Is hovering over the toilet bad?

November is National Bladder Health Awareness Month, observed every year to raise awareness about various issues that impact bladder health. HOVERING is one of these issues; specifically, hovering over the toilet in order to pee! This is something I see a LOT, and today I want to share with you why shouldn't hover, and why you shouldn't push to pee.

Urinary incontinence is super common.

While incontinence isn't a "sexy" topic, just take a look at how common it is:

• 25 million adult Americans experience transient or chronic urinary incontinence. NAFC (National Association for Continence) estimates that 75-80% of these sufferers are women.

• One-third of men and women ages 30-70 have experienced loss of bladder control at some point in their adult lives and may still be living with the symptoms.

• On average, women wait 6.5 years from the first time they experience symptoms until they obtain a diagnosis for their bladder control problem(s).

It's time to take the lid off of incontinence. People need to know how common it is, that they're not alone, that it does NOT have to be a normal part of aging, and that there's help!

There are two (simple!) lifestyle changes that anyone can make starting RIGHT NOW to support pelvic and bladder health, and to prevent or reduce symptoms of urinary incontinence, urgency, and frequency.

Tip One: Don't Hover Over the Toilet

As a women’s health physical therapist, I am an advocate for bladder health and wellness. When I was in clinical practice, I was shocked by the number of women with bladder issues who admitted to "hovering" above the toilet seat to urinate. I encouraged all of my patients who “hovered” (rather than sitting fully on the toilet) to stop this habit immediately!

Why? Because when you hover, your hip and pelvic muscles can't relax. Everything is tight and tense, and your bladder can't empty fully. This leads to feeling like you've "always gotta go," or like your bladder is the size of an acorn. In extreme cases, it can even contribute to an increased likelihood of bladder infections.

Amazingly, as soon as my patients stopped hovering over the toilet to pee, their symptoms of pelvic tension, bladder leakage, urinary urgency, and urinary frequency subsided.

If sanitation is a concern, use a toilet seat liner. If a liner is unavailable, line the toilet seat with toilet paper… Or just take a risk and sit down on the seat!  A person’s bottom and upper thighs, which are covered most of the day, are usually much cleaner than a person’s hands, and we tend to have no qualms about social situations that require a handshake.

So please, sit and relax when you need to pee.

Another problem with hovering: 

When “hovering” above the toilet seat, the muscles of your pelvic floor and your hip rotators, buttocks, back, and abs are extremely tense. This muscular tension makes it difficult for urine to flow easily, often requiring you to push or “bear down” to initiate urination.

You might also find yourself pushing to pee because it’s hard work hovering above the toilet! Your thighs are burning, and you’re thinking “let’s just hurry this along!”

Hovering can make you feel like you need to PUSH to pee. Pushing to pee is a no-no!

Bladder Tip Two: Don't Push to Pee

Even if you don't hover, frequent pushing or bearing down (i.e. straining) to pee is a COMMON issue. Regularly pushing to pee can contribute to bladder health issues, including pelvic organ prolapse. 

Some people push to pee because they're in a hurry and want to get it all out FAST!!! I see this a lot with busy moms, teachers, nurses, and doctors: over-stressed, over-hurried, over-worked people who LITERALLY feel like they don't get a moment to themselves. (Not even a moment to pee in peace.)

Other people push to pee due to extreme tension in the pelvic floor muscles (referred to as pelvic floor hypertonicity). This extreme pelvic tension can make it hard to start the urine flow, and/or it can make it difficult to empty the bladder fully. Therefore, people with hypertonicity often they push and strain to get out every last drop.

How to AVOID Pushing to Pee

In order to avoid pushing to pee, sit down fully on the toilet seat. Relax all of your pelvic muscles and the muscles in your genital area. Just let it all GO. Picture them softening and blossoming open like a rose in full bloom. 

Allow the urine to flow out naturally, in its own time. If you're busy, GIFT YOURSELF an extra 20-30 seconds to pee fully and completely. (The world won't explode while you're away, I promise!!!) 

When you're done peeing, tip your pelvis forward and back a few times, without tensing up your pelvic muscles, and see if you can "tip out" every last drop. This is much healthier and safer than pushing/straining to get it all out!

Wondering about pushing to have a bowel movement?

Ideally, you won't push or strain to have a bowel movement, either. Regularly pushing or straining into the pelvic area for ANY reason can contribute to bladder health issues (including prolapse). Keep your stools soft by eating a diet full of liquids and fiber (I talk about this in the nutrition portion of my Lift Program), and try my guided visualization for elimination: 

Just remember: don't hover, and don't push to pee.

Sit down and relax. Your bladder and pelvic floor muscles will thank you!