Overcoming urinary urgency with a “pee diary”
It’s 9:58 AM and you’re heading into a very important meeting, when, for the second time in an hour, you realize you have to pee. Like, really have to pee, as in may-not-make-it-scurrying-with-knees-together-body-slamming-colleagues-out-of-your-path have to pee.
You get there, but barely in time, and with a sigh of relief, you do your business. Sadly, in the middle of your two-hour performance review, you’re going to have to do this again.
If repeated, frequent urgency to urinate is disrupting your life, it’s time to start a Pee Diary.
What’s a Pee Diary?
A pee diary is a record of all the things you do and consume that could affect your bladder. Irritation of the lining of the bladder is the most common cause for that “gotta go!” urgency, so if you can figure out what’s causing the irritation, you can manage the urgency.
What do I record?
According to Meagan and Bri, the point of keeping a diary like this is to identify your individual triggers, since they’re not the same for everyone.
The best way to do this is to record everything you eat and drink, how much you consume, and at what time you consume it. Take note of when you need to pee and how badly, and when you actually go (as any nurse, teacher, or busy woman will tell you, those are not necessarily the same times). If you take medications, supplements, or vitamins, be sure to record those too, Meagan says, since they can have an effect on urination.
If you can, measure and record how much you go. According to our PTs, you can record if the “void” feels small, medium, or large; you can count the seconds it takes to empty out; or, for the truly detail-oriented, you can purchase a urine hat that will tell you the ounces.
Record your sleep: the time you went to bed, the time you got up in the morning, and how often and at what times you got up during the night to use the bathroom.
Stress can also be an irritant, so add in your stress levels as they rise and fall throughout the day. Don’t forget to say if it’s a workday or the weekend, since, Brianna says, our bathroom habits can change depending on how busy and distracted we are and how accessible a bathroom is.
The more you record, the better picture you’ll have of your actions and how far “off the norm” they might be.
What am I looking for in my pee diary?
You’re looking for a few things: first, if you’re having urgency issues, there are foods/drinks/substances that are common irritants. Reducing or eliminating those could moderate or even solve your urgency issues.
Look at what you drink for possible culprits: Do you start your day with a cleansing glass of lemon water? Or, if you’re like many adults, you probably start your day with coffee. How many La Croix are you throwing back each day? Maybe a glass of wine or two (or beer, or a cocktail) at the end of the day?
All of those drinks can be problematic, according to our PTs. Citrus, caffeine, alcohol and carbonation all can be really irritating to the lining of your bladder, so check your diary to see if you’re overdoing any (or yikes, all) of these.
Check your foods for possible irritants: Do you eat a lot of tomatoes and tomato-based foods? Do you have a curry or other spicy food for a few meals a week? Are you eating a lot of dairy, chocolate, sugar, honey, or corn syrup? Do your foods contain a significant amount of food coloring (if so, aren’t you a little old for Fruit Loops)? All of these are known to cause bladder issues in some people.
Are you drinking enough plain water? If you do drink irritating liquids, alternating (and hence diluting) them with water can reduce the irritation they cause. As the PTs have said before, your first drink every day should be plain water – this avoids having irritants splash down first and at full strength.
In addition to food and drink, what medications, supplements, vitamins, etc. are you taking? Some medications may have a diuretic quality, meaning you’ll need to go more often.
Other things to watch for: Are you springing any leaks? If you have a full bladder and leak a little with a sneeze, that’s cause for concern, but less so than if you leaked after having recently emptied (or tried to empty) your bladder. Are you constipated? That can impact your bladder as well.
Even if you’re not having issues with urgency or leaking, keeping a pee diary for a time might be very enlightening. Do you know how often you pee every day? Do you know how many potential irritants you consume in a day? These are variables within your control, Meagan says, so why not choose the healthiest route you can and avoid problems down the line?
What do I do with what I learn?
Your diary should be able to tell you if you’re within the “normal” range – at its most basic, peeing every 2-4 hours, voiding completely, feeling the pressure of needing to go but no great urgency and no pain. You should make it to the toilet in a calm and comfortable fashion and have no leaks. If this describes you, great: you’re good to go (ha ha).
But… says Meagan, if you’re peeing significantly more or less than 5 to 8 times in 24 hours, if you’re getting up to pee more than once a night, if you’re not voiding completely, or if you have a “pee cluster” (peeing several times in a short period, like three times in an hour first thing in the morning), your diary is telling you you have work to do.
And if you have “work to do,” it might be time to pull in a professional, like a pelvic physical therapist.
What do PTs see in the pee diary?
PTs view the diary not only as a chance to identify a problem but also as an opportunity to educate, Meagan and Bri tell us. “People don’t realize or understand what bladder irritants are,” Bri says, “so the review can really open their eyes.” She has clients track a second time a few months after the initial diary review. “If things have been going well, chances are it’ll show in the diary.”
Meagan tells us the story of a client who had had quite a lot of problems with urgency, but after working with her PT, she saw good results. Formerly a big coffee drinker, she now drank only water, and with Meagan’s help, she was able to pee – calmly – every 2 to 4 hours during the day and sleep through the night. Suddenly, after a month on her own, she was peeing every 30 minutes or so, and getting up to urinate 2 to 3 times a night.
When she and Meagan studied her diary, the culprit was clear: the cleanse the woman had started as part of her New Year’s resolutions was very high in vitamin B complex – a known irritant. Once the cause was clear, says Meagan, they were able to work together on a solution; in this case, spreading the 3-pill dosage out over the day instead of taking them all at once.
The best thing about a pee diary? It can make the problem – and the solution – obvious. We may not realize we’re drinking six La Croix a day or having our wine a little too late in the evening. Simple adjustments like cutting back on carbonation or drinking water first or more often, Bri says, can give people back control and some real quality of life.
When to get thee to a PT or doc*
If you’re falling significantly out of “normal” range, you might want to consult with your PT or doctor. Remember that just not drinking liquids is not a solution for urgency – in fact, when there’s not enough liquid, the urine that’s sitting in your bladder can become very concentrated, leading to more irritation, even infection.
A pee diary may not be the most glamorous journal ever, but if it can get you all the way through the movie, let you sleep your full 8 uninterrupted, and make it possible for you to run without scouting for porta potties, it may be one of the most useful journals you’ve ever kept.
Do you have a pee diary, and would you be willing to leak a little of it to us (ha ha)? Feel free to share with the community in the comments below, or fill us in on Gennev's Facebook page or Midlife & Menopause Solutions, Gennevs closed Facebook group.
*As ever, these blogs are for information only and are never intended to replace expert care by a physician. If you believe you have a serious medical condition, please contact your doctor immediately.
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