📚 Why Do I Have to Push to
Pee as A Female? 🔥
Table of Contents
- [Introduction]
- [What is Normal Peeing?]
- [The Urinary System]
- [The Urination Process]
- [Common Reasons for Having
to Push to Pee]
- [Weak Pelvic Floor Muscles]
- [Pregnancy and Childbirth]
- [Aging and Menopause]
- [High Impact Exercise]
- [Obesity]
- [Genetics]
- [Urinary Tract Infections]
- [Cystitis]
- [Urethritis]
- [Risk Factors]
- [Complications]
- [Interstitial Cystitis]
- [Symptoms]
- [Triggers]
- [Diagnosis]
- [Treatments]
- [Bladder or Urethral Stones]
- [Types of Stones]
- [Symptoms]
- [Causes]
- [Diagnosis]
- [Treatment]
- [Urinary Retention]
- [Causes]
- [UTIs]
- [Medications]
- [Pregnancy]
- [Enlarged Prostate]
- [Neurological Disorders]
- [Bladder Cancer]
- [Bladder Stones]
- [Constipation and Fecal Impaction]
- [Diagnosis]
- [Treatment]
- [Constipation]
- [Causes]
- [Low Fiber Diet]
- [Dehydration]
- [Medications]
- [Frequent Ignoring Urges]
- [Lack of Exercise]
- [Pregnancy]
- [Treatment]
- [Prevention]
- [Pregnancy]
- [Trimester Changes]
- [First Trimester]
- [Second Trimester]
- [Third Trimester]
- [Tips for Peeing While Pregnant]
- [Menopause]
- [Pelvic Floor Changes]
- [Treatment Options]
- [Coping Strategies]
- [Diabetes]
- [Nerve Damage]
- [UTIs]
- [Bladder Changes]
- [Treatments]
- [Prevention Tips]
- [Neurological Disorders]
- [Multiple Sclerosis]
- [Parkinson's Disease]
- [Stroke]
- [Spinal Cord Injuries]
- [When to See a Doctor]
- [Warning Signs]
- [Diagnostic Tests]
- [Treatments and Remedies]
- [Strengthening Pelvic Floor Muscles]
- [Kegel Exercises]
- [Biofeedback Training]
- [Vaginal Weights]
- [Bladder Retraining]
- [Timed Voiding]
- [Double Voiding]
- [Medications and Surgery]
- [Muscle Relaxants]
- [Alpha-Blockers]
- [Antibiotics]
- [Nerve Stimulators]
- [Surgery]
- [Dietary and Lifestyle Changes]
- [Stay Hydrated]
- [Healthy Diet with Probiotics]
- [Reduce Bladder Irritants]
- [Lose Weight]
- [Exercise]
- [Stress Management]
- [OTC Products]
- [Phenylpropanolamine (PPA)]
- [Mirabegron (Myrbetriq)]
- [Coping Strategies and
Self-Care]
- [Double Voiding]
- [Lean Forward]
- [Take Your Time]
- [Use Perineal Pressure]
- [Try Different Positions]
- [Use Devices]
- [Apply Warm Compresses]
- [Watch for Triggers]
- [Don't Delay Peeing]
- [Prevention]
- [Kegel Exercises]
- [Healthy Bladder Habits]
- [Avoid Constipation]
- [Control Diabetes]
- [Manage Neurological Conditions]
- [Improve Diet]
- [Reduce Stress]
- [Conclusion]
- [FAQs]
Introduction
Having to push, strain, or put
effort into peeing as a female can be frustrating, tiring, and concerning.
Peeing should normally happen automatically without having to consciously push
or force it. But many women deal with pushed or strained peeing at some point
due to an underlying medical issue.
This comprehensive guide covers
all aspects of having to push to pee as a female. It explores the various
possible causes, from pelvic floor dysfunction to urinary tract infections,
interstitial cystitis, bladder stones, pregnancy, and neurological disorders.
You'll understand what's happening in the body to make you have to push to pee,
warning signs that mean you should see a doctor, and the many treatment options
available.
You'll also find suggestions for
home remedies, self-care strategies, and prevention tips to help get back to
easy, care-free peeing without pushing and straining. Let's start by going over
what normal, healthy peeing looks like so you can recognize abnormal changes.
What is Normal Peeing?
To understand why you might have
to push or strain to pee, it helps to first review how normal urination works
when your urinary system is healthy and functioning properly.
The Urinary System
The urinary system is made up of
the kidneys, ureters, bladder, and urethra. The kidneys filter blood to produce
urine. The urine travels from the kidneys down the ureters and fills the
bladder, a stretchy muscular sac.
The urethra is the thin tube that
carries urine from the bladder out of the body. In females, the urethra is
around 1.5 inches long and opens right above the vaginal opening.
The urinary system works along
with muscles of the pelvic floor to control urine flow. The bladder's sphincter
muscles remain tight to store urine, then relax at the right times to release
urine.
