I have a tiny bladder, help!

Since I can remember, my mom has had a "tiny bladder." When she had to go, she had to go right then and she would always cite her tiny bladder. Every. Time. Until my specialized training and education, I always thought that some people had tiny bladders, and some people had stronger bladders.

Do you also have a tiny bladder? Many, many, many of my patients refer to their tiny bladder and will go to the restroom 2-3x within a 1-hour session. A tiny bladder is like a cute way of saying "I have to pee constantly" right? But it doesn't make it any less convenient.

Going pee all the time is a sign of a tiny bladder, myth or fact? – MYTH
There is such thing as a tiny bladder, myth or fact? – MYTH
It's normal to pee more than once every 2 hours, myth or fact?  – MYTH (with caveats)

Let's talk about the bladder

It's a visceral organ made up of smooth muscle, meaning when it contracts or relaxes it is involuntary and does so on it's own. The bladder itself can hold 1 liter of fluid. Should I say that again for emphasis? AN ENTIRE LITER! In a healthy bladder we get the urge to urinate when it is around 400-500 mL full, so about halfway. However once it's halfway full, we can continue to hold it anywhere from 600-800 mL full. Once we reach 600-800 mL (60-80%) we really need to go. The bladder can hold 1 liter of fluid, but that doesn't mean it should.

How do you know if your bladder is halfway full?

Normally you know when you get the urge to urinate, but that is in a healthy bladder unaffected by muscular tension, neuro-inflammation, pregnancy/postpartum, abdominal surgery, anxiety, pelvic organ prolapse, endometriosis, pelvic pain, interstitial cystitis, painful bladder syndrome, loose or tight connective tissue, or other pain/injury/issues. If you are dealing with any of the above, chances are you may get the urge to urinate far more often and before your bladder is half-full. Another way to tell if your bladder was at least half-full would be to time how long you pee. If you urinate between 8-22 seconds at a full stream (not weak or hesitant), your bladder likely needed to be emptied. If you urinate for less than 8 seconds, your bladder was sending you a false signal.  

This is something that happens over time. Likely, you used to be able to hold your urine after the initial urge to urinate, but now when you get the urge you're afraid you may pee yourself and you go to the restroom ASAP. You do it again, and again, and again. Before you know it, you've trained your bladder that it needs to empty as soon as it is stretched, even at 100 mL or 10% fill. The bladder is meant to be stretched! That's how it holds so much fluid!  

If this is a problem you deal with, there are many ways to improve your tolerance to bladder stretching or increased fluid in the bladder, but those really depend on the cause of frequent urination or your "tiny bladder."

One thing you can try is to hold it, just a little bit, after your initial urge to urinate. Tell yourself that your bladder is strong and is meant to hold plenty of fluid. Even if you hold it an additional 30 seconds, you've still built just a little more fluid tolerance. If your typical urine stream only lasts 2-5 seconds, this is something you need to practice.

Another trick to help suppress the need to "go" is to sit on your foot, with your foot putting pressure through your perineum. Sit like this for 10-30 seconds and see if it helps!

While I can't promise these strategies will cure your "tiny bladder," hopefully they will help. If you find that you are peeing more than once every 2-4 hours, or that once you have the urge to pee you need to get to a toilet STAT, you will benefit from pelvic floor physical therapy assessment and treatment. You don't have to pee so often and you don't need to run your life around counting on having a toilet nearby! We can definitely help.

Say it with me: My bladder is strong. My bladder can hold an ENTIRE LITER of fluid. My bladder is meant to be stretched.

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