The prostate is a gland unique to men that surrounds the urethra. The urethra is a tube that transports urine out of the body. As the prostate enlarges over time, it puts pressure on the urethra. This increasing pressure may make it difficult for a man to start or maintain a urine stream.

Also, men may experience an inflammation of the prostate called prostatitis. Infections are often the cause of prostatitis. The inflammation puts pressure on the area around the urethra and may make it difficult to urinate.

Typical causes for women

Women are not as likely to develop urinary hesitancy as men. However, women can develop urinary hesitancy during pregnancy and after childbirth.

Women are most likely to develop urinary hesitancy after childbirth if they experience any of the following:

  • prolonged second stage of labor
  • episiotomy
  • perineal tearing
  • use of forceps or vacuum during childbirth
  • epidural use
  • baby weighing over 4000 grams

Urinary hesitancy is relatively common after childbirth due to trauma to the nerves surrounding the bladder and urinary tract.

Proper postpartum bladder care, including voiding the bladder at least once every 6 hours, can help prevent and relieve urinary hesitancy after childbirth.

Urinary tract infections are another common cause of urinary hesitancy in women.

Prostate problems

Prostate cancer

In the UK, prostate cancer is the most common type of cancer in men, with more than 40,000 new cases diagnosed every year.

It’s not clear why it occurs, but your chances of developing prostate cancer increase as you get older. The condition mainly affects men over 65, although men over 50 are also at risk.

The risk of developing prostate cancer is also increased depending on your:

  • ethnic group – prostate cancer is more common among men of African-Caribbean and African descent than in Asian men
    • family history – having a brother or father who developed prostate cancer under the age of 60 seems to increase your risk of developing it, and having a close female relative who developed breast cancer may also increase your risk of prostate cancer

The symptoms of prostate cancer can be difficult to distinguish from those of prostate enlargement. They may include:

  • needing to pee more frequently, often during the night
  • needing to rush to the toilet
  • difficulty in starting to pee (hesitancy)
  • straining or taking a long time while peeing
  • weak flow
  • feeling that your bladder has not fully emptied
  • blood in urine or blood in semen

You should see your GP if you have these symptoms. It’s much more likely to be prostate enlargement, but it’s important to rule out cancer.

The outlook for prostate cancer is generally good because, unlike many other types of cancer, it usually progresses very slowly. Many men die with prostate cancer rather than as a result of having it.

Prostate cancer therefore does not always need to be treated immediately. Sometimes, it may initially just be monitored and only treated if it gets worse.

It’s one of the simplest things you do every day—relieve your bladder. Bathroom visits are so automatic, chances are you’ve not put much thought into whether or not you are urinating in the healthiest way possible. But, there are common bathroom mistakes people make that can lead to unnecessary urinary health issues.

“As urologists, we see many patients with urinary complaints, and sometimes our advice is as simple as educating the patient on healthy voiding habits,” says Yale Medicine urologist Joseph Brito, MD.

Find out if you’re making any of these common urination mistakes.

Mistake 1: Holding it

The sensation of having to “go” usually leads to a trip to the restroom. “But, sometimes life gets in the way—a long car ride, a movie, or simply doing something fun can cause a delay,” says Dr. Brito. Even though it can be inconvenient to stop what you’re doing and use the bathroom, urine-holding may lead to a variety of issues. “Ignoring an urge to urinate may lead to leakage. Or, it’s possible that chronic bladder ‘overstretching’ may lead to new bladder symptoms down the road as people age,” says Leslie Rickey, MD, a Yale Medicine urologist who specializes in women’s pelvic floor problems.

Delaying bathroom breaks is problematic for kids, too. Urologists occasionally see children with recurrent urinary tract infections (UTI) or foul-smelling urine. This is commonly associated with urine-holding, Dr. Brito says. “Encourage your children to take their time in the bathroom, and remind them to take breaks from their activities for it,” he says. “The best advice is to visit the restroom when you feel like you have to go; however, if you have to urinate very frequently, like every hour, you should talk to a physician.”

Mistake 2: Not emptying fully

When you’re in a rush, incomplete bladder emptying can cause issues far more problematic than taking the extra minute or so in the bathroom. Similar to urine-holding, incomplete bladder emptying allows a reservoir of urine to collect that can potentially cause urinary infections. It can also increase the odds of developing another painful problem—bladder stones, which are salt crystals that sometimes form when urinary concentration or ‘stasis’ develops.

