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Why You Shouldn't Strain to Pee

Updated: Nov 9, 2023

Hi friends! Do you ever push and strain to pee? Did you know that pushing and straining is often a sign of pelvic floor muscle dysfunction? Let’s talk about why this happens and what we can do about it.


Let’s start by reviewing how our bladder should function normally. Our kidneys are constantly filtering our blood to make urine. Once produced the urine travels from the kidneys to the bladder via tubes called the ureters (Irion, 2010).


Our bladders are essentially a hollow ball surrounded by a layer of muscle, called the detrusor. As the bladder fills up with urine, it causes a stretch that is sensed receptors in the bladder wall (Irion 2010). These receptors then send a signal along the spinal cord to the brain to let us know the bladder is filling (Irion, 2010).


Once the message is in our brain, the process starts to become more complex. Through a series of pathways, our brains decide whether or not it is a good time to pee. Our brains ask themselves: Is this a good time to pee? Am I near a bathroom? Am I busy doing other things? It is socially appropriate to go to the bathroom right now? If the brain then decides it is not time to go, it will suppress the urge to go and keep the opening of the bladder shut to keep pee in. But once we are ready to pee (and our brain recognizes that we are at the toilet), it sends a message back to the bladder to tell the detrusor muscle to contract. This contraction of the muscles is what gets the urine out and is why we shouldn’t need to strain to pee. The detrusor is a strong muscle!


With individuals with overactive bladder (OAB) and urge urinary incontinence, the brain has a hard time stopping the signal to the bladder that it is time to pee, often causing urinary leakage with strong, sudden urges to pee.


You may be asking yourself, what does the pelvic floor have to do with any of this? While we need to detrusor muscle to squeeze to help get urine out, the pelvic floor muscles need to relax allow urine to exit the body (Irion, 2010). If the pelvic floor muscles are unable to relax, the urethra (the opening where pee comes out) stays shut. This means that if the urethra stays shut, more pressure is needed to get urine out of the bladder which leads us to push and strain.

The pelvic floor muscles are made up of skeletal muscles, which means we have control over them and can contract or relax them at will. The detrusor muscle of the bladder is made up of smooth muscles, meaning we don’t have conscious control. Instead of pushing and straining to pee, relax and lengthen the pelvic floor muscles to open the urethra so that the detrusor muscle doesn’t need help to create extra pressure.


If you have a hard time coordinating a relaxation of the pelvic floor muscles, see a pelvic floor therapist. They are specially training to help you can better awareness, control, and strength of the pelvic floor muscles to make sure you don’t have to strain while also preventing urinary leakage, pelvic organ prolapse, pelvic pain, and other symptoms. You can ask your provider for a referral to a pelvic floor therapist, or find one near you at www.mypfm.com/find-a-pt.

Here are a few tips to help make peeing easier:

  • Don’t squat over the toilet, sit on it

  • Don’t kegel while you pee, instead relax the pelvic floor muscles and “let go”

  • Don’t stop and start you stream of urine, let it flow it one steady stream

  • Don’t get dehydrated (this causes concentrated urine), instead drink water throughout the day


To learn more about your pelvic floor muscles, check out these great resources:

For providers, join our Ambassador Program and most of our courses are included with your membership!

  • Treatments for OAB with Dr. Sarah Boyles, MD, MPH, FACOG, FPMRS

  • Urinary Incontinence and Urogynecology with Dr. Tessa Krantz, MD

  • Nocturnal Enuresis with Dr. Charley Peterson, PT, DPT


Written by Emily Reul, PT, DPT

References

  1. Irion JM, Irion GL. Women’s Health in Physical Therapy. Lippincott Williams and Wilkins; 2010.

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