Can you train yourself to pee less? From 'What's That Rash?'
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ABC Listen. Podcasts, radio, news, music and more. It's overwhelm season and if you're having trouble sifting through the avalanches of content coming your way from health and wellness influencers and you're squandering valuable minutes trying to decide which are true and which is 90% garbage, you need to mainline the only health and wellness influencers that you actually need.

Tegan Taylor and Norman Swan, who are hosts of the What's That Rash podcast. Every episode, they answer the health questions that everyone is asking. And this one is a topic close to my heart. It's about pee.

More specifically, is it possible to train yourself to urinate less if you want to? And how can we get our pelvic floors back into shape if things have gotten a bit flubbery, a bit saggy baggy, like a rogue bit of pizza dough or like Gary Oldman's face? Is it possible? Listen on to find out. Here it is. Enjoy.

Okay, Norman, are you ready to perform today's exercises? Yeah, I'm sitting down here in the studio. Yep, sitting down is perfect. Oh, is it really? Feet on the floor, a nice straight back. Yeah, do I shut my eyes and think of a sandy beach somewhere? Sure, if that makes you feel better, that's totally fine. Oh, okay. Now what I want you to do is just pretend that you need to stop weighing for a moment. Just lift. What? Just lift that muscle. Okay.

Just lift that muscle. Okay. Hold it for five and then let it go again. Don't let it go too far. Okay. Right, okay. And then lifting again and squeezing. Yep. And you can release again. Again, please don't wet the chair of the recording studio in which you are. So this is a kick or you're getting me to do this? Oh, yeah, yeah, yeah. Are you familiar? Obviously you are. Yeah, the other one is that you sort of try and pull your –

You're what, Norman? You're what? If you've got kids in the car, you know, just go with this for the moment, but, you know, or put their hands on. You actually try and pull your rectum up into your pelvis and hold it for 10. That's the other way of doing it, isn't it? This is why doctors invented medical terms for body parts. That's right. Because, so you can say... Well, it's a bit different for blokes than it is for women. It's slightly different from how you do the kegel. I wouldn't know. Well, you should know. You were asking me to do it. You could have caused me harm here, permanent harm. Touche.

I'm not a trained professional. I think it's important for people to know that. But I do know a thing or two about kegels and we're going to get into it a bit more in What's That Rash? Which is the podcast where we answer the health questions that everybody's asking. And Norman, the reason we're talking about kegel exercises today is because multiple people have written in asking us effectively, can you train yourself to pee less?

Christine writes,

Christine says, I could sleep seven hours straight at home, so it's a bit of a nuisance having to crawl from my tent and navigate the campground to the toilets every night. Christine has limited her fluid intake to zero after 5 p.m., stayed up till late, sometimes emptying the bladder before bed. I don't drink alcohol, only water, milk and decaf tea. Christine said that she's seen ads for products promising to help you pee less and is wondering if these help. So are these corks or what are they? Yeah.

I don't know. I think they're like a herbal product. We might get into it later. In a similar vein, Kerry says, my daughter came home from school saying she'd learnt that it's bad to hold on rather than go to the toilet whenever you feel like going. Apparently it wears out the muscles. Kerry always thought holding on strengthened the muscles, which is correct.

And one more question from Susan. I have been diagnosed with overactive bladder and exploring the treatment options. I have been recommended a sacral neuromodulation implant, but would like to know the benefits and cons of the different treatments of beta agonists, Botox injections, and the device. A lot of bladder-related questions today. Yeah. Yeah.

So, word of warning here, if you're getting up a lot during, I mean, obviously there's the circumstance, you're out camping, it's cold weather and what have you, and you might change your diet a little bit. But if you're getting up a lot to pass water and you haven't in the past,

You need to see a GP to get sorted out. There could be a kidney problem there. It could be an infection. It could be early signs of diabetes. And in men, it could be early signs of prostate disease. Yes, because what happens with the prostate is you get an obstruction there. And when you pass water, the bladder doesn't actually fully empty. So there's still urine left in the bladder.

And what urologists call this is the encore. So you go to the toilet, you pass water, you leave the bathroom or you're still in the bathroom and you feel the need to pass water again and you have another go. Bottom line here is it's not normal to be from having a normal bladder function to peeing a lot.

And you need to get that checked out just in case it's a sign of something going wrong. As always, if something new is happening that isn't nice, it's good to get it checked out. Yeah. But let's assume there's an issue here, which is you can't pass the toilet without going, that you've just got what seems to be a small bladder capacity. And can you train yourself to pee less? And then there's this notion that holding on is bad for you.

There's sort of two things here, right? Like there's the volume of the bladder as one part of the apparatus and then there's the sort of holding or not being able to hold mechanism at the other end. Actually, maybe a little bit of an anatomy lesson would be good here. I do have some feedback to the people who named the urinary system.

Two ureters and a urethra. I feel like we could have diversified the names for these a little bit more. Yeah. It starts in the kidneys, which have more than one function, but effectively they sieve your blood and blood goes into the kidneys and urine comes out. And urine tends to come out not quite in a steady stream 24 hours a day because- Luckily. You've got a hormone that's produced in the brain. It's called antidiuretic hormone.

