10:44pm July 30, 2014

DIY Guide On How To Urinate

I know this sounds like a very strange topic, but it’s one that I know some of my followers have had problems with. Don’t read unless you don’t mind mention of urine and the mechanics of urination and other parts of the body close to where you urinate from. Also, this is written from the point of view of someone with a vulva and the usual urinary mechanics involved with that. I don’t know how much of this advice is useful to people with penises. It’s all from personal experience, so I can’t speak outside those experiences.

My Story (skip this if you just want to get to the instructions – the instructions will have a bold section at the beginning, like this one)

I retain urine. What that means, is that it’s very difficult for me to empty my bladder fully, which has led to a bunch of urinary tract infections and bladder infections over the years since my problems urinating started. The problems started when I was 18 and I am about to turn 34, to give you some idea of the time I’ve been dealing with this.

When I initially started having problems urinating, I told a neurologist that I kept “forgetting how to urinate”. I’d sit on the toilet and nothing would happen. I’d strain and only get the tiniest amounts out. I’d try to remember how to work the muscles involved and get nothing. Just nothing.

The neurologist told me “Nobody forgets how to urinate. Urination isn’t voluntary.” He then proceeded to write me up as in need of psychiatric evaluation. This prevented me from seeing a urologist and getting diagnosed and treated for about seven years. Seven years full of UTIs and going to the bathroom every half hour or so, day and night. Seven years of believing nobody would listen.

Then one day a nurse saw me struggling to give a urine sample. She said the way I was struggling was not normal. She persuaded me to talk to my doctor about a referral to a urologist. I went to the urologist, petrified. I fully believed that he would not find anything wrong with me.

He did a series of pretty invasive tests on me, that involved watching my bladder and urinary tract in action, catheterization, and other things I hated and wasn’t sure I could tolerate. But I tolerated them.

And wonder of wonders, the test results came back abnormal. This is a running theme in my life: Expecting a test to show nothing, because I’ve been conditioned to believe my problems are all in my head. And then ending up with the test showing something that perfectly explains my symptoms. I think I have more proof of the reality of my symptoms than the average chronically ill person, yet I find it hard not to fall back into that fear.

So the muscles around my urethra are spastic. This means that left to their own devices, they try to spasm shut, closing off my urethra and making it very hard for urine to pass through. Which meant that I had to find some way to treat it.

The three options I was given were physical therapy, self-catheterization, and a surgical implant. Self-catheterization leads to an increased risk of infections, and even minor surgery is a major undertaking with risks, so the first thing they did was send me to physical therapy.

In physical therapy, I learned as best I could to control my pelvic floor muscle. They put electrodes on my butt and used biofeedback and video games and imagery to teach me how to relax the muscles around my urethra. Yes, I was playing video games with my ass.

Physical therapy worked to some extent, and I am now very glad that I went to the trouble. But I was still having a lot of difficulty urinating by the end of my course of physical therapy. They had started out very optimistic that physical therapy was all I would need. But as the weeks wore on, they became more and more pessimistic about my prognosis. Sort of “Really? Still not much improvement when you’re actually in the bathroom? Ugh…”

So then my urologist suggested to me something called an InterStim implant. This implant is used for two groups of people: People with incontinence, and people with urinary retention. In both cases, what they do is thread a wire through your tailbone into your pelvic floor muscle. The other end is attached to a battery and controller device in or near your buttock. It sends pulses of electricity into the muscle. For someone with urinary retention, the pattern of these electrical pulses help the muscle relax so that you can urinate easily. Then you get a little remote control that you can use to adjust the level of stimulation to what is comfortable for you and what you need. You can also switch between a few different programs of stimulation.

I went ahead with the surgery. First they do it on a trial basis. Which was successful, so they gave me the permanent version. I’ve had it ever since, and it’s been about seven years now I think.

Anyway, what I’ve found is that I needed both the surgery and the physical therapy. Because even with the implant, urination is not always easy for me. I still have a spastic urethra that doesn’t always do what I want it to do. So I need the techniques I learned in physical therapy.

It’s sort of like, neither the implant nor the physical therapy was enough for me on its own. But taken together, they work amazingly well. Now I can see what the physical therapy was supposed to do: By allowing me to relax that muscle, the urine just comes out pretty easily. But I still have to concentrate and practice the things I learned in physical therapy. I can’t just sit on the toilet reading and peeing. If I’m reading, I can’t pee.

That neurologist who said “Urination isn’t voluntary” told me one of the biggest lies I’ve ever heard from a doctor. Everything about the way I urinate is voluntary (except when incontinent, but that’s a different story altogether). And the same is true for most people: If it weren’t voluntary, people would pee everywhere they were standing. I can’t imagine why I was lied to, but I was lied to.

