By Korin Miller and Ashley Martens
Going pee is not usually something you need to think about. When you have to go you just well, go, but what about those times when you cannot go and want to somehow make yourself pee?
“When our bladder and surrounding muscles are working well, we take peeing for granted because it is not something we have to think about,” says Victoria Scott, MD, board-certified urologist with subspecialty training in female pelvic medicine and reconstructive surgery (urogynecology). “This is the way it should be. If peeing becomes difficult, you should always see a urologist for evaluation.”
But even if you’re healthy, peeing actually involves a lot more than you may think. Dr. Scott says peeing includes the production of urine, which is dependent on your fluid intake and kidney function, relaxation of the pelvic floor muscles and sphincters, and the contraction of the bladder muscle to squeeze the urine out. “The complex coordination requires good communication between your muscles, nerves, and brain,” says Dr. Scott. “The most common reason for a healthy woman to have difficulty peeing is poor relaxation of the pelvic floor muscles.”
Meet the experts:
Victoria Scott, MD, is a board-certified urologist with subspecialty training in female pelvic medicine and reconstructive surgery.
Mehran Movassaghi, MD, is a urologist at Providence Saint John’s Health Center in Santa Monica.
Sarah Adelstein, MD, is an assistant professor of urology at RUSH University Medical Center.
David Fishbein Yao, MD, is an associate physician diplomat with the UCLA Department of Urology.
Hypothetically speaking, why might I not be able to pee?
For starters, you shouldn’t stress if you tend to get a little pee-shy when you have to give a urine sample at the doctor’s office—it can be really tough to go on cue, especially if you’re not dealing with a full bladder.
But, if you regularly hold it in, you can also train your bladder not to work the way it should—and cause peeing issues in the process, says Mehran Movassaghi, MD, a urologist at Providence Saint John’s Health Center in Santa Monica.
He often sees this with young women, who will hold their pee in during social situations, then, when they actually decide they’re ready to go, they can’t. “They end up training their bladder to hold on too much,” he says.
This happens over time, of course—if you hold it in during an especially long meeting once, it’s unlikely this will happen to you—but if you repeatedly don’t pee when your bladder tells you it’s time, you can actually screw up the muscles in your pelvic floor that help let pee out, says Dr. Movassaghi. “If you don’t relax your pelvic floor, you can’t go,” he says.
Constipation can also be an issue: When your rectum is packed with poop, it can actually serve as a barrier that pushes against your bladder so you can’t empty it like you normally would, says Dr. Movassaghi. That can make you feel like you have to go, but not be able to get it out.
There’s also a little condition called paruresis (a.k.a., “shy bladder”), which is when you have trouble peeing when you’re around other people–say, in a crowded bathroom.
This is actually a social phobia, according to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders. People with paruresis tend to try to use the bathroom as much as possible at home and will restrict how much they drink when they’re out and even try to avoid social situation so they don’t have to try to pee in public, according to the International Paruresis Association (IPA).
10 Ways To Make Yourself Pee, According To Doctors
- Drink lots of water.
Staying well hydrated is clearly the most important thing here, says Dr. Movassaghi. That means making sure you’re taking in about 2.7 liters (11.5 cups) of fluid a day (and that includes fluids from things you eat and non-water drinks like coffee), according to The National Academies of Sciences, Engineering, and Medicine.
If you’re good on the hydration front and you’re just having some performance anxiety, you can run water or flush the toilet to help drown out noises, says Dr. Movassaghi.
- Try the breath-hold technique.
There’s also something called the breath-hold technique: When you’re sitting on the toilet, start by breathing normally, and then exhale about 75 percent of your breath, per the IPA. Then, hold your breath. After about 45 seconds, you should feel your pelvic floor drop and pee will start coming out. If that doesn’t work, any relaxation technique that works for you might do the trick, says Dr. Movassaghi.
- Drink acidic fluids.
Try drinking acidic fluids like coffee, orange juice, seltzer, or tea, as these bevs are more stimulating to your bladder than water, says Sarah Adelstein, MD, assistant professor of urology at RUSH University Medical Center.
You could still stick to drinking more water, which will help increase the volume of urine you produce and will help you pee more if you are dehydrated, notes Dr. Scott. (Unfortunately, it will not help if you have an anatomic or functional issue that is making it difficult for you to empty your bladder.)
- Optimize your pelvic floor ergonomics.
“People with a female urinary tract should lean forward while sitting on the toilet,” Dr. Adelstein says. “Rest your feet on the floor or use a Squatty Potty.” Squatty Potties can help to relax your pelvic floor, adds Dr. Scott. They can also help with constipation issues.
However, do not just hover over the toilet—actually sit down. “Hovering over the toilet prevents you from being able to relax your pelvic floor, adds Dr. Scott.
