Kim Vopni (00:01.72)
So in this episode, I wanna talk about very common question I get in the community. I get this question on Instagram, I get the question in the Buff Muff membership, Facebook, I get it all over the place. And that is to do with urinary urgency, so feeling like you need to go to the bathroom. Suddenly, it's an overwhelming urge. Coupled with that, people will also say, you know, I feel like I have to go to the bathroom all the time, so I'm starting to feel like I have both.
this strong urge, plus I'm getting that strong urge more frequently and I'm planning my life around the bathroom. And there's people that will self diagnose themselves as having an overactive bladder or sometimes they say I have a small bladder. So we have these terms that we use these beliefs that we have about why we're struggling with this reason. And so often people don't know all the root causes because there are many contributing factors to
urinary urgency and frequency. There is a medical diagnosis of overactive bladder and there is testing that you would go through, your dynamics testing that you would go through with a urogynecologist typically. And there are some people who go through those tests, that test and there are other people who will simply go to their family doctor and say, I'm struggling with this problem. And within the medical model, at least here in North America, we usually have, you know,
five to 10 minutes with a doctor and they're ruling out life-threatening conditions and what they are trained in and know is pharmaceuticals and surgery and there is medication for overactive bladder symptoms. Some of the overactive bladder symptoms actually contribute to some of the root causes of urinary urgency and frequency.
So my point of this episode is for you to understand all the root causes of urinary urgency and frequency, and then of course, what you can do about it. So I'm gonna go through a list, I've written them all down, generally the most common reasons why somebody might be struggling with urinary urgency and frequency. Number one, and this isn't in any order, but this is all the things that you can think about.
Kim Vopni (02:25.73)
Dehydration. A lot of people who have urinary urgency or frequency or maybe you also have stress incontinence, so if you're dealing with both it would be mixed incontinence, they restrict fluids of all types, but definitely water. And they think if I don't drink water then I won't have to go to the bathroom or I won't leak or I won't feel like I have those urges. While that sounds logical, what happens is when we are dehydrated,
First of all, we are going to then get constipated, which is number two on the list, pun intended. But we're also going to have concentrated urine. Urine that is not well hydrated, a body that's not well hydrated, that urine is going to be irritating to the bladder and it will signal, the bladder will signal more frequently and more urgently to get that urine out. So...
Dehydration is a major contributing factor to urinary urgency and frequency. And what we can do about that, so we're gonna go through what you can do, is of course drink more water. I recommend two to three liters of water a day. The bare minimum is half your body weight in ounces, but if you are more active, you're going to want to increase that. So as a general rule for the women in my community, two to three liters of pure water.
is what I would recommend and that's spread out through the day. Tapering off usually about two-ish to three-ish hours before you go to bed. Of course if you could drink a huge volume before bed that's also going to make you feel like you need to wake up to pee. That's going to be the topic of another episode but a lot of the same contributing factors do apply. So dehydration is a major contributing factor. How we deal with that is we become
hydrated. Some people benefit from electrolytes, but pure water is going to make a huge difference. Another factor, as I said, number two is constipation. So constipation is, we don't think like, well, it's poop related, not pee related, but when we have a mass of poop that's in the rectum and we're not getting it out, it is applying pressure through the vagina to the bladder.
Kim Vopni (04:48.856)
They're all very closely, they hang out together, they're like neighbors. So constipation is going to contribute to urinary urgency and frequency as well. When we are dehydrated, we are going to be constipated. We need to have water running through the system to hydrate our stool to make it easier to pass. When you increase your water intake, that will help with urinary urgency because we don't have concentrated urine. It's also going to help you poop.
better. Also when we are constipated we are straining and straining can contribute to or worsen pelvic organ prolapse. Pelvic organ prolapse is another contributing factor. So in terms of what we can do from a constipation perspective there's going to be a whole episode on this from my solo episode but I have several episodes dealing with constipation because it is such a pop that not popular but a common
challenge in the community. You want to see a pelvic floor physical therapist to see if it's something structural. Is it because of tight muscles? And spoiler alert, tight muscles is part of urinary urgency and frequency. So is it because of tight muscles? Is it because of maybe erectocele where we have a little poop pocket that things are getting trapped in? Is there some nerve damage that's disrupting the actual system of digestion and elimination?
