The Seven Habits of Highly Effective Bladders


A few years after I started treating pelvic floor dysfunction, Steven Covey published the book titled Seven Habits of Highly Effective People. Covey’s philosophies include self-mastery, seeking to understand and working with a team to achieve your goals, all messages applicable to anyone interested in maintaining pelvic and bladder health. Bladder health requires healthy habits that mirror many of Covey’s philosophies. It’s important to understand that the bladder is a trainable organ. What we do and the self-talk we use around bladder function make a difference!
November is Bladder Health Month and to celebrate that, I’ve outlined seven easy and healthy habits for your bladder.

First, a Word on Normal Bladders

An average bladder can hold about two cups of urine before it needs to be emptied. A person with a healthy bladder urinates 6-8 times each day or once every 3-4 hours. In reality, most people urinate (pee) a bit more during the day and less when sleeping. People urinate once every 2-4 hours on average. As you age, bladder capacity can decrease, which means you might have to pee more often, but not more than once every two hours or once a night.
The bladder sits in the front of the pelvis. The female bladder has the uterus above it, the male bladder has the prostate underneath it. This anatomical difference means the male bladder has more support. The female bladder can change position after childbirth, surgery or trauma.
The muscles at the bottom of your pelvis (pelvic floor) contribute to bladder support, control and position. If the pelvic floor muscles are overactive, they can contribute to bladder and pelvic pain.

Seven Habits to Maintain a Highly Effective Bladder

  1. Understand your bladder’s normal schedule. Avoid “just in case” peeing. Urinating more than every two hours can teach the bladder to send a signal to your bladder that it should be emptied even before it is full. Don’t’ ignore the urge to urinate (pee) for too long. “Too long” is generally considered more than four hours. This can be convenient for you but isn’t healthy for your bladder. This is bladder self-mastery.
  2. Learn about all your pelvic floor muscles (often called Kegel muscles and Kegel exercises).
    The pelvic floor consists of several muscles with 3 layers that span from side to side and from the front to the back of the pelvis. These muscles help support the bladder, uterus and rectum in the proper place, shut off and initiate the urine stream and contribute to sexual function. The muscles can be underactive or overactive. Not all people need to strengthen the pelvic floor muscles. Learn to soften and release the muscles, (reverse Kegel) as well as strengthening them.
  3. Let go of your pelvic floor muscles when urinating. Don’t start or finish with a push or strain. For females, when you urinate, sit on the toilet and after you empty your bladder, do some rocking back and forth rather than straining or pushing to empty your bladder completely. For more information see the book Below Your Belt  written to educate young women on information all ages should know.
  4. Learn what might irritate your bladder and use your diet to control your bladder symptoms. Limiting the amount of caffeine, chocolate, coffee, spicy foods and other highly acidic foods like tomatoes, citrus and vinegar can help control urgency and frequency and decrease bladder pain. Drinking fluids without carbonation or artificial sweeteners is the best, as some people are sensitive to these. Also, avoid constipation. A full bowel can press on the bladder, causing irritation and urgency or obstruct the bladder’s ability to empty.
  5. Use your pelvic floor (Kegel) muscles for controlling the bladder. Contraction or relaxation of the muscles can help with urinary urgency and frequency. Performing Kegels when you experience urgency sends a message to the brain telling the bladder to relax. If this is not helpful or causes pain, you may have overactive muscles that need to release and soften (relax) rather than contract to help your bladder symptoms. Over time, practicing Kegels will help strengthen the pelvic floor muscles, which has been shown to decrease symptoms of stress incontinence—accidentally peeing when you cough or sneeze.
  6. Keep the skin around the urethra and outside the vaginal opening (vulva) clean and dry. This can help decrease skin irritation caused by urine leakage. Regular soap can irritate the sensitive vulvar skin and bladder, so use mild natural soap and warm water outside not inside the vagina. Use pads specifically designed for incontinence and a moisture barrier cream if irritation occurs. (Some examples are Bag Balm®, Vaseline® or A and D ointment®, but please talk to your doctor or pharmacist about the best options for you.)
  7. Speak freely and get help for your bladder problems. Talking about bodily functions is not easy for most, but keep in mind there is help and support available. Work with a team of health care providers and physical therapy specialists that will help you understand your problem. Often simple lifestyle changes and proper exercise programs increase bladder effectiveness.

If you struggle with bladder control, bladder position changes known as prolapse, bladder or pelvic pain learning effective habits is a must.

Kathe Wallace

About Kathe Wallace

Kathe Wallace has practiced physical therapy since 1976, focusing on pelvic floor rehabilitation since 1988. As a nationally recognized leader in the pelvic floor specialty of physical therapy, she evaluates and treats many types of conditions referred to her by medical specialists in orthopedics, physical medicine and rehabilitation, urology, gynecology, gastroenterology and colorectal surgery. Full Bio.. →

2 thoughts on “The Seven Habits of Highly Effective Bladders

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    Paula Gorelick

    I just read this! Funny that I was talking with team members about Covey’s book today. Thanks, Kathe! Seeing Serena next week.
    Paula g


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