My Problem Is I Have A Very Small Bladder

Hello, welcome. You’re listening to Dr. Martha Reid Naturopathic Doctor Vancouver at Doctor’s Choice Integrative Medicine in Downtown Vancouver, a space where I bring passion, inspiration and nourishment to the conversation of your health.

So today, a patient came into my practice and asked me a question about bladder health. This particular patient identifies as a woman and uses the pronoun she and her. And so she said to me, I think I just have a really small bladder. I’ve always thought that’s normal for me, but it kind of bugs me. Is it a problem?

And I said, Well, let’s talk about that. It’s not likely that your bladder is smaller than the other human beings around you. And they tend, to my understanding, be a relatively stable size. I’ve certainly not seen all the bladders in this world, by all means. In my human dissection lab, which is part of our medical school training, we worked on seven human bodies and the bladders as we dissected them out were really all about the same size. And so my understanding is that in general, they are. I don’t think that, you know, when we’re lining up being built into a human, that we end up with teeny tiny bladders or really huge, huge, huge bladders.

I think they’re all about about the same size. So I said to her, I suspect that your bladder is a and average human body size. So let’s talk about what might be going on with it. I said, How much water do you drink? Oh, I drink a ton of water. I said, well, what is a ton of water? Well, at least eight glasses a day (eight glasses being about 250 mils), so about two litres a day. Absolutely. At least I said, OK, and that’s pretty normal hydration volume and your bladder ought to be able to handle that. When we’re well hydrated, we use the term in medicine, you hydrated, you hydrated, we should pee about once every hour or so.

And our urine ought to be nice and clear, right? It shouldn’t be too yellow. It shouldn’t be dark colored, it shouldn’t be cloudy. It shouldn’t have a particular strong odour to it. All of those things, cloudy urine, dark urine, odorous urine, all of those can be clues that there might be something out of balance with your body. We ran what’s called a urine analysis on this patient. Everything came back completely normal. And the appearance of this patient’s urine was indeed light colored and clear with no particular strong odour. And everything in the urine analysis came back completely normal. So then I said to her, well, what are you experiencing with your bladder and what do you mean by being a problem? Well, I just like I feel like I just go all the time and I don’t particularly have a ton to pee.

Oh, OK. Well, we can talk about that. I said, do you have stress or anxiety that you experience? Well, yeah. I mean, I think that’s pretty normal, too, though? I think we all have stress. I said, yes, a lot of us do right now, certainly in the time we’re living in. But stress can certainly negatively impact the bladder, and there’s a lot of different reasons that can be the case. I said, So let’s talk a little bit about stress and how that might be impacting your bladder. So I said, Do you notice that when you feel anxious or stressed that you have to pee more? And I said, Yeah, absolutely. Every time I get nervous, I feel like I have to pee. I said, OK, so that might be a hormonal issue, that a stress hormone issue, it could also be a concern with the microflora of the mucous membrane in the bladder. And so if there’s an imbalance there, you may have some inflammation in that bladder tissue, which then every time the urine is coming in and touching the bladder walls, that creates a bit of a feedback and irritation to the body and a feedback to the mind that, oh, I’ve got to pee, I’ve got to pee. Those are culture mechanical receptors. So the fluid filtering down from your kidneys coming into the bladder, it touches the walls and that’s a trigger that, oh, there’s something here. And so then your bladder tissue sends a message to your brain, oh, there’s something in the bladder and oh, I should release that urine. And if we have a sensitised internal bladder wall that will create what we call a neurogenic feedback loop to the brain, then oh my gosh, I’ve got to pee. And that can create what’s called an urge incontinence. We also have what’s called a stress incontinence where it’s like when you’re running or jumping or you laugh or you sneeze or you cough that you release a little bit of urine. And that has to do also with stress. It also has to do with the health of the mucous membrane. Which has to do with good quality microflora within the mucous membranes of your body. And ultimately where that begins is within your gut. But another area is what we would call interstitial cystitis. And this can negatively impact your bladder in that sense that, oh, I always have to pee in this sense of urgency. And there may be irritation that you feel like when you’ve had if you’ve ever had a urinary tract infection, many people will experience with that. This sense of either burning pain post urination or an urgency or real frequency or a sense of heaviness in their lower sort of pelvic bowl area. So lower abdomen. And that can all be signs and symptoms of a urinary tract infection. So you would run that urine analysis I mentioned a few moments ago and rule that out.