The Urination Process
Normally, peeing happens
automatically when your bladder muscle contracts to squeeze out urine through
the urethra. At the same time, your sphincter and pelvic floor muscles relax to
open the exit passage.
You shouldn't have to consciously
push, strain, or force pee out. The entire process occurs involuntarily using a
coordinated effort between the detrusor muscles of the bladder and urethral
sphincters.
Healthy bladder control means:
- Not having to push or make an
effort to pee 💪
- Urinating about 4-8 times daily
in regular intervals 🕰️
- Producing a steady, consistent
urine stream 💧
- Not leaking urine between
bathroom trips 🚽
- Not feeling pain or stinging
during urination 😣
- Sleeping through the night
without waking up to pee 🛌
Now that you know what normal
peeing entails, let's look at some of the most common medical causes of having
to push or strain when you urinate.
Common Reasons for Having to Push to
Pee
There are a number of possible
explanations for why you feel like you have to push or put extra effort into
peeing as a female.
Weak Pelvic Floor Muscles
One of the most common reasons
women have to push to pee is weakened pelvic floor muscles.
The pelvic floor muscles form a
hammock-like supportive structure. They stretch from the pubic bone to the tail
bone and support the bladder, uterus, and bowel.
Strong pelvic floor muscles keep
the bladder in the correct position and work together with the sphincter to
hold in urine. When they become weak or damaged, you can experience urine
leakage and trouble peeing.
Weakened pelvic floor muscles
don't have enough tone to fully relax and open to allow normal urine flow. You
have to consciously push or bear down to force the muscles to open up enough to
pee.
There are a number of factors
that can cause weakened pelvic floor muscles leading to a pushed pee stream:
Pregnancy and
Childbirth
Pregnancy puts added weight and
pressure on the pelvic floor. And vaginal delivery can overstretch and damage
pelvic floor muscles and nerves. Difficult, prolonged labor and delivery, use
of forceps, and large babies increase the risk of pelvic floor problems after
birth.
Up to 35% of women still have
some degree of pelvic floor dysfunction a year after delivery. After multiple
pregnancies and births, pushing to pee often gets worse due to progressive
muscle weakening.
Aging and
Menopause
Like all muscles in the body,
pelvic floor muscles weaken with age. Declining estrogen during menopause also
contributes. The tissues lining the urethra and vagina lose elasticity making
it harder for the sphincters to seal tightly.
About 23% of women in their 60s
and up to 50% over 80 years old have pelvic floor disorders leading to urinary
problems.
High Impact
Exercise
High-impact activities like
jogging, jumping, or heavy weightlifting put a lot of downward pressure on the
pelvic floor. This can overstretch the muscles over time, especially if Kegel
exercises aren't done to strengthen the muscles.
Certain exercises like lunges,
squats, burpees, and double leg lifts also increase pressure inside the
abdomen, stressing pelvic floor muscles.
Obesity
Carrying excess weight,
especially around the abdomen, increases pressure on the pelvic floor. This
constant heavy strain can weaken muscles and contribute to urinary problems
like pushing to pee. Losing weight helps reduce the stress on pelvic floor muscles.
Genetics
Some women are just born with
naturally weaker pelvic floor muscles or connective tissue that makes them more
prone to pelvic organ prolapse and incontinence. Genetics accounts for about
50% of your pelvic floor strength.
Urinary Tract Infections
Urinary tract infections (UTIs)
are another common cause of having to push or strain while peeing. Up to 60% of
women experience at least one UTI in their lifetime, so they are very
prevalent.
A UTI occurs when bacteria,
usually E. coli from the rectum, enters the urinary tract and attaches to the
urethra and bladder wall. This causes inflammation, irritation, and infection
of the urethra (urethritis) and/or bladder (cystitis).
UTIs make peeing painful and
urgent, even when just a small amount of urine is present. You have the
frequent feeling that you need to pee. Pushing or straining while peeing may
provide temporary relief from the discomfort and urgent feeling.
There are a few different types
of UTIs:
Cystitis
An infection of the bladder, also
called acute bacterial cystitis. This is the most common type of UTI among
women. Symptoms include pelvic pressure, pain above the pubic bone, frequent
and urgent peeing, painful burning during urination, foul-smelling urine, and
pushing to pee.
Urethritis
An infection of the urethra that
can happen along with or separately from cystitis. Causes burning pain during
urination and an urgent feeling of needing to pee frequently.
Risk Factors
Certain things that increase UTI
risk include:
- Sexual activity - spreads
bacteria
- Using a diaphragm or spermicide
- Menopause - less vaginal
estrogen
- Family history
- Blockages like kidney stones
- Catheter use
Complications
If left untreated, UTIs can
spread to the kidneys and cause serious infections like pyelonephritis.
Recurrent UTIs called a recurrent bladder infection (RBI) can also develop and
be hard to treat.
