Narrator/Promoter (1:53)

Yeah.

Norman (Guest Expert) (1:54)

The other one is that you sort of try and pull your. If you've got kids in the car, you know, just go with this for the moment, but, you know. Or put their hands. You actually try and pull your rectum up into your pelvis and hold it for 10. That's the other way of doing it.

Podcast Host (2:11)

This is why doctors invented medical terms for body parts, because. So you can see.

Norman (Guest Expert) (2:16)

Well, it's a bit different for blokes than for women. Slightly different from how you do the Kegel.

Podcast Host (2:19)

I wouldn't know.

Norman (Guest Expert) (2:20)

Well, you should know. You were asking me to do it. You could have caused me harm here. Permanent harm.

Podcast Host (2:26)

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 gonna get into it a bit more in what's that? Rash?

Norman (Guest Expert) (2:33)

Which is the podcast where we answer the health questions that everybody's asking.

Podcast Host (2:40)

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, hello, question solvers. I'm travelling Australia at the moment and since getting on the road, I have been needing to rise at least twice a night to go to the loo. 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 5pm I've 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 help you pee less and is wondering if these.

Norman (Guest Expert) (3:26)

So are these corks or are they.

Podcast Host (3:29)

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. A lot of bladder related questions today.

Norman (Guest Expert) (3:50)

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 have changed 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.

Podcast Host (4:14)

Men it could be early signs of prostate disease.

Norman (Guest Expert) (4:17)

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 in case it's a sign of something going wrong.

Podcast Host (4:50)

As always, if something new's happening that isn't nice. It's good to get it checked out.

Norman (Guest Expert) (4:55)

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.

Podcast Host (5:10)

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. And 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.

Norman (Guest Expert) (5:35)

Yeah. 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 and not quite in a steady stream 24 hours a day, because 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.

Podcast Host (6:07)

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, Apple.

Norman (Guest Expert) (6:17)

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 signaling too early that you need to go to the bathroom. Then beyond the bladder, you've got sphincters.

Podcast Host (7:18)

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?

Norman (Guest Expert) (7:26)

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 and 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.

Podcast Host (8:27)

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.

Norman (Guest Expert) (8:37)

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.

Podcast Host (8:56)

So on pelvic floor exercises, I don't know if you've heard of this guy who's trying to live forever. Brian Johnson.

Norman (Guest Expert) (9:03)

Oh, the guy who's spending $2 million a year on supplements and doctors and God knows what else. Yeah.

Podcast Host (9:08)

Yes.

Norman (Guest Expert) (9:09)

So he's made at 8 o' clock at night and has no life. Yep. Got him.

Podcast Host (9:12)

Well, he had. There's a bladder story in Brian Johnson as well. Would you like to hear it?

Norman (Guest Expert) (9:16)

Yes, probably.

Podcast Host (9:17)

He. 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.

Norman (Guest Expert) (10:02)

Well, he doesn't have much fun in his life, so maybe, maybe this is the replacement.

Podcast Host (10:06)

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.

Norman (Guest Expert) (10:29)

Oh, I'm sorry, I really made. I'm sorry I asked to hear the.

Podcast Host (10:32)

Story, but why do men care so much about how far they can pee reach with their pee stream?

Norman (Guest Expert) (10:37)

Ah, because that's the other side of an 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.

Podcast Host (10:53)

Right? So pee stream strength equals longevity and.

Norman (Guest Expert) (10:56)

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.

Podcast Host (11:08)

So, I mean, so what we're hearing there is there are some products for increasing pee power.

Norman (Guest Expert) (11:14)

And what's certainly true is, and physiotherapists and incontinence nurses who are really good at teaching people chemotherapy. 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.

Podcast Host (11:39)

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.

Norman (Guest Expert) (11:57)

Does pumpkin seed recurs again and again? 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 seed in large prostates.

Podcast Host (12:09)

But like, in what dose? If I've got in my muesli in the morning, Is that enough or do I need to be mainlining them?

Norman (Guest Expert) (12:15)

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?

Podcast Host (12:25)

So I guess coming back to what we do know could work to help you pee less. What evidence do we have?

Norman (Guest Expert) (12:31)

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.

Podcast Host (13:45)

So its sensor gets.

Norman (Guest Expert) (13:47)

The sensor gets. Goes off, the centre gets distorted. The core treatment for that is Kegel exercises, 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 trigone and your trigone is not triggering off with less urine in your bladder.

Podcast Host (14:59)

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?

Norman (Guest Expert) (15:10)

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.

Podcast Host (15:28)

Time for the literal bottom line here then, Norman.

Norman (Guest Expert) (15:31)

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.

Podcast Host (16:08)

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 thatrashbc.net au we really love hearing from you.

Norman (Guest Expert) (16:22)

See you next time.

Podcast Host (16:23)

See you then.

Norman (Guest Expert) (16:24)

Sa.