Hi and welcome the fifth and final installation of the Pelvic Empowerment overactive bladder
series! I’m Tori, and I am a doctor of physical therapy who specializes in pelvic dysfunction,
which means I treat things that can go wrong around the pelvis and this includes bladder
dysfunction.
If you have an overactive bladder and you haven’t checked out the previous four videos
in this series, please do, as these videos are the most effective if viewed in order
and they could make this technique even more effective in treating your urgency/frequency.
If you’ve stumbled upon this video and you’re on the other end of the spectrum, where you
have a hard time emptying your bladder, this technique may still be helpful for you; however,
if you are completely unable to empty your bladder whatsoever, that is a medical emergency
and you need to seek medical attention.
With that being said, today’s video is focused on reviewing the proper toilet positioning
for urinating and applies not only to women and men navigating urgency/frequency, but
also to people without bladder issues! Ass always, timestamps and links to any studies
or resources mentioned today can be found in the description below, and, without further
adieu, let’s get into it.
In order to understand why the position that we’ll be reviewing today is the best position
for bladder emptying, it’s important to understand the relationship between your bladder
and your pelvic floor during urination. Let’s take a quick look at the bladder and pelvic
floor. Imagine that this is my bladder and I’m facing you and have been cut down the
center.
You can appreciate that my bladder is here, sitting on top of my urethra, the tube that
connects my bladder to the rest of the world, and that my pelvic floor, a very important
group of pelvic muscles, is here, living underneath my bladder and surrounding part of my urethra.
Some of your pelvic floor muscles actually act as a urethral sphincter, and are in charge
of opening and closing the urethra pending on what you’re up to.
Now, your bladder is comprised of smooth muscle, which means you have no voluntary control
over it, much like you don’t have control over the smooth muscle in your intestines;
however, your pelvic floor is comprised of skeletal muscle, which means you do have voluntary
control over it, much like you have voluntary control over the skeletal muscle in your biceps.
So, as counterintuitive as it may be, when you urinate, the smooth muscle in your bladder
is actually contracting, in order to push the urine inside of it out of the urethra
while, simultaneously, your pelvic floor is relaxing, so that that urethral sphincter
is open and the urine can easily and effortlessly exit the bladder through the urethra and out
into the world.
So, when it comes to toilet positioning during urination, our primary goal is to encourage
the pelvic floor to relax and let the bladder and only the bladder be in control of emptying
itself.
This technique applies to women and men; however, if you are in a situation where it’s more
comfortable to stand, that’s okay, implement what you can in a standing position but please
try to use the seated technique whenever possible especially if you’re treating urgency/frequency!
With that said, the first move is to sit down on the toilet. No hovering, and if you can,
it’s better to sit than it is to stand, because, while hovering puts much more demand
on your pelvic floor than standing, both activate your pelvic floor. This is something that’s
actually been thoroughly researched, but for now, trust me when I say your pelvic floor
is one of your deep core stabilizers, and it canNOT fully relax if it is stabilizing
you in a standing position and especially not in a hovering position, so sit down and
if you’re in a public restroom and feeling icky about the toilet seat, either put some
toilet paper down or bring those disposable toilet seat covers with you and sit on the
toilet when you pee.
Next, you want to rest your hands on your thighs or your knees, or you can rest your
elbows on your thighs or knees. A gentle lean forward can be helpful, but what’s important
is that you keep your spine neutral, and relax your abdomen. I’m going to change my positioning
just to demonstrate what I mean when I say those things.
So again, a gentle lean can be helpful, but you want to keep your spine neutral. Don’t
arch or do a c-back—neutral spine. And you want to relax your abdomen.
Your abdominal muscles and pelvic floor are synergists, which means when one is activated,
so is the other. And, since our primary goal here is to relax the pelvic floor, we want
to make sure that our abdomen is also relaxed. So, it is super important to let your abdomen
pooch, you might be surprised to learn how often your abdomen is activated or tucked
when you’re in a seated position. So, when you’re urinating, practice letting your
abdomen pooch, or hang, or relax.
Next, you want to be sure your legs are apart, that your knees are wider than your hips.
That’s because your inner thighs and pelvic floor are also synergists, when your inner
thighs are activated it’s much harder for your pelvic floor to relax. So, if you’re
someone who is peeing with your knees close together, that can actually encourage you
to push through a urethral sphincter, to push through a pelvic floor, that isn’t totally
open or relaxed.
So, get your knees wider than your hips, and if you’re wearing pants or leggings that
don’t allow you to accomplish this position, take them off or even take one leg out so
that you can sit with your knees wider than your hips.
Now that we’ve assumed the proper position, it’s time to urinate. You should be able
to calmly breathe throughout this entire process, so please do NOT strain, do NOT inhale, hold
your breath and push down in order to urinate. Straining essentially uses pressure in your
abdomen to force the bladder to contract and push urine through a pelvic floor, through
a urethral sphincter that likely isn’t completely open. It’s a poor habit that can reinforce
pelvic floor tightness and urgency/frequency, because it forces the bladder empty against
the wishes of your pelvic floor regardless of how full your bladder actually is. Ideally,
you’re acting on a true urge, you’re not peeing just in case anymore, so the smooth
muscle in your bladder should contract and be able to fully empty your bladder without
your straining.
Finally, it’s important during this entire process that you take your time. You may recall
from the previous video in this series how important your behavior on the way to the
toilet is, how important it is to walk slowly and calmly, wait to undress until you’re
actually in the bathroom, and then assume this proper toilet positioning before you
pee. You want to bring that same calm, slow, and controlled energy into the actual act
of urinating as well.
Sometimes we get in our heads about needing to get things done quickly, but the extra
30 to 60 seconds that a calm, slow, and controlled urination will add to your day likely won’t
make or break anything you’re doing or trying to accomplish, and you can tell your brain
that if it tries to convince you otherwise.
Finally, often times in the clinic I’d run into patients who would tell me that they
have to strain at least at the end of urination in order to “get it all out,” that there
was always just a “little bit more” urine in their bladders, and they wanted their bladder
to be as empty as possible since urgency/frequency is so frustrating.
Even if you’ve never had a bladder health issue, you should ALWAYS be able to force
out a little bit more urine, and that’s because of something called post-void residual
volume, or PVR in the medical world. The “normal” PVR range varies pending on your source, but
usually 50 to 100mL is considered within normal limits, where the older you are the more likely
you are to fall on the upper end of that range. So, if you’re straining at the end of a
pee in order to get that “extra little bit out,” and what’s coming out is less than
100mL, you’re likely just forcing out your very normal post-void residual, and doing
that will not decrease frequency. If anything, it will increase it by encouraging your pelvic
floor to tighten and your bladder to empty at smaller volumes.
On that note, thank you so much for watching! I really hope that this series was helpful
for you, and if you enjoyed this video or found it helpful, please do give it a thumbs
up. If you didn’t like it, give it a thumbs down and let me know what I can do to improve
in the future. Feel free to comment absolutely anything below—questions, feedback, content
suggestions, anything really—I do try really hard to read and respond to all of my comments.
Don’t forget to check me out on instagram and finally if you want to see more content
from me please do consider subscribing to the channel. I make videos about pelvic things,
like today’s video, and I also make videos about life things. Thank you again so much
for watching, I hope you have a wonderful rest of your day and I will see you in the
next video, bye.