So if you suspect a UTI based on
painful, frequent peeing and needing to push - see a doctor right away for
antibiotics. Drink lots of water in the meantime and avoid spreading bacteria.
Interstitial Cystitis
Interstitial cystitis (IC), also
called painful bladder syndrome, is a chronic bladder condition causing pelvic
discomfort, bladder pressure, and pain.
It occurs when the protective
bladder lining loses its ability to stretch properly. This allows urine,
toxins, and chemicals to irritate the delicate underlying layers.
The exact cause isn't known but
may involve autoimmune factors, nerves oversensing signals, infection exposure,
or hereditary factors. People with other chronic pain conditions are more
likely to develop IC.
IC makes the bladder unable to
hold urine well, causing urgency and frequency. A constant uncomfortable
feeling persists like you need to pee even when your bladder isn't full.
Pushing or straining while peeing
may provide temporary relief from this irritated feeling, but pain and
discomfort returns shortly after. IC requires medications and lifestyle
modifications to manage symptoms long-term.
Here are some more details about
this challenging bladder disorder:
Symptoms
- Need to frequently pee during
the day and night
- Urgency to pee with little
warning
- Pelvic pressure and pain above
pubic bone
- Burning during urination
- Straining or pushing provides
brief relief
- Waking up multiple times a
night to pee
Triggers
Things that can flare up IC
bladder pain and irritation:
- Stress and anxiety
- Menstrual cycles
- Certain foods - coffee, tea,
soda, chocolate, citrus, etc
- Alcohol
- Exercise
Diagnosis
There’s no definitive test for
IC. It’s diagnosed based on symptoms, bladder exam, ruling out other conditions
like UTIs, and possibly cystoscopy to check bladder lining.
Treatments
- Stress management and bladder
training
- Diet changes - avoiding bladder
irritants
- Physical therapy to relax
pelvic muscles
- Oral medications like Elmiron,
antihistamines, antidepressants
- Bladder instillations of
medication
- Neural stimulation implants
If you suspect IC as the reason
you push and strain to pee without pain or infection, see a urologist or
urogynecologist for evaluation and treatment.
Bladder or Urethral Stones
Bladder stones (calculi) and
urethral stones are small mineral deposits or crystals that form in the bladder
or urethra. This can obstruct urine flow, leading to pushing and straining
while peeing.
Around 1-2% of American women
develop bladder stones at some point. People who get recurrent UTIs or have
blockages like an enlarged prostate are most at risk.
Types of Stones
Bladder stones can contain
various minerals, most commonly:
- Calcium oxalate
- Calcium phosphate
- Uric acid
Struvite stones can also develop
from UTIs caused by certain bacteria.
Symptoms
Signs of bladder or urethral
stones include:
- Need to strain or push to start
peeing
- Weak, dribbling urine stream
- Frequent or urgent need to pee
- Pelvic pain that comes and goes
- Blood in urine
- Cloudy, foul-smelling urine
- Inability to pee at all if
stones completely block urine flow
Causes
Factors that raise the risk of
developing bladder stones include:
- Recurrent UTIs, especially with
Proteus bacteria
- Blockage in the urinary tract
- Medical conditions that raise
mineral levels in urine
- Not drinking enough fluids
- Diet high in oxalates
- Gastric bypass surgery
- Long-term catheter use
- Immobility
Diagnosis
To check for bladder stones, the
doctor will:
- Take medical history
- Conduct physical exam
- Analyze urine sample
- Use imaging tests like CT scan,
ultrasound, x-ray
Treatment
Small stones may pass naturally
when you urinate. Larger stones often require:
- Lithotripsy to break up stones
- Surgery to remove stones, like
a cystolithalopaxy
- Antibiotics if caused by UTI
bacteria
- Prescription medication to
reduce recurrence
Drinking more fluids daily can
help flush out smaller stones or crystal fragments. Strain-free peeing should
resume once stones pass or are treated. See a urologist right away if stones
are suspected.
Urinary Retention
Another common cause of pushing
or straining while peeing is urinary retention. Also called incomplete
emptying, urinary retention is when you can't fully empty your bladder with
normal effort.
With retention, over 200 mL of
urine stays left behind after peeing. The bladder doesn't squeeze strongly
enough to push all the urine out through the urethra. So you have to push or
bear down to try to get more urine to come out.
Acute urinary retention happens
suddenly and completely prevents urination. This is a medical emergency
requiring immediate treatment.
Chronic urinary retention comes
on gradually and allows partial peeing. But you still have to strain to get
some urine out. Several conditions can cause urinary retention:
Causes
- UTIs
- Medications
- Pregnancy
- Enlarged prostate
- Neurological disorders
- Bladder cancer
- Bladder stones
- Constipation/fecal impaction
Let's look at these causes in
more detail:
UTIs
The pain and inflammation from a
UTI reduces your bladder's ability to contract fully. This leads to incomplete
emptying and post-void residual urine that requires pushing to get out.
