With public toilets on their way to extinction in the UK, one anxious writer goes on a mission to solve her bladder issues…
I’m standing by my front door, fumbling around in my handbag in search of my keys. FFS. The toilet is mere metres away, but I don’t know if I’m going to make it. My legs are crossed, the panicked feeling in my chest is getting stronger. I can feel the warmth running down my legs. Oh shit. I’ve wet myself.
It isn’t the first time. I have a vivid recollection, etched into my memory, of 15-year-old me standing at the front door of my friend’s house. We’d been sledging in the snow, and the loos in the park had been closed. By the time we headed back to her house, I was desperate. I pushed my hand against my crotch, hoping it might stem the flow. but no. My jeans were soaked, and I was mortified.
There have been plenty of near misses, too. Times when I’ve pissed behind cars parked down busy roads or found myself with my pants around my ankles in a bush on the morning dog walk. And then there are the moments when I’ve snuck into a bar, past the ‘toilets for customers only’ sign or pulled my car over at the next petrol station in the vague hope of finding a public loo without a massive queue.
Clearly, I’ve got issues. But there’s an access problem here too, because public loos in the UK are rapidly on their way to extinction. Back in 2000, there were 6,087 public toilets; today, there are 3,990. That’s over a third of public loos gone in two decades.
And when you do find a loo, invariably, there are already people waiting to use it. According to a YouGov survey, 59% of women regularly queue for a toilet compared with just 11% of men. When you need to pee as regularly and urgently as me, that’s a real issue.
So, I’ve decided to finally get to the bottom of my bladder woes.
From my symptoms, I’ve always assumed that I either have a thimble-sized bladder or really weak one. But when I get in touch with Dr Ginny Ponsford, a GP and director at The Women’s Hormone Clinic, she puts me straight on a few things. First up, she’s against using the term ‘weak bladder’.
“You can have weakness of the pelvic floor and the muscles around the bladder,” she explains, “which can give you incontinence when you cough, for example, or when you jump on a trampoline in a rebounding class.” This, she classifies as ‘stress incontinence’.
“Then there’s feeling the urgent need to wee often. “That’s an overactive – or irritable – bladder,” Dr Ponsford continues. That’s called ‘urge incontinence’.
To get a handle on your bladder issue, you’ve first got to work out which kind of incontinence you have, and bear in mind that it is possible to suffer from both. “For women with stress incontinence, [it’s important to] strengthen your pelvic floor muscles as would for any other muscle weakness in any other part of the body,” she explains.
“Pelvic floor exercises are key for good bladder function, and so too is strengthening the muscles surrounding and supporting the bladder.”
Overactive bladders, on the other hand, require bladder training. Dr Ponsford says that’s about “reprogramming signals from the bladder to the brain”. On a day when you’re at home, that might mean practising holding it in, ie waiting longer before using the loo. “The bladder will adjust to the feeling of filling up.”
How to improve bladder health
I decide to hit the issue from all angles. When I’m working from home, I hold my pee for longer than is comfy, resisting that urge to run to the toilet immediately. Ironically, I’ve always known that my pelvic floor muscles could do with some strengthening, but I’ve never really known how to go about it.
Pelvic floor training
So, I book in for a private online session with pilates teacher Sophie Ritchie who runs Discobarre Studio in Dalston. She teaches a class based on the Lotte Berk technique, a barre method that was founded over 60 years ago specifically with female bodies in mind. “A lot of the exercises are performed with your body in a pelvic tilt,” explains Ritchie as she lifts her crotch, “which helps you connect with that part of your body.”
Dr Ponsford is against using the term ‘weak bladder’
There’s a whole section of the class dedicated to strengthening the pelvic floor, which Richie calls ‘the inner spirit’. After a series of warm-up exercises (including pelvic tilts and leg raises), I’m instructed to sit cross-legged on the floor and close my eyes.
“Rest your hands on your knees and circle your hips and torso,” Ritchie says. “Now bring your awareness to three sections: the clitoris, vaginal passage and anus.” Eyes still closed, I imagine separating them in my mind. “I’ll call each part tip, middle and back,” she continues, and then I’m led through a series, where I clench each part and then slowly – “always slowly” – release the hold. “Like a flutter of the eyelids,” Ritchie explains.