And it goes up at night to stop your kidneys or reduce the amount of fluid that your kidneys are producing. We talked about it. We talked about it in our episode of, is your emotional support water bottle too big? So if you want to go back and listen to that, because it was a cracker, you can do that on the ABC Listen app. So we don't produce the same amount of urine evenly during the day. We produce less at night.

Bottom line is kidneys produce urine. The urine goes down these ureters, which are tubes which go into your bladder. Urine collects in your bladder and then at a certain point, a signal goes to your brain that your bladder is full and you want to go to the toilet to pass urine. That's effectively how it works. Now, inside the bladder...

There's a kind of triangular area called the trigone. And the trigone is part of the bladder muscle and has nervous tissue there as well. And the trigone is what's thought to produce the signal that goes to the brain from the bladder saying, you need to pass water. And where they're going frequently, it's often not an issue of bladder capacity. It's often an issue of the trigone being overactive.

and signalling too early that you need to go to the bathroom. Then beyond the bladder, you've got sphincters. So there's bladder capacity, which we talked about. The sphincter is like a muscle and that can get stretched or weakened. Is that correct? Yeah, all this is not separate from the anatomy of the pelvis, which has muscles and ligaments which help to support the bladder and the structures such as the uterus in women,

And the sphincters are enmeshed in both the nervous system of the pelvis and the muscular system of the pelvis. So if you've had babies, then you've stretched all that. And many women get a period of stress incontinence because their sphincters are just not working as well as they otherwise would.

Aging does it too. Aging is probably the commonest cause of this in both men and women. And it's aging of the muscles, aging of this nervous feedback to the brain where it just becomes harder to control. And either that's reflected in wanting to go more often or you're going more often because you're terrified of being incontinent and you get into this vicious cycle.

When I'm doing Kegel exercises we were doing together before, what am I actually lifting? It's not the sphincters. It's like the kind of everything. You are lifting the sphincters to some extent. You're really trying to restore...

muscle strength in that pelvic hammock, if you like, and the neurological supply to it. You're toning up. It's essentially gym for the pelvis, gymnasium for the pelvis, trying to strengthen all that and restore function. So...

On pelvic floor exercises, I don't know if you've heard of this guy who's trying to live forever, Brian Johnson. Oh, the guy who's spending $2 million a year on supplements and doctors and God knows what else. Yes. Who goes to bed at 8 o'clock at night and has no life. Yep, got him. Well, there's a bladder story in Brian Johnson as well. Would you like to hear it? Yes, probably.

So he wants to live forever. Part of that, as you say, is optimising his sleep schedule and so he really wanted to not be interrupted at night by needing to get up to go to the toilet. So improving his bladder function was an important focus for him. One of the ways that he has done this is that he spent...

30 minutes at a time, sitting on top of an electromagnetic machine that is designed to strengthen the pelvic floor. Apparently, if you use this thing, it feels like two small hands repeatedly punching you in that region in quick succession. It's typically used for women who are trying to rebuild strength of that pelvic hammock, like you said, after birth. But Johnson wanted to basically make it

So he didn't have to get up to go to the toilet in the middle of the night. Well, he doesn't have much fun in his life, so maybe this is the replacement. Anyway, he uses his watch to measure his sleep activity. Apparently it was working. He had a perfect 100 score every night, eight and a half hours sleep on average. But there were other benefits from this as well. Apparently the machine increased his urination strength.

in that he could stand further away from the toilet while he peed. I'm sorry. This is a really male thing. I'm sorry I asked to hear the story. Why do men care so much about how far they can reach with their pee stream? Because that's the other side of enlarged prostate is the strength of your stream drops and that can be quite embarrassing when you're standing in a urinal. Maybe the audience doesn't want to hear all this, but it's a sign of being an older man.

Right. So P-stream strength equals longevity and youth. You know, pumping iron, being able to bench lift, you know, 400 kilos and being able to hit the wall at 20 meters. This is obviously the criterion here. So, I mean, so what we're hearing there is there are some products for increasing P power. And what's certainly true is, and physiotherapists and incontinence nurses who are really good at

teaching people cable therapy, there are biofeedback mechanisms to help you. Some people find it really hard to know when they're contracting their pelvic muscles. So getting a sense of that biofeedback and a sense of when these muscles are contracting is very important so that you can strengthen them as you go along. So there are devices around to help you. Well, our question askers did ask about specific products to help you pee less.

Christine mentioned a specific herbal supplement that we won't name, but basically it has things in it like magnesium amino acid chelate, dry stem bark, pumpkin seed and other things. And pumpkin seed does- Pumpkin seed recurs again and again, and it's supposed to be good for enlarged prostates and so on.

