6 Signs of a Healthy Bladder, From a Double Board Certified Pelvic Physio

A white paper with two concentric rings of complementary colors; image of Dr. Kelly looking ponderous, pointing to the text "What's Normal Down There" Bladder & Pee Problem Edition. There is a small pink, shiny bladder in the top left of the picture, with a sign that reads "Help"!

Great questions. What is a healthy bladder?
What is normal down there?  

Hi  🙂 I’m Dr. Kelly Sadauckas (sed-OW-skiss, thanks for asking). I am one of a handful of Doctors of Physical Therapy IN THE WORLD who are double board certified in Pelvic Health and Orthopedics.  Today, I’m taking you on a deep dive to learn more about your healthy bladder!  Do you know why this is important?

80% of Humans Will Have Some Type of Pee Problem in Their Lifetime

That’s 8 out of 10 of us, folks!  Wowza! 

8 out of 10 of us will have some type of pee urgency, anxiety pees, frequent pees, pee leaks, pee dribbles, or trouble peeing at some time in our lives.  You name it, it’ll happen to most of us.

And yet, most (70-80% by some studies) will never seek medical support, and those that do seek medical support often wait 5-7 years (sad face)…then sometimes are told to just do kegels (angry devil face).  And maybe, just maybe, that’s because we don’t know what a healthy bladder is…so we don’t know when we’re seeing signs that it is ‘not-so-healthy.’

But have no fear, friends!  Dr. Kelly of Pelvic Floored is here to change this troubling trend, by doing the most audacious thing possible…teaching you to know “what’s normal” about your private parts, so that you can identify when something is off.  

So…without further ado:

6 Signs of a Healthy Bladder in Adults

1. When you are awake, you pee once every 3-4 hours.

A happy, healthy bladder is essentially a balloon that fills up steadily to about 12-14 fluid ounces (like the fluid in a soda can or pint glass).  

When a normal, happy, bladder is half full, it ‘whispers’ to the brain that “I have to pee”…but you’re busy, and the bladder is polite, so when you ignore this preliminary urge, your normal, happy bladder happily goes back to filling up quietly.  

Then, when it is more like 75% full, your normal, happy bladder starts to give a ‘gentle and gradually building’ signal that it has to pee, that eventually you will listen to.  You sit down, pee easily and fully, a nice stream of at least 10-seconds (ahh…), and the cycle resets. 

This cycle normally takes 3-4 hours, but it could be shorter if you have drank or eaten a bladder irritant, or if you have drank A LOT of water at once…or heaven forbid you drink a bunch of water and THEN a bladder irritant.  

Pees that are regularly more frequent than 3-4 hours, especially if they are small voids of <5 seconds, are extra devilish, because these will actually reset the “full and half-full” points…so that overtime, instead of “full being 14 ounces, and half-full 7-ounces”, if I always pee when my bladder is only 7-ounces full…suddenly I’m getting the first urge at only 3.5 ounces 🙁 ( 

2. Your Pee Stream is easy to start, easy to maintain, and lasts at least 10-seconds.

I touched on it in #1, but when you finally listen to your normal, healthy bladder, after you sit down on the toilet, it should be easy to start your pee stream, easy to maintain a medium stream, and the stream should last at least 10-seconds. 

This “10-second” value is approximately equal to 10 fluid ounces of urine.  Yes, you could measure the urine with a plastic tub that you put in a toilet called a hat (not a real hat, please), but honestly, who wants to do that??  

If you have a medium stream for at least 10-seconds, our bladder is functioning at a baseline okay state.  If we are peeing for less than 10-seconds, or more than 15-seconds, we could have an angry bladder.

3. You can sleep through the night without waking up to pee.

A happy, healthy bladder (which is the part that stores the pee), is in a sexy-threesome with two healthy kidneys.  At night, when we sleep, the kidneys (which are the organs that make the pee), slow down their work-load, meaning they make pee more slowly.  This allows you a full night’s rest, which is VERY important for overall health. 

The only time that it is considered “normal” to wake up at night to pee is A) if we are in our first or third trimester of pregnancy, or B) if we are over 65 years old.  At those two times, we are technically allowed a “once a night” pee as normal…but I still think we can get you to sleep through the night 😉

Oh, and as an aside, in general, it IS better to be hydrated than not.  So if I go through my whole day and don’t drink enough water, then I drink 32 ounces right before bed…even at a slower pace, my kidneys will still fill up my happy normal bladder, so I might have to wake up to pee.  But it should be non-urgent, at least 10-seconds, and not happen every night.  

4. You have NO rapid uncontrolled Pee urges or Pee Anxiety

Your happy, healthy bladder fills up to more than 10-seconds worth of pee nice and steadily.  

An irritated, angry, bladder might react to that first “half-full” signal like an Angry Bull With a Flank Strap in a Rodeo, and FREAK OUT.  That results in a rapid, sudden urge that makes you feel like you “have to pee right that instant or you’ll pee your pants”.  

Real pee urges build up gradually.  Fake urges come out of no where. 

Another sign of this irritated, angry, bladder are frequent pees or ‘anxiety pees’, where you get nervous and feel like you have to pee before leaving the house, office, library, etc.  Or you “always have to pee as soon as you get home” even if you just peed 10 minutes ago, or you end up peeing “just in case”, which is one of the 7 Deadly Sins of Pelvic Health.  A normal, happy, bladder never does those things.

5. You can pee without straining (or putting anything up against, or into, your private parts).  

Again, for those in the back: No POWER PEEING!

A normal, happy, bladder is able to empty without outside pressure.  

That means NO POWER PEEING.  No straining to push the pee out.  No physical pressure on the belly to push the pee out (unless you have a spinal cord injury and have been instructed to do so, of course), and certainly no splinting by putting a finger outside (or inside, #iykyk), the pelvic region in order to start, or keep, a pee stream. 

6. You can run, jump, laugh, cough, sneeze without peeing your pants!

And finally, normal, happy, bladders have a supportive social network of muscles throughout the whole body, who help absorb and manage pelvic pressure to allow you to run, jump, laugh, cough, and sneeze without leaks!  

It is NEVER normal to leak pee, except maybe in the first few days after birthing a child, and NEVER listen to anyone who says “it’s normal, you just have to live with it.”  

What do I do if My Bladder is Misbehaving?

I’m so glad you asked!  First and foremost, educate yourself about how to improve your bladder (& overall health).  This website and my Instagram page have a tremendous amount of free, awesome, educational content to help your angry bladder become a bit happier 🙂  For instance, this post teaches you more about your amazing pelvic floor muscles, and this one talks about ‘how’ we use our Kegel muscles (or pelvic floor muscles) in real life.  

If you need more guidance, consider seeing a Pelvic Physio in person (here’s a link to a blog post on how to find one near you), or buying a streamable online course from a reputable, trusted source (like me!).  

xoxo, Dr. Kelly

Dr. Kelly, double board certified specialist, with greenish tint to picture, pointing to pelvis.

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