Medications
Certain medications have side
effects that relax the bladder muscle or interfere with normal nerve signals.
These include:
- Antidepressants
- Antihistamines
- Opiates
- Antipsychotics
- Antimuscarinics
- Calcium channel blockers
Pregnancy
Hormonal changes relax the
bladder muscle. The growing uterus also puts pressure on the bladder,
preventing complete emptying. These effects worsen as the pregnancy progresses.
Enlarged Prostate
In men, bladder outlet
obstruction from an enlarged prostate is the most common cause of urinary
retention. The prostate surrounds the urethra. As it grows, it pinches the
urethra and blocks urine flow.
Neurological Disorders
Conditions like multiple
sclerosis, Parkinson's disease, stroke, or spinal injuries can impair nerve
signals between the brain and bladder. This prevents the bladder muscle from
contracting normally to fully void.
Bladder Cancer
Cancerous bladder tumors can
partially block the urine passageway, making it harder to pee out all urine
from the bladder.
Bladder Stones
Large bladder stones can obstruct
the urethra and prevent complete emptying, requiring straining to urinate.
Constipation/Fecal Impaction
Severe constipation and compacted
stool in the rectum put extra pressure on the bladder. This pressure impairs
the bladder's ability to fully empty when peeing.
Diagnosis
Urinary retention is diagnosed
through:
- Physical exam
- Medical history
- Bladder scan to measure
post-void residual urine
- Renal function tests
- Pelvic ultrasound
- Cystoscopy
Treatment
Depending on the cause, urinary
retention is treated by:
- Catheterization to drain urine
- Medications that strengthen
bladder muscles
- Prostate surgery or medications
(for enlarged prostate)
- Removing bladder tumors or
stones
- Treating constipation
- Alternating catheterization
until retention resolves
Pushing or straining no longer
needs to happen once the retention is properly treated. See a doctor right away
if your pee stream becomes very weak and you can't fully empty your bladder.
Constipation
Severe constipation and inability
to pass stool can also cause problems with fully emptying the bladder. Chronic
constipation leads to bladder dysfunction in a few ways:
- Stool backed up in the rectum
and colon presses on the bladder. This added pressure prevents the bladder from
relaxing and filling completely before needing to pee.
- Constant straining to pass
hardened stools can weaken and damage pelvic floor muscles. Weak pelvic muscles
allow the bladder to drop and protrude into the vagina.
- Having infrequent bowel
movements allows feces to sit longer and grow harder and larger. This puts even
more pressure on pelvic organs.
Constipation makes you feel like
you need to pee more frequently, even when very little urine is present. You
often have to push and strain to get the urine out around the backed up stool.
Let's look at some of the common
causes of constipation:
Causes
Low Fiber Diet
Fiber helps form soft, bulky
stool that's easy to pass. Low fiber diets cause small, hard stools that are
painful or difficult to pass.
Dehydration
Not drinking enough water each
day leads to hard, dry stools that don't move smoothly through the colon.
Medications
Many medications have
constipation as a side effect, like:
- Antidepressants
- Antihistamines
- Opioids
- Antacids
- Iron supplements
- Antispasmodics
Frequent Ignoring Urges
When you often ignore the urge to
have a bowel movement, the stool continues to move through the colon and loses
moisture. This makes it harder to pass later.
Lack of Exercise
Regular exercise helps increase
muscle movement in the colon to efficiently pass stool. Lack of movement allows
stool to sit longer and dry out.
Pregnancy
Hormonal changes slow down
digestion. The heavy uterus also presses on the colon. Both make constipation
more likely in pregnancy.
Treatment
To treat constipation and improve
bladder emptying:
- Drink more water
- Eat more high fiber foods
- Exercise regularly
- Try magnesium supplements
- Use stool softeners and
laxatives if needed
- Improve toilet habits - don't
delay bowel movements
- Treat any underlying medical
conditions
Prevention
Ways to prevent recurrent
constipation include:
- Stay well hydrated
- Eat 25-35 grams fiber daily
- Follow daily exercise routine
- Establish regular toilet
routine
- Don't ignore urges to have
bowel movement
- Check for medication side
effects
If simple home treatments don't
resolve chronic constipation that's making you push to pee, see a
gastroenterologist. Surgery may be needed in severe cases.
Relieving constipation can
significantly improve bladder emptying function so you don't have to strain and
push while peeing.
Pregnancy
Pregnancy puts a lot of stress on
the bladder and can make having to push or strain to pee more likely. Growing
pregnancy hormones and the increasing weight of the fetus interfere with normal
bladder function.
During pregnancy, the heavy
uterus rests right on top of the bladder and applies direct pressure. The
bladder gets squashed and can't expand as much before feeling full.
Hormones like progesterone also
relax smooth muscle tissue throughout the body, including the bladder. The
relaxed bladder muscle doesn’t contract with as much force to empty the bladder
fully.
