Why do I need to go to the loo all the time?

Why do females feel the need to go to the loo more than men? Photo / Getty Images

My life has been ruled by my bladder. But is it all in my head? And can I train myself to hold it in for longer? The experts weigh in.

Earlier this month, I was faced with a familiar and knotty problem. I had booked tickets to the theatre and discovered in advance that the performance was 90 minutes long, without an interval. An hour and a half, squeezed into a tiny and inescapable spot – from where it would be nigh on impossible to go to the loo.

So I would be faced with my usual choice. I would either sit, clenching away in an increasing amount of discomfort as my bladder began to fill and complain so much I couldn’t concentrate on the play. Or, the alternative: to make the leap and decide to go and relieve myself, causing a huge amount of clattering embarrassment as my row-members stood to let me pass and I stepped on toes and fell over bags, distracting the actors. Anticipating this scenario filled me with stress and concern. This is nothing new.

It recently occurred to me that my life has been ruled by my bladder. I go to the toilet a lot. On family car trips, my parents would groan as I demanded to stop at yet another motorway service station. Even today, I always book an aisle seat on the plane and get antsy if the seatbelt sign takes too long to be switched off after take-off. I have suffered through interminable wedding ceremonies and describe long films as “one or two-loo-trip movies”. (By the way, I vastly prefer the cinema to the theatre as you can get up without raising as much merry hell.)

It’s a kind of an embarrassing problem – but the thing is, I know I’m not the only one who has to deal with this. Before the above play, my friend Lesley said to me: “90 minutes? I’d better not drink anything beforehand then.” Just yesterday, I was delivering a presentation with a colleague who beat even me with four loo-trips in two hours. “Sorry,” she said. “I’m always like this.”

Sushma Srikrishna is a consultant urogynaecologist and obstetrician at the London Bridge Hospital. “Forty to 50% of women suffer from frequent urination, or polyuria, at some point in their lives,” she says. “We are told to be stoic and laugh it off, but depending on your lifestyle, it can be really disruptive.”

Needing the loo more often doesn’t mean you have a small bladder – it’s often learned behaviour. Photo / 123RF

Of course, men can also have this issue. One in three men over 50 will have some symptoms of prostate enlargement and one of the signs is needing to pass urine more often. “When you have an enlarged prostate, it makes it more difficult to empty your bladder, and the tank is going to fill back up again quickly so you may have more frequent urination,” says the Cleveland Clinic.

Then there are conditions such as urinary tract infections (UTIs) that make people wee more frequently (and more painfully) and these can be contracted by both men and women.

But there’s no doubt that the casual: “God, I need to go to the loo” is more of a female lament. As Srikrishna puts it: “‘Women are always telling me: ‘I always have to know in my head exactly where the closest toilet is at all times in a way that often isn’t the case for men.’”

So, for those without prostate glands, why does this happen, and is there anything we can do about it?

What is a ‘normal’ amount of times to need the loo?

“There’s no one-size-fits-all answer to this,” says Srikrishna. “If your frequency is normal for you, and doesn’t interfere with your quality of life, then that is fine. I would usually expect the female bladder to hold 400 to 600ml of liquid before it’s time to go with a gap of three to four hours between visits, on average. But this depends on how much you have had to drink (more on which below).”

According to Srikrishna, it’s unusual for a person under 50 to get up in the night to pee. “After your 50s, it’s normal to get up once a night, and in your 60s and 70s, more than once a night. This is the same for men and for women.” For women, the increased frequency is due to hormonal changes, and for men, prostate issues – or, in both sexes, diuretic medications such as those used to treat heart conditions.

Your urinary frequency often increases when you are pregnant. Otherwise, suddenly needing to go more than your regular pattern can indicate a health problem.

The difference between frequent urination and incontinence

While they’re often mentioned together, polyuria is different from incontinence, the involuntary urination that can result in leaking. But frequent urination can be just as inconvenient to your day-to-day life.

Should I see a GP about my frequent weeing?

You should see a doctor if there’s no obvious reason for your frequent urination (ie you haven’t been drinking more fluids such as alcohol or caffeine), the problem disrupts your sleep or everyday activities, or you have other symptoms that worry you such as pain when you pass urine, fever, or a loss of bladder control.

Otherwise, you may have what the experts call an “overactive bladder”. “First of all, we have to rule out conditions such as a UTI or diabetes,” says Srikrishna. “Certain neurological issues such as Parkinson’s disease can make you go to the loo a lot, as can the side effects of diuretic medications including blood-pressure pills. But even if there is no obvious source for the excess urination, we can still treat your symptoms.”

