Bladder control; Reclaim your natural ability

Jane O’Brien, PT, MSPT

Women’s Health Physical Therapist
recipient of Certificate of Achievement in Pelvic Physical Therapy ( CAPP)

Squeeze Before You Sneeze

When it comes to bladder control, embrace what comes naturally. Forget the prescriptions and surgeries. Simple behavior changes can create huge results. Here are 5 ways in which you can regain control of the frequency, urgency and leakage:

1) Retrain you bladder

Our parents taught us to go to the bathroom before we left the house to avoid the need to urinate while we were traveling in a car. In other words, to go while we have the opportunity “just in case”  the sense of urgency arises and we are unable to answer nature’s call. I call this a “JIC” pee. Our bladders have the capacity to hold 8-12 oz of urine. If we empty the bladder before we reach maximum capacity, we have retrained the detrusor muscle ( the bladder muscle) to hold less and to alert us sooner. Try waiting at least 2 hours between voids. Don’t practice “JIC” pees.

2) Avoid drinking 2 hours before bedtime

Imbibing beverages of any sort within 2 hours of bedtime will certainly lead to the need to arise and void during what is intended to be a time for us to rejuvenate and sleep.  Try to stop drinking early in the evening.  If you must take medicine in the evening, do so with your dinner to allow your body the time needed to process the liquid and send the waste in to the bladder.  Empty your bladder just before you climb into bed.

3) Squeeze Before you Sneeze

Perform a pelvic floor muscle contraction,aka Kegel, before you sneeze, laugh or cough. Tightening the muscles of the pelvic floor will help you to avoid leakage of urine during a forceful contraction, which occurs with the previously mentioned activities. If you are unsure how to perform a Kegel, imagine that you are trying to hold back gas from escaping or trying to stop urine from flowing.The muscles yo,u tightened for this task are your pelvic floor muscles, or your pelvic floor muscles (Kegel muscles).

4) Relax

Urination requires that one relax during the activity. In other words, one should not force the stream. Sit on the toilet, if you are a woman. Men should stand and allow their muscles to soften, not strain. Many people in jobs where their potty breaks are few are far between with an extremely short time to be away from their duties, such as teachers and nurses, are in the habit of trying to urinate quickly. They push the urine out in attempt to get done quickly. This forcefulness can cause pelvic organ prolapse, where the bladder and even the uterus can descend in the pelvic cavity and fall through the vagina. Another consequence can be excess stretch of the pelvic floor muscles, which leads to weakness. When the muscles are not strong enough to support the organs, leakage can occur. So, relax when you void.  It is, however, often necessary to push when you defecate.  Just don’t strain.

5) Exercise

If we don’t use it we lose it. Muscles of the pelvic floor are no different than other muscles in the body. To keep the muscles of the pelvic floor strong, one must practice daily. Contract the muscles 3-5 seconds, for 10 repetitions. Try to work up to 10 second holds, 30 times per day. The exercises are easiest when performed while lying on your back. Challenge yourself by sitting reclined to 45 degrees. Advance to sitting upright, then progress into standing. These exercises can be performed while settling down to sleep, while brushing your teeth or while driving to work. Check to see if you are properly performing the exercise by holding a mirror between your legs. Women will see the area between the legs, called the perineum lift with a squeeze. Men will see the penis rise a bit. If you have any doubts, ask your women’s health physical Therapist or the gynecologist to check your status.

The field of women’s health Physical Therapy has increased awareness of issues, such as bladder control, painful intercourse, pelvic pain tailbone pain, post breast surgery rehabilitation and high risk pregnancy. Physical Therapists in the practice of women’s health have completed special training to enable them to evaluate, diagnose, and treat these sensitive issues. Despite the name, men benefit from women’s health therapy as well. After prostate surgery, men should seek the services of a women’s health therapist to assist with bladder control and erectile difficulties. Most importantly, Women’s health physical Therapy is a natural method of regaining control and function of the pelvic floor without surgery or medicine.


1)   Pelvic Physical Therapy, level 1,2,3 course manuals

2)   The Gynecological Manual, Section on Women’s Health of the American Physical Therapy Association, 2002

3)   To find a women’s health PT in your area, go to

For more info, contact Jane O’Brien at 775-831-6600