So you want to have that checked out from a structural perspective. You also potentially want to work with a gut health specialist, maybe a functional diagnostic nutritionist or a gastroenterologist, somebody who can understand your transit time, somebody who may be looking at certain foods, look at your fiber intake, look at your water intake and see if there's something that can be helped there. You also want to use a squatty potty, get your feet elevated. You also want to have a good circadian rhythm.
day. You want to wake up with the light, you want to start winding down as the sun is setting, you want to have time in the morning that allows you to poop. We are so often rushing out the door we don't leave ourselves time to have an optimal bowel movement. So you want to really address constipation that will help your urgency and your frequency that's sort of the quote-unquote overactive bladder symptoms will be better when you address constipation.
Kim Vopni (07:12.47)
Circling back to the dehydration and drinking more water. Something else we want to pay attention to is when we're not drinking water, what else are we drinking? What else are we eating? What are we consuming or putting in our body that could potentially be a bladder irritant? This could also be supplements. It could also be vitamins. It could also be medication. So using a bladder diary to track your food, to track your
fluid intake, also noticing how much water you drink or don't drink, times of the day symptoms will help you uncover some of the other root causes, but also some of the trigger foods or drinks for you as well. So the most common bladder irritants are carbonated beverages, alcohol, artificial sweeteners, spicy food, acidic food.
gluten and dairy for some if you're sensitive. I think I've mentioned the top ones. But you also want to pay attention to the medication that you're on. You also want to pay attention to the supplements. So vitamin B, vitamin C is very common as an irritant. Not saying any of these things are bad and I'm certainly not saying stop your medication. You would need to speak to your doctor. But is it a side effect of any medication that you're on that you that would increase urination?
want to check that out. But then you can make choices you could maybe drink more water when you take your supplements or your vitamins or you may work on all of the other things and hopefully that will end up resolving the other parts of urgency.
Excuse me.
Kim Vopni (09:06.735)
So you wanna make sure you're looking at your bladder irritants as well and doing a bladder diary. I'll have a link in the show notes for you to be able to download the bladder diary that I recommend to my community that gives you a 24 hour period to track what you're reading, what you're drinking, what symptoms you have, how, like the volume, how much urine is coming out, because that's the other thing is people say, I feel like I have to go all the time, but not much comes out when I sit down. And that's the classic sign of.
your bladder signaling you inappropriately. So we need to figure out why it's signaling you inappropriately. So we have dehydration, we have constipation, we have bladder irritants, we've talked about pelvic organ prolapse. So pelvic organ prolapse when there is organs that are bulging or like descending, bulging into the vagina, again that pressure can create symptoms.
doesn't have to necessarily be the bladder that's prolapsing. It could be the uterus, it could be the rectum. All types of prolapse could potentially contribute to urinary urgency and frequency. So again, when you see the pelvic floor physical therapist, you're getting evaluated for prolapse. Make sure they're assessing you in standing. And if you can, make your appointment later in the day, which is typically when prolapse is more symptomatic for people, potentially more pronounced. So you wanna get an understanding if that's something that's playing a role. And if so,
Buff muff exercises, establishing a really strong foundation and base in the pelvic floor. Hypopressives to add the lift, helping guide the organs upwards back into closer to their anatomical position. A pessary is something you could investigate. Pessaries are like orthotics that we put in our shoes that are supposedly supporting, I don't mean supposedly, they are meant to support our feet. Pessary is like a
an orthotic that's being placed in the vagina and it can provide support to organs that are shifting out of their optimal position. Generally for pessaries, I recommend that people put them in early in the day and that could be as soon as you wake up, it could be after you've had a bowel movement, but put it, don't wait for you to become symptomatic and then put your pessary in. You want to put your pessary in to help prevent the symptoms and mitigate the descent and the movement of the organs as much as you possibly can.
Kim Vopni (11:32.292)
They can be transformative and really make a big difference in people's lives. So that's what you can potentially do to address prolapse. And again, you want to make sure you're drinking enough water so you're not constipated. You want to make sure you address all the things about constipation so you're not straining to poop. The other thing you want to pay attention to, especially if you are using a pessary, is you want to have an estrogenized vagina. Low estrogen is also a contributing factor to
urinary urgency, frequency, other things like burning, itching, irritation as well. Could be a contributing factor to the development of prolapse, can be a contributing factor to stress urinary incontinence. There's an umbrella term called genitourinary syndrome of menopause. There's also a term genitourinary syndrome of lactation. Both reflect low estrogen states. The difference, typically low estrogen post-baby,
generally the person will come out of that. Whereas once we reach our menopause, we are forever in that low estrogen state unless we are supplementing or using hormone therapy. Vaginal estrogen is something that I do consider to be essential. I've said that for a long, time based on the evidence, based on many people that I follow. And recently, so at the time of this recording, this is early 2026.