Incomplete emptying isn’t something you are always aware you’re doing, but it’s a good idea to make an effort to ensure you are emptying your bladder, says Dr. Brito. He says this is a particular problem for older men with prostate issues. For them, incomplete bladder emptying can lead to a smaller functional bladder capacity and subsequent urinary frequency and urgency problems.

“Often as men get older, they will not completely empty their bladder. The problem there is, if your bladder’s full and you empty it halfway and then drink fluids like you normally would, it fills up more quickly,” says Dr. Brito.

Incomplete bladder emptying becomes a problem as men age because of prostate enlargement (also called benign prostate hyperplasia or BPH), a common condition. This can bring a number of symptoms including increased urinary frequency, urgency, and nocturia (nighttime urination), as well as incomplete emptying. “BPH is usually not a dangerous condition,” Dr. Brito says, “but the symptoms can become pretty frustrating and often life-altering.” Though it is rare, these symptoms can also be a sign of something more serious like prostate cancers, and therefore should be discussed with your primary care physician or urologist.

“Sometimes educating patients to take their time in the bathroom and ensure their bladder is as empty as possible can help,” says Dr. Brito. Other times, patients may need medications or surgery to help the bladder empty better.

Mistake 3: Going too often

One more trip to the bathroom before rushing out the door may seem like smart planning, but it can backfire. The danger is that you can end up “training” the bladder to respond to small volumes, which can lead to overactive bladder symptoms—the sensation of needing to urinate more frequently than is normal, explains Dr. Rickey.

“Going too often at night can also be a problem for men who then can’t fall back to sleep,” says Stanton Honig, MD, director of Male Urology, adding that this condition, called nocturia, can affect quality of life. “If this is bothersome to patients, there are treatment for it,” says Dr. Honig.

Other problems can also cause increased urinary frequency, such as an infection along the urinary tract. Therefore, if you find that you need to visit the bathroom far more often than you used to, talk to your primary care physician or urologist. You may need a urinalysis (urine test) to rule out a UTI, as well as to check for blood in the urine (hematuria), which can happen to a small number of people with an overactive bladder who have a bladder tumor, Dr. Brito says. “Blood in the urine is never normal and usually requires further testing to determine its cause,” Dr. Brito says.

Diet can also be a factor for people who notice an uptick on their need to pee. “The bladder is increasingly sensitive as we age,” says Dr. Brito, “and urinary frequency can be due to certain ‘irritative’ foods and beverages such as caffeine, alcohol, carbonated beverages, chocolate, spicy foods, and acidic foods.”

Some people may also visit the bathroom frequently in an attempt to avoid leakage. Although urinary incontinence (an unintended loss of urine) is common and affects a large number of women, it is not something you should just live with,” says Dr. Rickey. “Directed pelvic floor muscle exercises can resolve these symptoms.” Other treatments such as medications and minimally invasive procedures are available, too, to help with urinary frequency, urgency, and incontinence.

Mistake #4: Pushing

You shouldn’t have to use your muscles to force urine out. A healthy bladder works best if the body just relaxes so that the bladder muscles naturally contract to let the urine flow, rather than using the abdominal muscles to bear down as with a bowel movement.

In men, the need to push urine may be a sign of bladder outlet obstruction, which is commonly due to BPH. “This benign condition causes swelling in the prostate and problems starting the urine stream—or a weak flow,” says Dr. Honig.

Women are less likely to have bladder outlet obstruction, though advanced pelvic organ prolapse can lead to difficulty starting the flow of urine, says Dr. Rickey. The main symptom of prolapse is seeing or feeling a vaginal bulge; it is the result of the pelvic organs (vagina, uterus, bladder, or rectum) descending into the vaginal canal due to weakened pelvic organ muscle support. Having to work hard to push your urine out can also lead to other problems such as hemorrhoids or a worsening of hernia symptoms, explains Dr. Brito.

If you can’t help but push urine out, see a urologist or primary care doctor to determine if you need medication, specific exercises, or other therapies to address your underlying urinary issue.

