When You Always Gotta Go

By Dr. Mercola

Millions of people experience problems with urination, ranging from incontinence and urgency to nighttime urination. The severity of these symptoms can be mild or debilitating, causing embarrassment or anxiety that keeps people from socializing and enjoying their lives.

Yet, no study has ever determined which lower urinary tract symptom (LUTS) is the most bothersome. Many researchers have simply cited their own area of interest as the most troublesome, shedding little light on which urinary symptoms are in need of the most attention.

Researchers from Finland have changed that, however, with a study that gets to the bottom of bladder symptoms among men and women of all ages.

The Most Troubling Urinary Symptoms? Urinary Urgency and Urgency Incontinence

A survey of 6,000 people in Finland revealed urinary symptoms were common across the board.¹ This included:

• The feeling of having to go now, or urinary urgency, in nearly 8%
• Stress incontinence (leaking urine with coughing or exercise) in nearly 7%
• Nighttime voiding (nocturia) in 6%
• Dribbling after urination (post-micturition dribble) in nearly 6%
• Leaking urine before reaching a toilet (urgency incontinence) in 5%

Urination problems tended to differ among men and women, with women experiencing more issues with incontinence and men struggling more often with slow urination or dribbling. Overall, they found urinary urgency was the most common troubling symptom but, individually, urgency incontinence was rated as the most embarrassing problem.

The study's lead researcher, Kari Tikkinen, MD, PhD, explained that some of the most overlooked urinary symptoms are actually those that deserve the most attention:²

"In women, stress incontinence is the condition whose investigation and treatment we should particularly focus on. The symptom occurs in approximately one in eight of all women at a level of severity that causes substantial bother…

In both genders, rushing to the toilet and waking at night-time to urinate were listed as fairly common and troublesome problems – approximately one in twelve people stated they had substantial trouble with rushing to the toilet, and one in seventeen said they had trouble with getting up at night-time to urinate…

According to this study, however, the most common cause of bother among men is post-micturition dribble, which has been usually ignored."

A Closer Look at Some of the Most Common Urinary Symptoms

You've probably heard of the term "overactive bladder," which refers to symptoms such as urinary frequency, urinary urgency, and having urge incontinence, or accidents. It has become a buzzword in recent years as pharmaceutical companies began promoting medications to treat this recently coined condition, urging (primarily) women to seek "help."

Not only are many cases of "overactive bladder" mild – i.e. not requiring treatment – but the term itself may be problematic, according to Tikkinen, who noted:³

"It implies that the cause of the symptoms lies in the bladder, even though this is often not the case."

Certain drugs for overactive bladder (anticholinergics) work by relaxing your bladder muscle to reduce urinary urgency, frequency, and accidents. These drugs may cause side effects like blurred vision, constipation, faster heartbeat, drowsiness, confusion, and memory loss while doing nothing to treat the underlying cause of your urinary troubles. Common causes of urinary symptoms include:⁴

• Stress Incontinence (leaking urine while laughing, coughing, sneezing, etc.): This is often caused by physical changes resulting from pregnancy, childbirth, and menopause.
• Urge Incontinence (leaking urine after feeling a sudden urge to urinate): This may be caused by abnormal nerve signals that cause bladder spasms and may be associated with certain medical conditions like uncontrolled diabetes and hyperthyroidism. Other health conditions may also impact your bladder nerves and muscles, leading to urge incontinence. This includes multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke, and injury.
• Overactive Bladder: This may be caused by abnormal nerves sending signals to your bladder at the wrong time, causing it to contract and leading to frequent urination, urgency, incontinence, and nighttime urination.
• Lower Urinary Tract Symptoms in Men: These may include urinary hesitancy, weak stream, dribbling or leaking, along with more frequent urination (especially at night). These symptoms may be caused by an enlarged prostate that affects the flow of urine.

How Often Is 'Frequent' Urination?

You may be wondering just what constitutes an actual urination "problem." For starters, if the frequency of your urination is bothersome (i.e. it wakes you up at night or interferes with your ability to carry out your regular activities), you should seek help. The same holds true for feelings of urgency or incontinence that is interfering with your daily life.

Please do not feel embarrassed, as these problems are incredibly common and can often be treated (using non-drug methods), leading to significant improvements in your quality of life.

That said, urinating six to eight times per day is "average." You might go more or less often than that, depending on how much water you drink and how active you are. Increased frequency can be caused by an overactive bladder (involuntary contractions), caffeine, a urinary tract infection (UTI), interstitial cystitis, benign prostate enlargement, diabetes, or certain neurological diseases.

It is important that you urinate when you feel the urge (except if you're undergoing bladder training, as discussed below). Ordinarily, delaying urination can cause bladder overdistension — like overstretching a Slinky such that it can't bounce back. You may habitually postpone urination if you find bathroom breaks inconvenient at work, or if you have Paruresis (also known as Shy Bladder Syndrome, Bashful Bladder, Tinkle Terror, or Pee Anxiety), the fear of urinating in the presence of others. Seven percent of the public suffers from this condition.⁵

6 Natural Methods for Treating Urinary Symptoms

If you're struggling with urinary symptoms that are interfering with your life, the following methods can be very effective:

1. Do Kegels: More women than men might be familiar with this term. A Kegel squeeze is performed by drawing your lower pelvic muscles up and holding them up high and tight. For men who aren't familiar with that term, it's similar to trying to stop urinating in the middle of the flow. This can help to strengthen the muscles that help you hold in and control the flow of urine. Kegels can also help you suppress the need to urinate if you have trouble with frequency.
2. Keep a Bladder Diary: This will help you become familiar with your bathroom habits so you can identify a pattern. It may help you develop a plan to visit the bathroom at timed intervals to avoid accidents, as well as help you strategically increase time between bathroom trips as you gain control.
3. Bladder Training: The bladder diary is often one step of bladder training, which involves visiting the restroom according to a fixed schedule. When you feel the need to urinate before a scheduled visit, practice Kegels or relaxation exercises like deep breathing to suppress the urge.
4. Osteopathic Manipulative Treatment or Chiropractic Adjustments:  Research has shown that osteopathic manipulative treatment provided virtually the same therapeutic effect as pelvic floor muscle training (Kegels) in women with lower urinary tract disorders.⁶
5. Limiting Fluids at Certain Times of the Day: If you're getting up during the night to urinate, stop drinking three to four hours before bedtime. Coffee, tea, and alcohol should also be restricted.
6. Enlarged Prostate: Men, if you believe an enlarged prostate is causing your urinary symptoms, read these tips for maintaining a healthy prostate.

If you only experience occasional incontinence, wearing a thin absorbent pad may help give you confidence and allow you to go about with your daily schedule without fears of embarrassment. But, ideally, try the safe options above so that you can fully recover. Remember, this is a very common problem that can often be effectively treated, naturally. As the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) put it: ⁷

"…many women are afraid to mention their problem. They may have urinary incontinence that can improve with treatment but remain silent sufferers and resort to wearing absorbent undergarments, or diapers. This practice is unfortunate, because diapering can lead to diminished self-esteem, as well as skin irritation and sores. If you are relying on diapers to manage your incontinence, you and your family should discuss with your doctor the possible effectiveness of treatments such as timed voiding and pelvic muscle exercises."