and towards the end of 2025, the FDA removed the black box label warning on estrogen. Initially, there was a panel, there was a group of doctors who created a petition and it was to remove the black box label on vaginal estrogen, but it did apply to all estrogen products in the end. Estrogen has been thought to be something that causes cancer and that is a hangover from the Women's Health Initiative.
there was no evidence that vaginal estrogen created any increased risk of cancers or heart attack or stroke, all the things that this label said, also probable dementia. So there was no evidence, meaning the label was medically inaccurate, which prevented many, many people from a really, really truly beneficial life-changing treatment. So it's going to take some time until we are all back on board, I guess.
Kim Vopni (13:53.988)
both from a physician perspective and the general public perspective, but vaginal estrogen is something that I do consider to be essential from the start of our menopause, sooner if you're symptomatic, for the rest of your life. There are some people who may have sensitivities to estrogen or to some of the ingredients, so you could have it compounded as an option, meaning it's not the regulated version with the other additives in there. Sometimes that's what's creating a reaction.
The other option is Vaginal DHEA, also called Intrarosa, which is a prescription you can get from a doctor. There is also a cream in the United States called Gelva, is available over the counter, available on the internet, actually from Dr. Anna Kabeca, who is a friend of mine and an amazing women's health practitioner. She formulated that. She is a specialist in women's health. So.
You can purchase that directly from her. It is an incredible cream. I recommend it to anybody who can get their hands on it. But unfortunately, we can't it can't be shipped across the border to anybody in Canada or elsewhere in the world. So you would either need to go to the States and order it yourself or have somebody there order to you and potentially ship to you. Or you can ask your doctor for intra Rosa, which is also vaginal DHEA. Now, intra Rosa is not a cream like Jalva is. It is an ovule that you put in at night, typically.
But DHEA can also help in the way that it helps with the conversion of our own hormone. So it's not a hormone in and of itself. What it does is when it is consumed or put into the body, an enzyme converts the DHEA to testosterone, and then another enzyme comes and converts that testosterone to estrogen. So it's helping from a hormonal perspective, even though it end up.
itself is not an estrogen like sorry it's not a hormone like estrogen is but I do I do consider it essential to help with the urinary symptoms so GSM genitourinary syndrome menopause has genital symptoms and signs and symptoms urinary signs and symptoms and sexual signs and symptoms. The urinary pieces which we're talking about today the urgency and the frequency can be helped with vaginal estrogen.
Kim Vopni (16:15.021)
Now of course none of these, like really all of these boxes need to be checked. wouldn't, you know, don't worry about your constipation as long as you have estrogen on board or if you've got your constipation in check you don't need estrogen. We need all of these things to be in check, yes for our pelvic health but also just for our overall health as well. So vaginal estrogen will help and a recent study also showed that pelvic floor exercise with estrogen
is more beneficial. So this study looked at a group of women with, at the time they used the term vulval vaginal atrophy, which is now called GSM. And they had one group do Kegel exercises and another group do Kegel exercises with vaginal estrogen. The form of estrogen they used was Estriol. The group that had the combined Kegels and estrogen, well, Estriol, they're better than the group that had Kegel exercises alone. So Kegels,
When done correctly, do help with blood flow circulation, which can be helpful. But when you add estrogen, that helps with the delivery of the estrogen to the tissues and you get more bang for your buck. So another reason to do the exercises, but you wanna make sure that you have estrogen on board and or vaginal DHEA for some tissue support.
muscular support, need that on board to help us build our muscle as well. So I can give you all the magic exercises in the world. If you're not consuming enough protein, if you don't have the right micronutrients, if you don't have the right hormones in place, it can be more challenging to build that muscle. So low estrogen is another one. That is something that I do recommend. And another now contributing factor root cause is muscular tension. So tension in the pelvic floor.
And this has been well established in the literature as well. Hypertonic, so high tone or overactive tone or non relaxing muscles. There's different terminology. Overactive muscles can also contribute to urinary urgency and urinary frequency. When the muscles are really tight, it's going to restrict blood flow circulation, but it's also going to irritate those organs, particularly the bladder.