But now that I have the implant and the physical therapy, I feel like I have the tools I need in order to urinate properly. Instead of getting clusters of UTIs lasting months, I can’t remember the last time I got a UTI. So this has been my story about how I’ve gotten where I’ve gotten. Now onto the instructional part.

How To Urinate – The Instructions

This is a guide for people who, for whatever reason, can’t see a doctor, or can’t get this information out of their doctor. It is usually better to get help from a medical professional than to take advice from a random person on the Internet. Especially since inability to urinate is extremely serious and may require catheterization and other medical care. But since I know not everyone can get to a medical professional, this is the advice I’d give to people who are having trouble peeing. Some of it you’ve probably seen before, others you probably haven’t. It might not work for you, depending on why you can’t pee. And it’s centered around the experience of people with vulvas, because that’s what I have and I don’t know how a penis would make things different. It also does reference various anatomical parts. And urine.

1. Lean forward

The more forward you lean yourself on the toilet, the more you help the urine flow out of your urethra at a good angle. I’ve been known to sometimes lean forward so far that my feet touch the ground and I’m more hovering over the toilet than sitting on it.

2. Press on your bladder

This can help stimulate it to get the urine out, in some circumstances. If you don’t know where your bladder is, find a diagram.

3. Forcing it

I was told by my physical therapist never to use brute force to get urine out. As in, straining. The reasoning was that when you strain, you tighten your muscles, including the muscles that are preventing you from urinating. But I’ve still found that straining works some days, when nothing else does. I just try not to make a habit of it.

4. Learning to open up

This is what I learned in physical therapy. It’s much easier to learn with electrodes attached to your butt that let you know every nuance of your pelvic floor muscles and how open or closed they are. But I think it can be done without that.

Start out actually learning to clench those muscles. Whether it’s doing Kegels (clenching your vagina shut), clenching your rectum shut, clenching the area around your urethra, or clenching several of these at a time, they’re all attached to the same pelvic floor muscles and they’re all going to likely help you with urination.

So when you’ve learned to clench it shut, learn to relax it. This is the hardest part. Learn to feel how relaxed it can get. One thing they had me do was look at a picture of a flower petal slowly opening. You can look at that or imagine it in your head, and try to open those muscles yourself. Try to open them until they’re completely loose, until there’s no pressure or clench left in them. And then try to open them further, as far as you can possibly go.

Once you’ve learned how to open them, you can do that on the toilet. It can take a lot of concentration, but this is the most surefire way to make sure urine comes out. This is what I was learning to do in physical therapy.

5. Combining pushing with opening up

This one is hard, and I don’t think my physical therapist would’ve approved. But sometimes it seems necessary, especially when I’m in a hurry.

This combines two things. One is pushing. Not pushing hard, not trying to squeeze every bit out with brute force. But maintaining a steady push from the top.

And the other is opening up like I talked about before. So you’re basically pushing with your bladder area and opening up your urethra at the same time. This has a lot of success, for me, with getting urination done in a hurry. Normally it takes me quite some time to urinate even now, but this cuts that time in half even if I don’t get all the urine out.

6. Combining several of these things

That’s probably what you want to do in the end. You’ll definitely want to involve relaxing your pelvic floor muscles as part of it, because that helps you open up and urinate. But you also might want to be leaning forward and pressing on your bladder at the same time. And then sitting up again and pushing while opening up. And then leaning forward and opening up without pushing to get the last dregs of urine to trickle out of your urethra.

It all depends on what your needs are.

Conclusion

And it may be that none of these things help at all. It may be that it’s hard to convey in writing how to loosen up your pelvic floor muscles, without actually going through the physical therapy with biofeedback. It may be that whatever your condition is, it doesn’t respond to this. It may be that having a penis is a game-changer in ways I don’t understand because I don’t have one.

But I really hope that this helps at least one of the people I know online who are struggling with urinary retention and don’t have the means to see a doctor right now. Because the more urine you can get out, the less UTIs and bladder and kidney infections you will have. Which is why I decided a DIY guide to urination was a good idea — if this prevents even one UTI I’ll be ridiculously happy.

And of course, if you have more additions of advice for people on how to urinate, feel free to reblog with commentary. I’m fully aware of the medical implications of letting these things go untreated, I went seven years without treatment I desperately needed, and got a lot of infections in that time, some of which I could only pee small amounts… of blood. If you have an infection, find a way to see a doctor even if it’s in the ER, a UTI can easily kill you untreated. But I know not everyone has the means to see a doctor about the urinary problems themselves, and I wrote this as a stopgap measure until they can see a doctor. Because these techniques would’ve helped me.