I mean, you're not doing yourself any harm with a lot of these products, whether they actually work. There's a little bit of evidence for pumpkin seeds in large prostates, but... Like in what dose? If I've got pumpkin seeds in my muesli in the morning, is that enough or do I need to be mainlining them? I don't know. There's a short answer to that question. I suspect the people who are producing pumpkin seeds as a supplement don't really know the right dose either. They'll tell you, but who knows? So I guess coming back to what we do know could

could work to help you pee less. What evidence do we have? Let's just deal with the risks here that people perceive. People have been led to believe that if you hold on and don't go to the bathroom, it's bad for you. Now, where this comes from is that if you've got an obstructed bladder,

you can get kidney damage because the pressure goes back up through the ureters to the kidneys and the kidneys then atrophy. That can happen with chronic and fairly severe obstruction here. It's a different story if what you're doing is bladder training here and trying to train your bladder to pee less often. Because one of the problems, particularly with incontinence, is urge incontinence.

And you feel that you want to go urgently. That's part of that overactive bladder syndrome. And it's a vicious cycle because you go to the bathroom with less and less urine in your bladder.

And the bladder gets used to that. That trigone starts to trigger at lower levels of urine in your bladder. And it's not necessarily that your bladder shrinks. Sometimes the bladder can be a normal size. In fact, it often is. But it's that triangle of tissue there that's the key here. So its sensor gets... The sensor gets... It goes off. The sensor gets distorted. The core treatment for that is Kegel exercises, right?

but also holding on. And when you want to pass urine, I'm not going to give specific advice, but continence nurses are really good at this sort of thing, is that you hold on and you don't go when you've got that immediate sense that you want to pass urine and you try and hold on. Now, if you've got an incontinence issue because you've had lots of babies or what have you, then that can be quite hard. But that's when the Kegel exercises start to kick in.

But if you hold on, you can progressively train your bladder to hold more urine and you're not going to cause kidney failure by doing that.

And that's the core process. But it's an extended period of time because you might have been doing that since childhood. And it does take a conscious training to extend the number of minutes that you go once you feel that you really want to pass urine. And you do get better at controlling that. And you feel, well, my bladder capacity has gone up. It may not be that your bladder capacity has gone up. It may simply be that you've relaxed your trigon and your trigon is not triggering off

With less urine in your bladder. Just one more thing on Kerry's question about holding on being bad. Is there something in that in terms of UTIs? Are people more at risk of that because of holding on too long? So holding on for two or three minutes longer on one occasion and then after a week it's maybe five minutes longer and you're just slowly increasing the time you take to go to the bathroom, just holding on, holding on.

To my knowledge, that's not associated with urinary tract infections because you're going to empty your bladder quite soon. So coming to Susan's question, Susan has a diagnosis, overactive bladder, and is looking at treatment options. Is there anything that a podcast can tell her that's useful in this regard? Well, she talks about sacro-neuromodulation. So that's putting in a stimulator to do bladder stimulation.

They do not have a good reputation. And I think the evidence is dubious and it's going to cost you a lot of money. Before you go to an intervention like Botox or sacral neuromodulation, you really want to have tried everything else first. And often what people find when you go and see a continence nurse, you haven't been doing the Kegel exercises as effectively as you could.

Then maybe I'll be a small group of people who would benefit from some kind of intervention, but just be very careful. Time for the literal bottom line here then, Norman. Oh, so I can relax now, can I? Because I've been doing my Kegel all the way through so I can unclench.

Look, for most bladder problems, you can train yourself to help them without any medical intervention in terms of needles or operations and what have you. If you've got a new symptom, you need to see your GP and get that checked out to make sure it's nothing unusual. And if you want to train yourself to pee less, you can. And by peeing less, it's really not so much about peeing less, it's about peeing less often during the day.

Well, if you're a bladder owner, I hope this conversation has been useful to you. Thanks so much, Christine, Kerry and Susan for the question. If you have a question you'd like us to answer or have a go at answering, you can email us thatrash at abc.net.au, which is also where you can send your feedback as Jeff has done this week, Norman. So we talked a couple of weeks ago now about whether wearing glasses made your eyesight better or worse, like your actual eyes themselves.

And Jeff says, many years ago, I found a book called The Art of Seeing by the English writer Aldous Huxley.

of Brave New World, if I'm not mistaken, in which he proposes exercises to help eyesight. In 1939, he started practicing a method of visual re-education developed by Dr. W.H. Bates. This included getting more exposure to sunlight, which you talked about, Norman, and also working on the neural processing of the images that the eye picks up.

His vision improved significantly. He never had very good vision, but he eventually achieved his best vision without lenses. I will add here, Aldous Huxley famously also experimented with LSD. How much can we place on this anecdote, Norman? I think there is a sense, and it goes back to the question that we've just had in this episode of What's That Rash?, which is about bladder training. The eyes have a very complicated muscular structure.

And in theory, you could train your eyes to accommodate your vision and actually change the shape of your lens and focus it on different parts of your eye. And there's a little bit of evidence that you can do eye muscle training that will help that. But it's rarely as good as proper correction using spectacles or contact lenses.

What about the use of LSD? Certainly your vision would be a lot better, a lot more interesting during LSD. Best left unsaid there. Well, thank you, Geoff, so much for the feedback. If you've got feedback, again, thatrash at abc.net.au. We really love hearing from you. See you next time. See you then. Bye.