Kim Vopni (18:39.287)
It could also be a contributing factor as I mentioned earlier to constipation and then constipation could be the reason why you have urgency and frequency. So you can kind of see how we can jump all around and there's so many factors that influence one another. But tension, releasing tension in the pelvic floor is really, really important. You can do that with exercises. So I share a lot of release exercises online. I shared in my Buff Muff community, Buff Muff release work.
Hypopressives. Hypopressive means low pressure. So low pressure fitness is another technique that helps normalize tone. It can help with the reaction time of the pelvic floor. can also help from a prolapse perspective. It can help with the digestion perspective. So potentially help alleviate constipation as well. The other thing is posture. So how we stand or sit is going to influence our
deep core system and also potentially adaptations we have in our body for sitting and standing with a tucked pelvis that is going to contribute to more tension in the pelvic floor. Also the footwear that we have so right from the base of support if we have footwear that has an elevated heel even if it's quote unquote a neutral shoe and even if it doesn't look like it's a heeled shoe
small little shifts in the heel being elevated translate up the chain, shortens our calves, shortens our hamstring, pulls our pelvis into a posterior tilt and can contribute to urgency, frequency as a result of tension in the pelvic floor. So what do do about it? We learn to release tension. We could transition to minimal footwear. We can work on lengthening our calves and our hamstrings. We can release tension in the pelvic floor. One of my favorite exercises is the posterior pelvic floor release. You can find that on
my YouTube channel. Also a hamstring release. So I've mentioned stretching, but we can do releasing of the hamstring as well. Releasing tension in and around the pelvis. So the glutes, the belly, the inner thighs. So releasing tension is going to be a big part of reducing urinary urgency and frequency as well. And the other thing would be behaviors that we have.
Kim Vopni (20:55.575)
And part of using the bladder diary is also going to help with this. We may pay when we start to pay attention might notice that whenever I hear the sound of running water, whenever I come home and put the key on the door, whenever I think about or see a toilet, I suddenly feel like I need to go. And that becomes a trained behavior. It's like a Pavlov's dog response. And just like the bladder became trained to associate the sound or the sight of those things.
with going to the bathroom, we can now put new inputs in to help train the bladder the opposite way. So potty training or bladder training is going to be a big part of this as well, identifying the triggers. And then I've always used the term exposure therapy, standing in front of a toilet and not going when you feel the urge. If it's an appropriate urge, go, but if you know that you just went 30 minutes ago and you haven't had a huge volume of water, then that's not an appropriate urge and you need to take back control.
your bladder shouldn't be the one dictating your life. So you want to make sure that you do some bladder training. And I think that's most of what's on my list here. One other thing that I want to mention is the overactive bladder medication that is so often prescribed. Again, if we have that five, 10 minute visit, don't have, the doctor doesn't have time to do a proper pelvic floor evaluation to really.
dive deep into more questions and to get to the root cause. So in their training, they hear these symptoms, there's a drug for that, they will prescribe the drug, let's see if it works. And sometimes it does, sometimes it works for a little bit of time and then it stops. But I hear so often people try multiple different medications and it might help a little but not really. And it's so often because the root, all of the root causes have not been addressed.
And side effects of overactive bladder medication are dry eyes, dry mouth, can also read dry vagina, constipation, high blood pressure, and cognitive decline and increased risk of dementia. Not all of them, but many of them. So you wanna make sure if you are on an overactive bladder medication, really pay attention to those side effects. And if you are struggling with constipation, if you struggle with high blood pressure, if you have dryness, especially as you're
Kim Vopni (23:21.731)
moving into the postmenopause phase of life and you don't have vaginal estrogen on board, that's going to be a problem. And cognitive decline is a major, major concern. pay attention before you start your medication, address all of these root causes, go through the list, check what you have, use what I've recommended in terms of overcoming these. It doesn't happen overnight, but when you are hydrated, when you...
are pooping well, pooping well like a Bristol stool chart number four, when you have an estrogenized vagina, when you have removed bladder irritants, when you address prolapse, when you release tension in the pelvic floor. All of these things help and can transform your life. So I hope you found this helpful and you can look in the show notes for some of the links that I have shared here.
One would be getting the bladder diurene starting noticing how much water you do or don't drink, how much fiber you do or don't eat, and some of the behaviors that could be contributing to your challenges. I will see you in the next episode. Thanks for joining me.