- Practice pelvic floor relaxation.
When it comes to the pelvic floor, you can also practice pelvic floor relaxation with diaphragmatic breathing and yoga poses like child’s pose, happy baby, and yogi squat, shares Dr. Scott. “Do these exercises when you are not trying to pee to help you coordinate your muscles and relax them properly when you do want to go.”
You can also enroll in pelvic floor physical therapy. “There are personal trainers who can help you learn to relax and coordinate your pelvic floor muscles.”
- Run water.
Our bodies have been conditioned to associate the act of peeing with the trickling sound of water, Dr. Scott says. So, turning on a faucet can help relax your muscles if you are looking for ways how to make yourself pee.
- Try tapping.
Dr. Adelstein says to tap the low abdomen over your bladder (above the pubic bone) lightly and repeatedly with your fingertips. To wit: “Tapping over the bladder may assist in triggering a contraction in some people,” reported The Urology Group of Virginia.
- Try the Crede maneuver.
Place both hands on your abdomen above the pubic bone, says Dr. Adelstein. Then, gently and slowly press your hands downward and into your pelvis toward your full bladder. Hold that hand pressure for about 30 seconds.
- Use urgency triggers.
Some people have learned (or accidentally taught themselves) triggers for the urge to urinate, such as pulling into the driveway, putting keys in your front door, running water sounds, or even walking to the bathroom, says Dr. Adelstein. Not all of those triggers can be harnessed all of the time, but if you know one that works for you, employ it!
- Ask for help.
If you are having issues regularly with peeing when you feel you need to go, it is time to see a doctor. That is especially true if you tend to go eight hours without peeing and feel like you have been drinking normally or you feel like you have to go all the time and nothing comes out, says Dr. Movassaghi.
While your inability to pee is likely due to something less severe, in rare cases it can be a sign of a neurologic disorder like multiple sclerosis, he says. Either way, you want to get it checked out so you can pee normally again ASAP.
Conditions that can make it difficult to pee include:
Urinary tract infections (UTIs)
Medication side effects
Obstruction to the bladder
Pelvic floor muscle dysfunction
“Constipation can drive urinary frequency symptoms and even cause urinary retention,” says Dr. Adelstein. “If you have hard stools, pebbly stools, or stools less than every three days, you would benefit from a bowel regimen.”
Dr. Adelstein recommends increasing water and fiber consumption as well as trying gentle over-the-counter medications like docusate, polyethylene glycol (e.g., Miralax), or magnesium including milk of magnesia. Exercise may help too.
“Popular over-the-counter medications used for allergies such as antihistamines (Benadryl, diphenhydramine, cetirizine, fexofenadine, and loratadine), and prescription medications used for pain such as opiates (hydrocodone, oxycodone) and for overactive bladder such as anticholinergics (oxybutynin, tolterodine), weaken bladder contractions that result in the bladder being unable to empty,” says David Fishbein Yao, MD, associate physician diplomat with the UCLA Department of Urology.
General or epidural analgesia can do the same. Another common class of over-the-counter medications that causes urinary difficulties is decongestants (ephedrine, phenylephrine, pseudoephedrine), which do so by tightening the bladder neck, resulting in bladder blockage. The good news is that stopping these medications will often allow the bladder to recover and be able to empty again. Be sure to speak with your doctor about any potential side effects from the medication you are taking or make an adjustment if urine retention is bothersome.
Urinary tract infections (UTI) can also make urination difficult, notes Dr. Scott. “If you suspect a UTI, you should always see a doctor immediately. UTIs are also commonly associated with blood in the urine, frequent peeing, or painful urination.”
Nerve issues associated with neurologic conditions such as multiple sclerosis, Parkinson’s disease, a recent vaginal delivery, or trauma may make it difficult to contract your bladder muscle or relax your pelvic floor muscles as well. If pelvic muscle dysfunction seems to be the culprit, you can try pelvic floor physical therapy, notes Dr. Adelstein.
Pregnancy may also make it more difficult to urinate if you experience a tipped uterus. “When a pregnant woman has the uterus tipped backward, called a retroverted uterus, the fetus can compress the bladder and cause urinary retention during the end of the first trimester and the start of the second trimester,” explains Dr. Yao. The good news is that as the pregnancy progresses beyond the 16th week, the fetus moves up and away from the bladder, and the urinary retention typically resolves on its own.
Cystocele is another cause of bladder obstruction, which is when the bladder drops into the vaginal canal resulting in blockage of the urethra, says Dr. Yao. This occurs when the pelvic floor is weakened from childbirth, obesity, and menopause. A cystocele can be treated with pelvic muscle exercises, a vaginal pessary, or surgery.