You’re Peeing Wrong

(or how to get the patriarchy out of your pelvis)

I peed myself the other day. Let’s just get that out of the way up front. It had been a long day of cooking and caring for others, too much non-alcoholic sparkling wine, not enough attunement to my body’s signals, and that’s what you get.

I share this with you because any time I’ve told someone that I have peeing issues, they usually have responded “OMG me too.” In fact, rarely do I talk to someone these days who isn’t having peeing issues. So just in case you thought you were alone, I want you to have that ‘OMG me too’ moment.

All my life, I’ve thought a lot about peeing. Like a lot a lot. Will there be a rest stop? Should I try to pee once more before we leave? How long before the little ‘no smoking’ sign goes off in the plane and I can get up? Aside from pee-related self-preservation, however, a lot of my thoughts are caused by the distress others seem to feel about my peeing. A sampling of what others have said about my peeing:

“Hollenstein, your bladder is the size of a lentil.” ~ my 10^th grade chemistry teacher

“You don’t really have to pee, it’s in your head.” ~ an ex (and a physician, though not a urologist)

“That’s not normal. Should you see a doctor?” ~ my partner (also a physician)

“You have to go again?” ~ literally everyone

Granted, my bladder may be on the smaller side. Granted I tend to drink things that increase glomerular filtration rate (the rate of liquid moving through the kidneys and out through the urine) like coffee and kombucha. But the comments from others throughout my life about how often I pee have really made me self-conscious, guilty, embarrassed, and ashamed.

There was one discussion I found helpful about peeing though, and I’d like to share it with you. It was with the urologist I waited months to see, which I took as evidence that peeing is on a lot of people’s minds. I made the appointment because peeing had become a source of increasing suffering. Yes, I always went frequently when I was younger. Yes, I also noticed an uptick in my urgency after I gave birth vaginally. But, holy Depends undergarments Batman, things got bad as I entered peri-menopause. So bad that my first signal to pee was also my last and sometimes there was no signal at all.

What made this conversation with the urologist so life-changing, though, was how she helped me understand my peeing issues within a greater context. There were things that I was doing unconsciously because of cultural pressures that were actually making my peeing life more difficult, specifically clenching my stomach and treating peeing as an inconvenience. What’s more is that she helped me understand my relationship with peeing was nothing to be ashamed of, that it was partly due to my unique body, and partly due to the collective confusion around women’s bodies that is so emblematic of the patriarchy.

Sucking In My Gut

As a young child, I learned that girls’ and women’s stomachs should be flat. Even before the collective obsession with six-packs and the flex of wearing only a sports bra, I was holding in my little tummy because a relaxed, rounded tummy was unacceptable.

What I didn’t realize about that was that the tension created by constantly clenching my abdominal muscles was compressing and irritating the nerves that pass through my abdomen and pelvis, including the iliohypogastric and ilioinguinal nerves (that run through the lower abdomen) and the pudendal nerve (that enervates the pelvis). This can cause nerve damage, pain, numbness, and even alter the sensations communicated from the body to the brain.

Because the movement of my diaphragm and pelvic floor was constricted by bracing my abdominal muscles, I was reducing my breath capacity and the ability for my body to regulate the pressure in this area. I was also constantly contracting my pelvic floor, which can lead to urinary urgency, constipation, pain during sex, and a heavy, blocked sensation. Ironically sucking in your gut can decrease core muscle coordination – the diaphragm, pelvic floor, transverse abdominus, and multifidus are meant to work together but gripping overuses some muscles, underuses others, and creates imbalances that cause pain and dysfunction.

My urologist helped me make the connection that in trying to make my body more acceptable (to whom? Men? Other women?), I was harming myself. By shaping myself to those who might objectify me, I was creating dysfunction, pain, and robbing myself of sensation. This felt tragic.

Treating Peeing Like an Inconvenience

The second thing I was doing was not giving my body enough time to pee fully. Because peeing might inconvenience someone else or get in the way of work (or some other form of ‘doing’), when I did break for the bathroom, I rushed, bore down, and got up too quickly.

This can cause its own set of issues. Because rushing doesn’t let the bladder empty fully, there can be urinary retention that increases risk of UTIs, bladder stones, and chronic urinary retention. It can also lead to bladder overactivity (story of my life), urge incontinence (latest chapter), and reduced bladder capacity (sounds very familiar), and kidney disease (which I hope will not be the final chapter of my story). And it can contribute to pelvic floor dysfunction such as tension and tightness, hesitancy, and incomplete emptying.

In a more existential way, the story I told myself about my peeing was that there was something wrong with me – a narrative I realize was not limited to my bladder. When my urologist explained what was actually happening, she helped me understand that I was not broken. Rather I was trying to fit in and feel safe in a culture that not only doesn’t understand my body, but actively ignores it, hates it, diminishes it, and tries to control it.

The realization hit me like a punch to the gut: despite all the work I’ve done to root out these harmful influences – rejecting diet culture that told me my worth was measured in how small and disciplined I could be, rejecting the pornification of sex so I could reclaim my own sensations instead of performing, rejecting the rigid hierarchies and militant rationality that try to flatten exquisite complexity – the patriarchy still lived in my pelvis. That truth was too much to bear, and I broke down right there during my physical exam. The idea that shedding these toxic layers of mind and body control might take the rest of my life was overwhelming, and I couldn’t hold it in.

The upshot of my urology appointment was that I learned how to let my body do what it has always known how to do:

1. First, don’t wait until the figurative lights are flashing red. Go to the bathroom regularly without waiting for strong urges.

2. Allow myself to fully sit on the toilet rather than crouching, perching, or trying not to take up too much space (I mentioned in my book Eat to Love the horrendous story of a woman who lamented how her body took up too much space on the toilet – like we need more things to worry about).

3. Lean forward while relaxing my pelvis, rest my elbows on my knees, and breathe deeply and diaphragmatically.

4. Just stay there until the bladder has stopped emptying. Don’t rush, don’t push, don’t pathologize. Everything else can wait.

That appointment was like walking through a gate: I could never unknow what I learned about the complexity of something so seemingly straightforward. And it has heightened my awareness of the ways I still try to contort my body and mind into being acceptable to a very confused, very sick culture. The experience has also increased my resolve to listen to the wisdom of my body, question any time what comes naturally is being pathologized, and lean ever more confidently into what cannot be oversimplified.

Photo by freestocks on Unsplash