Is there such a thing as a “small bladder”?

No, says Srikrishna. “Most women – most humans, in fact – are similarly constructed. It’s more about how people are taught early in life to train their bladders. We learn from our older relatives. If it was normal in your family circle to say ‘oh, we all do this’, and ‘let’s have a wee before we leave the house just in case’ then that’s what you become used to. But you can also train yourself the other way.”

Do things naturally get worse as we get older?

“As we age, our bladder capacity diminishes meaning we are less likely to be able to ‘hold it in’, and we’re also more likely to be on medication that could have frequent urination as a side-effect,” says Srikrishna. “The menopause also has a massive effect.” The lack of oestrogen weakens the bladder and the urethra, the tube that carries urine out of the body, compromising their ability to control urinary functions.

Does psychology have anything to do with it?

“I hear this all the time from my patients,” says Srikrishna. “The fear of not being able to get to the toilet absolutely reinforces the need to go.” (A bell is ringing with this writer, and her theatre-going friend.) “There’s also something called ‘latch-key urgency’ where you suddenly need to urinate the minute you get in the door.” Both the above scenarios are caused by brain conditioning and can also be addressed.

Are we drinking too much during the day?

“It’s one of the absurdities of modern life that people think they have to drink water every minute of every day, carting around giant water bottles,” says Srikrishna. “We don’t live in a hot, tropical country. You only need to drink one and a half to two litres of fluid a day. What goes in, has to come out.”

But contrary to popular belief, restricting your fluid intake below what you “need” to drink will not make you go to the loo less. “Dehydrating yourself is counter-productive,” says Srikrishna. “Your kidneys will still make the urine, but it will be more concentrated and it will be more uncomfortable to go.”

Do any types of food or drinks make it worse?

The trigger depends on the individual, but certain foods are known to irritate the lining of the bladder and make you want to go more. “One of the most common triggers are acidic foods, like tomatoes or orange juice,” says Courtney Barth, a registered dietitian.

Some drinks can make it worse than others. “Coffee is also a big one because of the caffeine [which is a diuretic],” says Barth. Srikrishna agrees. “Caffeine and fizzy drinks will make you want to pee more as will industrial quantities of green tea.” Chocolate can be a trigger because it contains caffeine. Alcohol is also a trigger.

So, how can I treat my overactive bladder?

“When I see my patients, I do a number of diagnostic tests,” says Srikrishna. “After I have ruled out a medical cause such as infection, I’ll look at the structure of their bladder through a camera and then do what’s known as a ‘urodynamic assessment’, where we fill the bladder with a dye, then watch it empty under an X-ray. I will then ask my patients to look at their lifestyles: what they eat and drink. Then we try a suite of treatments.”

1. Bladder retraining

“There will always be that time where you think you won’t be able to make it,” says Srikrishna. “So you have to tell yourself: ‘brain, I am the boss of you’.” This process involves telling your brain nothing terrible will happen if you can’t go immediately, and allowing your bladder to stretch. You go for increasingly longer periods, and learn to ride it out. Tell yourself, “if I wet myself, so what”? A person is programmed to last three or four hours without “needing” to go.

This all sounds a bit like “controlled crying” – a kind of Gina Ford nanny routine for your bladder. Women who had their babies in the early 21st century may appreciate the reference. Note: it’s a myth that “holding it in” for too long is bad for you, according to Sikrishna. You won’t be able to last longer than 24 hours before it all comes streaming out, regardless.

You only need about 1.5 to 2 litres of fluid daily – more isn’t always better. Coffee, fizzy drinks, alcohol and even tomatoes can trigger more loo trips. Photo / 123RF

2. Vaginal oestrogen

According to Srikrishna, vaginal oestrogen, delivered in a pessary or a cream, can have miraculous results by restoring tissue health and reducing bladder irritation.

“It’s totally safe, and works in a different, more localised way to HRT [hormone replacement therapy] with no side effects,” she says. “Most GPs should be able to provide vaginal oestrogen.”

3. Medications

For more serious cases of frequent urination – present with neurological conditions, for example – there are medications known as antimuscarinics, which block the activity of certain receptors in the brain. “But these can have side effects such as dry eyes, dry mouth, and constipation,” says Srikrishna.

4. Botox

Botox can be injected directly into the bladder wall, where it temporarily paralyses the muscles, preventing them from contracting too quickly and causing the urge to urinate. While it’s generally considered safe, potential side effects include a temporary difficulty in emptying the bladder completely. “We generally only use Botox when other methods have failed,” says Srikrishna.