Mistake #5: Not drinking enough water

Many urinary complaints are related to poor hydration. Generally speaking, if your urine is clear or very light, that’s a sign you are drinking the right amount of water. If your urine is dark yellow or amber, that’s usually a sign of dehydration.

Odor, an “off” color, and (occasionally) the sense of burning while voiding (dysuria) are other signs that might indicate you are not properly hydrated. Not drinking enough water can contribute to UTIs and kidney stones. Concentrated urine can irritate the lining of the bladder, making it more sensitive. It is also more likely to form kidney or bladder stones.

“Many patients ask if drinking alternative fluids will suffice, but many beverages contain high sugar concentrations or caffeine, which can have other health effects,” says Dr. Brito, noting these might make overactive bladder symptoms worse. “Water is the safest option to maintain hydration and keep your kidneys and bladder healthy.”

There are some conditions that can make your urine appear more concentrated even if you are well-hydrated, such as liver problems or hematuria. So, if you are drinking enough water (about 2 quarts a day) but have dark-colored urine, odor, or burning, it’s worth a trip to a urologist, who can evaluate your symptoms more closely.

“The ability to urinate freely and without difficulty is taken for granted by most people,” says Dr. Brito. So, next time you have to “go,” follow the above advice for better urinary health.

What can you do to induce urination?

Share on PinterestA person may need to try several techniques to induce urination.

There are several ways that a person may be able to force themselves to pee on demand.

These techniques may not work for everyone. A person may need to try several methods in order to find what works best for them.

The National Institutes of Health recommend the following techniques:

1. Tapping the area between navel and pubic bone

While sitting on the toilet, a person can tap the area located between the belly button and the pubic bone.

Using the fingertips, a person can gently but firmly tap the skin near the bladder every 30 seconds to encourage urination.

2. Bending forward

Bending forward while sitting on the toilet puts additional pressure on the bladder, which can encourage urination.

3. Placing a hand in warm water

Placing a hand in warm water can trigger the urge to pee. A person should do this while sitting on the toilet.

If the toilet is within reach of a sink or tub, a person can let warm water run from the tap over their hand.

4. Running water

The sound of water can trigger the need to urinate. A person having trouble urinating can turn on the bathroom sink before attempting to pee or flush the toilet before using it.

Some people find that playing recordings of running water can also have the same effect.

5. Drinking while trying to urinate

Drinking water or another low-sugar liquid while attempting to pee may also trigger the body to urinate.

People may need to drink several sips before trying to pee in order to get this technique to work.

Drinking caffeinated beverages or alcohol is not recommended, as they can make a person more dehydrated.

6. Trying the Valsalva maneuver

The Valsalva maneuver involves pushing down as if trying to have a bowel movement. A person may find that using their forearm to push on the lower abdomen also helps.

People should avoid putting pressure directly on the bladder, as this can cause urine to back up into the kidneys and may cause an infection.

7. Exercising

Simple exercises such as walking or doing jumping jacks can help a person urinate.

Before heading to the bathroom, a person may wish to do a few laps of the house or office to stimulate urination.

8. Massaging the inner thigh

Rubbing the inner thigh while on the toilet can help induce the need to pee. A person should gently massage the inside of their leg with their hands or fingers.

9. Using relaxation techniques

If a person is nervous or stressed about being unable to pee, they can try some basic relaxation techniques to encourage urination.

Keeping their eyes closed, a person can focus on relaxing the muscles, starting with the fingers and hands and working through all parts of the body. The goal is to relax the bladder and encourage urination.

Constipation

Constipation is when your bowel motions (‘poo’ or faeces) are less frequent and you have trouble passing them as they are often hard and dry. You may only be able to pass small amounts at a time or have difficulty passing them. Other signs you may be constipated are pain, cramps or swelling in the abdominal area or perhaps you leave the toilet feeling your bowel is not completely empty.

What causes constipation?

Constipation usually happens because the colon (part of the digestive system) absorbs too much water from your food. If the food moves through the digestive system too slowly, too much water may be absorbed. The bowel motions at the end of the digestive process are then too dry and hard.