Let's look at how bladder changes
and urinary symptoms progress through the trimesters:
Trimester Changes
First Trimester
In the first trimester, hormonal
changes in the body start impacting urinary function. Increased blood
circulation results in more urine production. The high levels of progesterone
begin relaxing muscles.
Frequency of urination increases
significantly during the first trimester, requiring going to the bathroom about
every 2 hours. You may have to go many times a night.
Second Trimester
During the second trimester, the
growing uterus applies more direct pressure on the bladder as it gets up out of
the pelvis. More pushing or straining may be needed to start the urine stream.
The increase in peeing frequency
continues, up to every hour now. Nocturia, or waking to pee at night, becomes
very common.
Third Trimester
The third trimester poses the
biggest challenges for the bladder. The heavy uterus sits right on the bladder
and greatly reduces its capacity.
You may now need to pee every
30-60 minutes. Straining and pushing often becomes necessary to fully empty the
bladder with the intense direct pressure. Leaking can also happen when
laughing, sneezing, or moving certain ways.
Be sure to monitor bladder
changes throughout pregnancy and notify your OB provider about any concerns or
difficulties peeing. Staying hydrated by drinking adequate water is extremely
helpful for reducing pressure on the bladder and strength of urine.
Tips for Peeing
While Pregnant
To make peeing easier during
pregnancy:
- Drink plenty of extra fluids
- Avoid bladder irritants like
caffeine, alcohol, spices, etc
- Go pee often and don’t “hold
it”
- Do pelvic floor / Kegel
exercises regularly
- Lean forward to straighten out
urethra when peeing
- Take your time and relax
muscles when peeing
- Place a small footstool under
feet when using toilet
Most bladder symptoms resolve
within about 6 weeks after delivery as the uterus shrinks back down and
hormones regulate. But you should notify your OB/GYN about any ongoing issues
with pushing, straining, frequency or incontinence after birth.
Menopause
Menopause and the declining
estrogen in a woman’s body also lead to changes that can make pushing or
straining to pee more likely.
Estrogen plays an important role
in maintaining muscle tone and elasticity of tissues like the vagina, urethra
and bladder. When estrogen drops around menopause, these tissues become drier,
less elastic and somewhat atrophied.
The bladder and urethra lose
strength and structural support. Let’s look at two specific changes:
Pelvic Floor
Changes
Loss of estrogen leads to
thinning of vaginal walls and weakening of pelvic floor muscles. The pelvic
floor can no longer provide enough structural support to keep the bladder and
urethra in the proper position.
This allows the bladder to drop
down and bulge into the vagina. The kinked urethra prevents the bladder from
fully emptying, leading to post-void residual urine.
Treatment Options
To manage menopausal bladder
effects, doctors may recommend:
- Vaginal estrogen therapy -
estrogen creams, tablets or rings help improve tissue atrophy and dryness to
support the bladder and urethra.
- Kegel exercises to strengthen
pelvic floor muscles.
- Electrical stimulation to help
contract pelvic floor muscles.
- Pessary device to support
pelvic organs.
Coping Strategies
These self-care tips can also
help you pee better after menopause:
- Stay well hydrated
- Take your time relaxing muscles
when peeing
- Try the double void technique -
pee, relax, then pee again
- Lean forward to straighten
urethra
- Limit bladder irritants like
caffeine and alcohol
- Use vaginal moisturizers to
ease irritation
Symptoms usually gradually
resolve over 1-2 years as the body adjusts to lower estrogen levels. But see
your gynecologist about any persistent symptoms.
Diabetes
Women with diabetes often deal
with pushed or strained peeing due to diabetic bladder dysfunction.
Over time, high blood glucose
levels damage the nerves that control the bladder muscles. Damaged nerves
prevent normal bladder function in a couple key ways:
Nerve Damage
Damaged bladder nerves reduce
sensation and make it so the bladder doesn’t know when it’s full. This allows
larger volumes of urine to accumulate.
The bladder also can’t contract
strongly enough to fully empty all the excess urine pooled inside. This leaves
urine leftover in the bladder that requires pushing or straining to get out.
UTIs
High blood sugar allows bacteria
growth and increases the risk of UTIs. The inflammation from the infection also
inhibits full bladder emptying.
Bladder Changes
Nerve damage may also cause
overactive bladder spasms that suddenly contract before the bladder is full.
This leads to more frequent peeing and urgency.
Treatments
To manage diabetic bladder
problems:
- Improve blood sugar control
through diet, exercise, medication. This helps prevent nerve damage.
- Try timed voiding - urinating
every 2-4 hours rather than waiting for urges.
- Practice double voiding - pee,
relax, then pee again to empty bladder more fully.
- Pelvic muscle exercises can
help strengthen pelvic floor and improve muscle coordination.
- Prescription medication may
help bladder contractions.
- Treat any UTIs with antibiotics
as soon as they occur.