Then she gets me to imagine those parts are a lift that I’ve got to squeeze as I travel up 10 floors of a building before coming back down slowly. “This is all about control,” explains Ritchie. Something I clearly need in my life. I leave the class with a warm feeling inside my body. It’s different to any exercise I usually do and offers a sense of bodily awareness I’ve never really felt before.
Bladder-friendly diet choices
Exercise aside, other lifestyle factors and tweaks can play a role in improving pelvic health. Diet is hugely important. “Anything acidic, carbonated, alcoholic or containing caffeine can cause cystitis-like symptoms,” explains Dr Sarah Jenkins, a leading expert in pelvic health.
She recalls having to deal with an acute case of urinary retention (where you’re unable to empty all the urine from the bladder) caused by cocaine consumption when working as a junior doctor at a hospital. “Until then, I didn’t have a clue that lots of drugs can induce urinary symptoms,” she tells me.
Addressing psychological aspects
And then there’s the psychological aspect of peeing. I’d describe myself as an anxious pee-er, always needing a wee before a journey or meeting. Dr Ponsford confirms that this is definitely a thing. “The adrenaline released when we’re anxious can stimulate the detrusor muscle of the bladder, as well as having an effect on the nerve pathways to the bladder,” she explains. “That causes the bladder to contract and gives us the urge to pass urine.”
Natasha Richardson, founder of Forage Botanicals, used to struggle with this too. “I used to plan trips around knowing where the loos were,” she tells Strong Women. Richardson is a medical herbalist and works mainly with menstrual and hormonal health, but she has several clients who also live with recurring cystitis, interstitial cystitis and irritable bladder syndrome.
“I worked with a patient with a sensitive bladder who found great relief in daily nettle tea, which is a diuretic. But her symptoms would always flare up when she was stressed. She wasn’t very good at identifying when that was, but her bladder would tell her instead.” That sounds familiar.
Switching up my thinking has been hard, but I’ve learned some valuable pointers. I’ve realised I don’t have to be ‘the one who always needs to wee’ – it isn’t inextricably linked to my personality. Weaving pelvic floor exercises into my weekly schedule has made me stronger and more aware of what’s going on in my body. Just thinking about that pelvic floor muscle has made a difference.
I’ve just returned from my morning run, and for the first time in ages, I didn’t have to stop off for an al fresco park pee. My daily Diet Coke has become a treat and I’m drinking more soothing nettle tea these days. These things might sound boring but they work. For the first time in a long while, I’m enjoying days out without anxiously seeking out a route to the loo.
How to deal with an overactive bladder
Find a public loo
You can pop your location into The Great British Toilet database to find all the loos near you that are open to the public. It’s an absolute lifesaver. Your local area may also have a Community Toilet Scheme, which encourages pubs and cafes to open up their toilets to the public, so look out for stickers in windows.
Grab a ‘let me in’ card
The Bladder & Bowel Community offers a free “I Can’t Wait” card that can be shown in places where toilets aren’t usually accessible to the general public. You can apply online and get either a digital version for your phone or a physical card to pop in your purse.
Drink nettle tea
Forage Botanicals’ Soothe & Comfort tea tackles bladder irritation and eases stress, ingredients include nettle and chamomile.
Wear leak-proof pants…
There are loads of leak-proof options out there that offer peace of mind while you’re out and about or exercising. Jude pants absorb eight teaspoons of urine, while Modibodi’s also makes pee knickers. Its leggings are a game-changer for running and rebounding classes.
… and easy access jumpsuits
If you love the look of a jumpsuit, but never wear them because they are so hard to get down for public peeing, say hello to Leim. These jumpsuits are handmade by Hetty in her home studio in the UK and have an easy-access panel at the side.
Know that weather makes you pee more
“When we’re cold, our bodies work hard to maintain our core body temperature,” explains Dr Ponsford. “If our bladder is full then the body has to work to keep the urine at core temperature, too. This is an unnecessary use of energy and hence we have the urge to pass urine when we are cold.”
Try electrical stimulation
Dr Jenkins’s clinic, The Door W4, offers an electrical stimulation treatment called Vtone, which powerfully stimulates the pelvic floor muscles to strengthen them.
Images: Getty