But with interstitial cystitis, you can get that level of urgency and irritation and frequency, but it typically has to do with inflammation within the mucous membranes, which has to do with stress has to do with food sensitivities, has to do with the microflora. So that’s a really important thing to speak to a health care provider about and get checked out because there is so much that can be done to relieve that.

Another cause of why we can get this frequency in this sense of “we have a really tiny bladder” has to do with our pelvic floor. So for those of us that have bodies that have vaginas and uteruses, and then we have a bladder and a urethra that releases from the bladder and then on the backside of everybody’s we’ve got our anuses, all of those exit ways. So from the urethra out of the vaginal canal, out through the anal canal, they all exit through what is called your pelvic floor. And this is a whole bowl of muscles that really kind of sling at the bottom of the body. And that pelvic floor can become damaged over time by many things like chronic stress. So if you hold the weight of the world on your shoulders and don’t have an easy and comfortable way to communicate that and you sort of hold that in your body, a common place for people to hold that is down in through their guts in their abdomen. And then, for those who have this pelvic floor, as I’ve mentioned, where you’ve got a urethra and then a vagina and then an anus, that pelvic floor is often a place that we hold tension. If we have experienced trauma in our intimate lives and we happen to have a vagina that can create damage to the pelvic floor, if we have had low back issues or issues with our hips or the alignment of the bones of our low back and pelvis, that can negatively impact the pelvic floor. And it’s the pelvic floor that, to a large, large, large degree, controls the health of the release of fluid from our bladder. So if your pelvic floor is dysfunctional… so, for example, perhaps you have a really hypertonic pelvic floor (meaning it’s clenched and it’s really tight) that will over time weaken the pelvic floor. And so then you can end up with a weakened external bladder sphincter, which then can make it hard for you to hold your urine when either you cough or run or jump on a trampoline, or you just happen to have a full bladder so that level of control to release the fluid from the bladder has to do with the internal bladder sphincter and the external bladder sphincter. And the external one in particular can be affected by a pelvic floor that has been damaged over time. And the pelvic floor is something that we don’t typically talk about with people. It’s not something we tend to talk about with our health care providers as a human in this world.

I have had a really interesting road with pelvic floor and in my own health journey have learned a ton about pelvic floor. And so I can speak to the concerns I see in my patient base from a place of having been there. And so there is so much that one can do to support a healthy bladder experience by ensuring that you have a healthy pelvic floor.

So if you are somebody that has concerns about your bladder and potentially how that might connect to your pelvic floor, please come see me. It’s something that is so worth taking a few moments to talk about because what happens when we have an imbalance in the pelvic floor and an imbalance in the bladder, both or one or the other, it affects so much our quality of life we shift the way we interact with our world. We change our exercise and our fitness and our activities. We map where bathrooms are often because we want to make sure that we’re going to be able to have a safe place to release our bodies when we need to. All of that impacts how we feel about ourselves. So a lot of what we may normalise in our bodies, for example, “oh, I just have a really small bladder and that’s why I pee all the time”, well, it may not be that you just have a really small bladder. There might be a lot of other things going on that we can support you in to correct. So it might not just be something you got to live with. If you have questions about this or would like to just hop in on this conversation with me, I would so welcome it. And, and all you need to do if you’re interested in doing that is pop over to our website and book a discovery call with me and we can just have a really lovely conversation regarding this area of health for you. I would hope to be able to create some insights for you that would generate some peace in that arena.

Thanks so much for listening. I always welcome any questions, concerns or comments and I look forward to talking to you again soon. Take care.