Prevention Tips
These steps can help prevent
bladder dysfunction:
- Maintain good blood sugar
control
- Practice healthy lifestyle
habits
- Stay very well hydrated
- Urinate as soon as you feel the
urge
- Take prebiotics/probiotics to
prevent UTIs
Seeing your primary care doctor
and urologist regularly is important for managing diabetes and monitoring for
bladder complications. Report any symptoms like straining to pee, incontinence
or pain.
Neurological Disorders
Various neurological conditions
that impair nerve signals between the brain and bladder can lead to voiding
problems like pushing, straining and urinary retention.
Some common neurological causes
of pushed peeing include:
Multiple Sclerosis
The nerve damage from MS disrupts
normal signals between the brain and bladder muscles. This causes urinary
retention and incomplete bladder emptying.
Parkinson's
Disease
Parkinson's hampers the muscles
needed to contract the bladder. Nerves controlling sphincter muscles also
deteriorate, preventing the bladder outlet from opening normally.
Stroke
Strokes affect the cortical nerve
pathways and make nerve transmission to the bladder slower. This impedes normal
urination.
Spinal Cord
Injuries
When spinal cord damage occurs
above the sacral region, communication gets disrupted between the bladder and
brain. This leads to urinary retention and dysfunction.
Treatments for neurogenic bladder
issues may include:
- Timed intentional urination
every 4-6 hours
- Intermittent
self-catheterization
- Kegel exercises
- Medications that help initiate
bladder contractions
- Injections of Botox into the
bladder muscle
- Nerve stimulators
- Surgery like sphincterotomy or
bladder augmentation
Work closely with your urologist
and neurologist to find the right therapies to manage any nerve-related causes
of straining to pee. Protecting bladder health is very important.
When to See a Doctor
Don't ignore changes in your
normal peeing function. Pushing, straining and other urinary symptoms can
indicate potentially serious underlying problems.
See your doctor if you
consistently experience:
Warning Signs
- Having to push or apply extra
abdominal pressure to pee
- Urgency and frequency -
constantly feeling like you need to pee
- Trouble starting a urine stream
- Weak urine stream that dribbles
or sputters
- Leaking urine when sneezing,
laughing or exercising
- Waking many times at night to
pee
- Pain, stinging or burning when
peeing
- Blood in urine
- Cloudy, strong or dark urine
- Fever, back pain or nausea
along with urinary problems
Diagnostic Tests
To check for a medical cause of
urinary pushing and straining, the doctor may conduct:
- Urinalysis to check for blood,
bacteria or crystals
- Urine culture to identify
infections
- Cystoscopy - a scope exam of
the urethra and bladder
- Bladder ultrasound or CT scan
- Urodynamic tests to evaluate
bladder function
- Post-void residual urine test
to check for retention
Don't try to self-diagnose or
self-treat persistent pee problems. Proper diagnosis and treatment by a
urologist or urogynecologist can provide symptom relief and prevent
complications.
Treatments and Remedies
The treatment options for pushed
or strained peeing depend on the underlying cause. Here are some of the main
therapies:
Strengthening Pelvic Floor Muscles
If weak pelvic floor muscles
contribute to bladder emptying issues, Kegel exercises and other techniques can
help strengthen the muscles. This improves urethral closure control and allows
more coordinated relaxation during urination.
Different pelvic strengthening
approaches include:
Kegel Exercises
Kegels involve contracting and
relaxing the pelvic floor muscles repetitively to build strength. You can do
these subtly anytime during the day.
Aim for 3 sets of 10-20 reps
daily. Make sure to allow the muscles to fully relax between contractions. Over
time, the improved muscle tone makes peeing, holding urine, and preventing
leakage easier.
Biofeedback
Training
With biofeedback, sensors monitor
your pelvic floor movement. This info displays on a computer screen and helps
you learn which muscles to focus on contracting and relaxing.
Seeing the visual feedback of
your muscle contractions greatly helps improve technique and results. A pelvic
floor physical therapist provides biofeedback training.
Vaginal Weights
These small cone-shaped weights
insert vaginally and rest against the pelvic floor muscles. You contract the
muscles to hold the weight in place during your normal routine.
The muscle contractions around
the weight strengthen the pelvic floor. Start with a lighter weight and
gradually work up to heavier weights as the muscles become stronger.
Aim to do pelvic floor
strengthening exercises for at least 3-6 months to rehabilitate the muscles
effectively. You should notice improvement in symptoms like less urgent peeing
and less pushing or straining when peeing.
Bladder Retraining
If an overactive bladder causes
urgency and frequency leading to incomplete emptying, bladder retraining can
help regain control. This involves relearning how to hold more urine and pee at
normal intervals.
Strategies like timed voiding,
double voiding and avoiding triggers help retrain your bladder habits and
pelvic floor muscle coordination.
