Help! I Can’t Pee!

Have you ever felt like you needed to pee so badly only to find difficulty urinating when you finally make it to the toilet? Or maybe you feel like you can’t fully empty your bladder when you try to.

Sometimes this happens when you have had to “hold it” for a long time. Your pelvic floor tightens up to make sure that urine stays inside. When you finally get to the toilet, the pelvic floor feels like it just won’t release and you have to take a couple of deep breathes before anything starts coming out.

But, what if this happens to you regularly?

Recently, we had a patient (we will call her Maureen) who showed up at our office after going to the Emergency Room because she simply couldn’t pee. In the ER, they inserted a catheter and took out 2 liters of fluid!

Now, Maureen thought her problems were solved until the doctor walked in and told her that she would have to learn to use a catheter on herself in order to pee in the future. And she is in her 20’s!

As you can imagine, Maureen was not in a good place when she made it to our office. She did not want to have to use a catheter to pee for the rest of her life. And, she wanted to have children one day – what was going to happen then?

After we talked to Maureen, we learned that this was not the first symptom of her problem. Maureen had suffered with pain during intercourse for years. She also had extreme neck and shoulder tension that often caused headaches. She sometimes even got migraines!

During the evaluation, we found that Maureen had increased pelvic floor tension. She also had increased tension in her diaphragm and was unable to take a deep breathe. The tension in her diaphragm was leading to increased tension through her neck and shoulders.

The first step for Maureen was to decrease the tone in her pelvic floor so she could pee without a catheter. This was the first step because it was her most important goal. Then we moved on to decreasing the tone in her diaphragm so she could perform proper deep breathing. This also helped to keep her pelvic floor from tightening up.

Now, Maureen also needed help releasing her neck and shoulder muscles because they had been tight for so long that they simply wouldn’t give up! And, today, Maureen never has to worry about using a catheter, enjoys pain free sex, and has eliminated her migraines.

What does your pelvic floor have to do with peeing?

Your pelvic floor is a muscle just like every other muscle in your body. It was designed to contract – and relax. Obviously, the pelvic floor needs to maintain enough tone that your urine and poop don’t end up everywhere. But, when the pelvic floor muscles get too tight it can make it difficult to pee or poop at all.

The urethra is a tube that carries urine from the bladder, through the pelvic floor, and out of your body. If the pelvic floor muscles are tight, the tube will get squeezed. This will make it difficult to allow the urine to get out of your body.

Why is your pelvic floor tight?

There can be many direct reasons that your pelvic floor is tight. You may have suffered from trauma, had difficulty in child birth, be going through menopause, or had an injury to your pelvis. These are only a couple of examples of direct reasons that cause pelvic floor tightening.

The #1 indirect reason that your pelvic floor is tight is your diaphragm. The diaphragm and pelvic floor are designed to work in opposition to each other. Think about when you are trying to poop. You increase tension in your diaphragm and relax your pelvic floor.

However, when one of these is too tight, the other may become tight also and prevent you from functioning correctly. This is because both the diaphragm and pelvic floor are made of muscles. Muscles are dumb. They are designed to contract and relax. When they sense any pain they do the only thing they can – they contract.

Important note here: This pain may be caused by physical or emotional symptoms. Our brains process physical and emotional pain pretty much the same. So, if you are anxious, stressed, or exhausted, your pelvic floor and diaphragm muscles can tighten up.

Why is your diaphragm tight?

What we see most commonly in the clinic is that people have forgotten how to breathe properly. In today’s society we are constantly bombarded with information and decisions. This leads to stress and fatigue which activates our fight or flight mechanism.

When the fight or flight mechanism is activated you start using the muscles in your neck and shoulders to increase your lung capacity. But, these muscles are only supposed to be used in emergency situations. When they are used consistently the muscles get fatigued. And then they get tight. And then they start causing pain, headaches, and even migraines.

Bonus Point – The pelvic floor and diaphragm are both part of your “core”.

You may have been working on strengthening your abdominals to decrease your low back pain, improve your posture, or just to be able to do yard work without hurting yourself and found that you never achieve these goals. Your limiting factor may be increased tension in the pelvic floor or diaphragm – or both!

Here at Physical Therapy for everyBODY, we include the diaphragm and pelvic floor when we are discussing the core muscles (we also include the hips!). Because if all of these muscles are not working correctly together you are not able to do what you want to do in life. You will be stopped by pain or an injury which is super frustrating.

If you are having difficulty peeing or find it difficult to fully void when you do go to the bathroom, we encourage you to reach out for one of our Free Discovery Visits. During this visit we will listen to your story and together decide if you are a good fit for what we offer. There is absolutely no obligation for you to continue with us as our goal is to help people find the best path for their health.