Many things can cause or worsen constipation including:

  • not eating enough fibre (fruit and vegetables, wholemeal bread, high fibre cereals)
  • not drinking enough – always drink more when you increase fibre in your diet
  • not doing enough exercise
  • anxiety, depression, grief
  • delaying the urge to go to the toilet
  • using laxatives for a long time
  • the side effects of some medicines (even some common ones like pain killers or iron tablets)
  • pregnancy
  • being overweight
  • not being able to go to the toilet because of poor mobility
  • some nerve diseases
  • some bowel problems like haemorrhoids, irritable bowel syndrome, or diverticulitis
  • anorectal pain caused by haemorrhoids, fissures (tear in the skin of the anus) or birth trauma, or
  • a slow transit bowel which means it takes longer for the faeces to travel all the way to the rectum, so more water is removed over time and constipation is much more likely. This occurs where there is nerve damage such as with stroke, Parkinson’s, multiple sclerosis or trauma.

What should I do?

If you think you have constipation, talk to your doctor who can recommend some ways to help. One way to treat constipation is by taking a type of medicine called a ‘laxative’. There are various types of laxatives and they all work differently so it’s important to talk to your doctor before taking laxatives. Types of laxatives include:

  • bulking agents
  • lubricants, and
  • stimulating/irritant laxatives.

How does constipation affect my bowel?

Severe constipation is the most common cause of faecal incontinence (or bowel leakage), especially in older people. This is because hard bowel motions are difficult to pass and may cause a partial blockage high up the bowel, resulting in watery bowel motions flowing around the constipated stool without warning. This is sometimes mistaken for diarrhoea.

You can use the Bristol Stool Chart to check what your bowel motions should look like.

How does constipation affect my bladder?

Constipation can affect bladder control and urinary continence. If you sometimes leak urine or feel that you need to frequently visit the toilet to pass urine, it could be that constipation is involved. An over-full bowel (due to constipation) can press on the bladder, reducing the amount of urine it can hold or making you feel like to need to pass urine urgently.

Constipation can also affect your pelvic floor muscles. Pelvic floor muscle strength is important for both bladder and bowel control. These muscles stretch like a trampoline from the pubic bone at the front to the coccyx (tail-bone) at the back. They can be weakened by straining due to constipation, pregnancy and childbirth, or perhaps heavy lifting. Strong pelvic floor muscles are necessary for bladder and bowel control – to be able to ‘hold on’.

We have a number of fact sheets available for download on bladder and bowel health. Visit our Resources Page for a more advanced search or have a look at some of the popular factsheets below.

Poor Bowel Control

Healthy Bladder and Bowel Habits

Looking after yourself: A guide to improving bowel function

Using a bladder or bowel diary

Caring for someone with incontinence factsheet

Caring for someone with bladder and bowel problems booklet

Bladder and Bowel Dysfunction

Bowel incontinence can be caused by things such as:

  • Diarrhea

  • Constipation

  • Damage to the nervous system from disease or injury

  • Vaginal childbirth

  • Rectum bulging down into the anus (rectal prolapse)

  • Rectum pushing into the vagina (rectocele)

  • Crohn’s disease or ulcerative colitis

Either type of incontinence can be caused by things such as:

  • Medicine side effects

  • Stress

  • Multiple sclerosis

  • Stroke

  • Alzheimer’s disease

  • Diabetes

  • Infections, including spinal cord or brain infections

  • Hemorrhoids

  • Problems with the pelvic floor

  • Damage after surgery

Managing bladder and bowel incontinence

Some common treatments are:

  • Changes in food or drink. Increasing your fiber intake can help manage diarrhea and constipation. Drinking plenty of fluids can also ease constipation. Not drinking fluids at certain times can help manage overactive bladder and urinary incontinence.

  • Exercises. Kegel exercises can strengthen the sphincter muscles and pelvic floor. This can help you have better control.

  • Medicines. Some medicines can help control bowel incontinence. Antidiarrheal medicines can help manage diarrhea. And medicine can help bladder muscles relax to give you better control.

  • Keeping a bathroom schedule. Setting a regular schedule for using the toilet can give you better control. This includes attempting to urinate or move your bowels at the same time each day.

  • Electrical stimulation. This therapy can stimulate damaged nerves. This may give you better muscle control in your bladder or bowel.

  • Surgery. In rare cases, you may need surgery to repair damage to muscles or nerves.

Your healthcare provider will work with you to create a treatment plan.

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