Timed Voiding
This involves following a strict
pee schedule rather than going “just in case” or whenever you feel a slight
urge. Use the bathroom every 2-4 hours during the day. Gradually extend the
time between bathroom trips as you’re able to hold more urine.
Double
Voiding
After peeing the first time,
relax your body completely for a minute, then try peeing again. This empties
the bladder more fully.
With frequent practice, bladder
retraining reduces urgency and fear of leakage. In turn, you can fully relax
muscles while peeing rather than straining or pushing.
Medications and Surgery
If structural problems like an
enlarged prostate or fallen bladder cause straining to pee, medications or
surgery may help.
Muscle Relaxants
These medications allow the
bladder muscle to contract more strongly to get urine out. They may also relax
urethral and pelvic floor muscles that tense up and obstruct flow.
Alpha-Blockers
In men, these drugs relieve
prostate obstruction by relaxing smooth muscle around the urethra. This
improves urine flow.
Antibiotics
Antibiotics treat bacterial UTIs
that cause swelling, irritation and impaired bladder emptying. Preventive
antibiotics may be used for recurrent UTIs.
Nerve Stimulators
Small implanted devices send
electrical pulses to nerves that initiate bladder muscle contractions. This
allows more complete emptying.
Surgery
Removal of bladder or prostate
tumors improves urine flow. Sling surgery can reposition a fallen bladder.
Prostate surgery or urethral dilation relieves obstructions.
Talk to your urologist about
medication or surgical options that may improve your specific peeing problems
due to structural factors.
Dietary and Lifestyle Changes
Certain diet and lifestyle
modifications can also help you pee more easily and fully:
Stay Hydrated
Drink 6-8 glasses of
non-caffeinated fluids like water daily. Well-diluted urine puts less strain on
the bladder.
Healthy Diet with
Probiotics
Eat a balanced diet focused on
whole foods. Take probiotics to promote urinary tract health.
Reduce Bladder
Irritants
Avoid or limit consumption of
alcohol, citrus juices, carbonated drinks, chocolate, tea, coffee, and spicy
foods.
Lose Weight
Excess abdominal weight strains
the bladder. Losing even 5% of body weight can significantly improve urinary
symptoms.
Exercise
Daily moderate aerobic activity
keeps the bladder and its supporting muscles strong and healthy.
Stress Management
Anxiety and frequent stress
overload the pelvic floor and bladder function. Relaxation techniques like deep
breathing, yoga, and mindfulness meditation help reduce effects on the bladder.
OTC Products
Some over-the-counter supplements
may also help strengthen bladder muscles and reduce urgency and frequency.
Phenylpropanolamine (PPA)
This OTC decongestant also
tightens the smooth muscle around the urethra to prevent leakage and improve
control.
Mirabegron
(Myrbetriq)
Myrbetriq helps the bladder
muscle stay relaxed so it can fill to higher volumes before triggering urgency
and frequency.
Discuss trying these OTC
supplements with your doctor to see if they help relieve your particular
urinary symptoms.
The right treatments can
successfully reduce or resolve the need to push, bear down or strain to
urinate. But managing any underlying condition also remains important for
lasting results.
Coping Strategies and Self-Care
While dealing with pushed peeing,
these self-help tips can make urinating less difficult:
Double Voiding
Urinating twice in succession
empties the bladder more fully when straining.
Lean Forward
Leaning forward while peeing
straightens out any urethral kinking. Let your abdomen relax into your thighs
as you lean forward from the hips.
Take Your Time
Rush peeing tends to tense
muscles and cut flow short. Relax fully and allow time for complete emptying.
Use Perineal
Pressure
Pressing a finger gently on the
perineum between the vagina and anus can allow better urine flow, similar to
how bearing down does.
Try Different
Positions
Position the body so gravity
helps empty the bladder whether sitting leaning forward, squatting, or standing
in a wide stance with knees bent.
Use Devices
A footstool elevates legs into a
squat. Grab bars, raised toilet seats, and urinals can help get into an easier
pee position.
Apply Warm
Compresses
A warm compress across your lower
abdomen provides comfort and may help relax pelvic floor muscles.
Watch for Triggers
Note lifestyle factors or foods
that seem to worsen the need to strain and limit them.
Don't Delay
Peeing
Holding urine strains the bladder
and causes urgency and retention over time. Listen to your body’s signals.
While seeking treatment, using
these simple self-help tricks can aid urine flow and make pushing or straining
less necessary. But always consult your doctor about persistent peeing
problems.
Prevention
Making certain healthy lifestyle
changes may help prevent the need to strain or push when peeing.
Kegel Exercises
Stay consistent with daily pelvic
floor muscle exercises throughout your life to maintain strength and tone.
Healthy Bladder
Habits
Urinate at regular intervals
without delaying. Otherwise urine sits in the bladder, causing urgency and
retention issues.
Avoid Constipation
Eat high fiber foods, stay
hydrated with fluids, and don’t ignore urges to have a bowel movement.
