dx w/ bladder dysfunction

Working on mind over bladder? Urine good company

In Interstitial Cystitis by Molly BachmannLeave a Comment

By Molly Bachmann PT, DPT, PHRC San Francisco


Urination is one of the most reliable body functions a person can have. You go about your daily routine, you receive a little message to your brain that says “Hey there! It’s me, your bladder. We’re pretty fully down here. Do you think you could empty me?” You listen to your body’s cues, find a toilet, eliminate, clean up, and continue about your day. It’s one of the most important ways your body can communicate with you that your organs, muscles, nerves, and microbiome are all working as they should. It’s a daily check on homeostasis. 


But what happens when the balance shifts? What does it even mean to be within normal limits? How does one establish their individual baseline? How do I know when a change in statues is a true emergency that warrants in depth investigation? What could this change in status really mean?


And the tricky thing is, it could mean one thing or many things have changed. It all depends on the symptoms, the event that caused the change, and what else is happening around that time. 


Based on years of research, medical professionals have a pretty good idea of what “normal” looks like. Take a look here:


  • Normal urination frequency is six to eight times in a 24-hour period
  • Leaking urine is never normal but has been normalized for postpartum people
  • Bladder urge should not feel like a five-alarm fire, just a subtle feeling in the lower abdomen
  • Normal voiding time is roughly 20 seconds
  • Starting the urinary stream should be easy and quick
  • Bladder urgency should go away after voiding
  • Increasing our fluid intake should increase the amount we urinate, not the amount of times you have to urinate
  • Normal bladder capacity is 300 – 600ml (1.5 to 2.5 cups)
  • People under 60 years old may wake once per night to urinate, over 60 years old twice per night
  • Pain before, during, or after urinating is never normal


When we fall outside of these normal ranges, it feels really distressing. It interferes with our sleep patterns, work productivity, enjoying time with family and friends, and distracts us from living in the moment. This distress usually leads to a series of doctors visits for multiple testing to rule in or out infection, changes to the bladder lining, organ prolapse, hormonal changes . . . you name it. 


What we’re finding is that many people are misdiagnosed or the root cause of the issue is not identified. And within that population, seeing a doctor who understands the link between pelvic floor muscle control, mobility, strength, etc and urinary/bladder symptoms can be difficult to find. And many times, these muscles are involved on some level. Pelvic floor dysfunction that results in bladder symptoms can look like: 


  • Stress incontinence (leaking urine when coughing, laughing, sneezing, and/or during exercise)
  • Urge incontinence (leaking on the way or before you get to the bathroom)
  • Mixed Incontinence (both stress and urge incontinence)
  • Pain or burning in the bladder and/or urethra before, during or after urinating 
  • Urinary urgency without a full bladder
  • Urinary frequency without a full bladder
  • Urinary hesitancy, slow or deviated urine stream
  • Urinary urgency during sexual activity
  • Urinary urgency/frequency after sexual activity or exercise
  • Urethra or bladder pain 
  • Climacturia (leaking urine with orgasm)


Do any of these sound familiar? Do they sound like a UTI, bladder infection, STI, signs of dehydration, changes during pregnancy? Our pelvic floors have three layers of muscles, any one of which can mimic symptoms of the above mentioned diagnoses. Often we find that individuals diagnosed with Endometriosis, Vulvodynia, Painful Bladder Syndrome, chronic pelvic pain, Post-prostatectomy, Genitourinary syndrome of Menopause and postpartum changes can also experience pelvic floor dysfunction that presents with bladder or urinary changes. 


How do I know if my pelvic floor muscles are involved? This requires a thorough examination from a pelvic floor physical therapist. No, it is not appropriate to “just do kegels” as some doctors or social media accounts recommend. As I mentioned before, your pelvic floor is THREE ROBUST LAYERS OF MUSCLE. Imagine presenting to your doctor for pain or weakness in your biceps, and your provider tells you to carry around a five pound weight in your hand all day to strengthen it and reduce pain. That would never happen! Why? Because that isn’t evidence based practice nor was that prescribed after an actual musculoskeletal evaluation. We should not be treating the pelvic floor any differently. 


If you are experiencing any changes to your bladder/urinary function, pelvic floor physical therapy should always be on the table and included in part of the diagnostic process. 



Are you unable to come see us in person? We offer virtual physical therapy appointments too!

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

PHRC is also offering individualized movement sessions, hosted by Melissa Patrick, DPT. Melissa is a pelvic floor physical therapist at the Berkeley and San Francisco locations. Patients can expect a one hour 1-on-1 private session with Melissa Patrick, an experienced yoga instructor and pelvic floor physical therapist. Melissa will take a complete medical history, consider questions and concerns that the person may have, and discuss goals for the movement sessions. Melissa will provide the person with a tailored set of postures and mindfulness techniques to address the musculoskeletal needs of the individual. To schedule a 1-on-1 appointment visit us online.


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