Preventive steps keep stool soft and regular.
Control Diabetes
Keep blood sugar levels in the
target range through medication, diet and exercise. This prevents nerve damage
that causes bladder dysfunction.
Manage
Neurological Conditions
Work closely with your doctor to
optimize treatment for any nerve conditions like Parkinson’s disease.
Preventing progression helps protect bladder function.
Improve Diet
Eat a balanced diet focused on
whole foods. Stay hydrated, get nutrients, and avoid bladder irritants like
caffeine and alcohol.
Reduce Stress
Finding healthy ways to cope with
stress protects the pelvic floor muscles and nervous system that control the
bladder.
Implementing prevention habits
promotes optimal bladder health throughout life so issues like straining urine
flow don’t arise. But see your doctor if any symptoms develop.
Conclusion
Having to push or strain when
peeing is a common annoyance many women experience. But it's not normal and is
usually a sign of an underlying medical issue needing evaluation.
Weak pelvic floor muscles, UTIs,
bladder stones, pregnancy, diabetes, neurological disorders and other problems
can all contribute to inefficient bladder emptying. This requires extra
abdominal pushing to force more urine out.
Don't ignore changes in your
usual urine flow like straining, weak stream, pain or leakage. See a urologist
or urogynecologist to diagnose the cause. Treatments like Kegels for pelvic
floor weakness, antibiotics for infection, bladder retraining for urge
incontinence, and surgery for obstruction can help resolve the problems.
Implementing healthy bladder
habits, doing pelvic floor exercises, and managing any medical conditions are
vital to reduce bladder issues. Take steps to care for this important body
system so you can pee freely and fully!
FAQs
FAQ 1
Why does it take me so long to pee?
It can take longer to pee if you
have weak bladder muscles, pelvic floor issues, bladder stones, a partially
blocked urethra, or neurological problems. See a doctor to identify the cause
and get proper treatment to improve urine flow.
FAQ 2
Can a tilted uterus cause straining when peeing?
In some cases, yes. If a
retroverted (tipped) uterus is applying extra pressure to the bladder, this can
obstruct urine flow and require pushing or straining to pee. Try positioning
your body leaned forward when peeing to allow better flow. See your OB-GYN if
symptoms persist.
FAQ 3
Does alcohol make you push when you pee?
Alcohol is an irritant to the
bladder and can cause inflammation that leads to inadequate bladder emptying
and post-void residual urine. Plus, alcohol suppresses an anti-diuretic
hormone, so the kidneys produce more urine. This combination can make you feel
like you need to push or strain more when peeing after drinking.
FAQ 4
Can a cystocele cause straining when peeing?
Yes, a cystocele or prolapsed
bladder that bulges into the vagina often causes straining and incomplete
emptying when peeing. The prolapsed bladder doesn’t fully empty, allowing urine
to pool. This requires extra abdominal pushing to force more urine out. See a
urogynecologist for treatment options.
FAQ 5
How can I pee faster without pushing?
Tips to speed up peeing without
straining:
- Lean forward to straighten the
urethra
- Try peeing in a warm shower
- Avoid suppressing urges to pee
- Stay hydrated to dilute urine
- Follow pelvic floor
strengthening exercises
- Use a footstool to widen the
urethral opening
FAQ 6
What problems can chronic pushing to pee cause?
Chronic pushing or straining to
pee over time can lead to:
- Weakened pelvic floor muscles
- Urinary incontinence
- Increased risk of UTIs
- Hemorrhoids
- Pelvic organ prolapse
- Bladder damage and reduced
capacity
So it's important to see a doctor
and treat the underlying cause.
FAQ 7
Should I see a urologist or gynecologist for pushed peeing?
You can see either type of doctor
for evaluation and treatment. A gynecologist may be better if you think it's
related to pregnancy, menopause or pelvic floor issues. See a urologist for
suspected UTIs, bladder problems, or neurological disorders. Your primary care
doctor can give you a referral.
FAQ 8
Can stress incontinence cause straining when peeing?
Yes, stress incontinence
resulting from weakness of the urinary sphincter and pelvic floor dysfunction
can lead to incomplete bladder emptying. The weak muscles may require bearing
down or pushing to fully pass urine. Pelvic floor muscle exercises can help
treat this type of incontinence.
FAQ 9
Does estrogen help strained urination?
Yes, estrogen helps maintain
muscle tone and elasticity in tissues like the vagina, bladder and urethra. Low
estrogen after menopause can contribute to muscular weakening that impairs
urine flow and leads to pushing or straining. Estrogen creams or supplements
may help strengthen pelvic floor function.
FAQ 10
Can urinary retention cause straining to start peeing?
Yes, chronic urinary retention
prevents complete bladder emptying so urine gets left behind in the bladder.
This urine that stays in the bladder after peeing requires extra abdominal
straining or pushing to force more of it out. Treating the cause of the
retention allows normal urination without straining.