Why Do I Have to Push to Pee: The Top Causes

Having to push to pee isn't typically normal. A healthy bladder should allow urine to flow easily when you sit on the toilet without needing to strain your tummy muscles to release it.

While about half of all women face some difficulty with urination during their lives, many still avoid talking about it, even with their doctors. Here at Jude, we're dedicated to bringing women's health issues into the light by exploring common conditions and creating specialised products for bladder leaks.

If you find yourself pushing to pee, this article offers helpful information about possible causes, related symptoms, and ways to treat the problem.

Why Pushing to Pee Isn't Natural

Normally, when you pee, your bladder muscles contract, and the pelvic floor muscles relax, allowing your urine stream to flow naturally from your urethra. When you push to pee, you're often forcing this process by tensing your abdominal muscles, which can sometimes negatively affect the natural sphincter and pelvic floor relaxation needed for healthy urination. Consistent straining can potentially lead to other pelvic floor issues over time.

Potential Causes for Needing to Push to Pee

It’s always important to seek medical assessment to find out why you may be needing to push to pee but let's look at some common reasons why you might need to strain to empty your bladder:

Nerve damage

Spinal cord injuries, diabetes, multiple sclerosis, stroke and other conditions can damage the nerves that control bladder function.

Bladder outlet obstruction

Bladder outlet obstruction can be caused by bladder stones, significant scar tissue, or tumours partially blocking the opening of the bladder urethra. Rarely, a severe pelvic organ prolapse can also cause obstruction. This blockage requires you to push to try and overcome the obstruction and initiate urine flow.

Pelvic floor dysfunction

Dysfunctional pelvic floor muscles which may be overly tight (hypertonic) or weakened often linked to factors like pregnancy and childbirth, chronic straining (e.g. constipation), pelvic surgery, or even habitual ‘hovering’ over toilets, and can disrupt the coordinated peeing process. If the pelvic floor doesn’t relax properly during urination, you may have difficulty emptying the bladder properly, leading to a feeling of needing to push when you pee.

Urinary tract infection

UTIs are the most common cause of urinary issues. These infections cause inflammation in the bladder and/or urethra, which can make initiating a flow of urine difficult and sometimes painful. Fortunately, most UTIs are readily treatable with appropriate antibiotics prescribed by a healthcare professional.

Constipation

Constipation is characterised by infrequent bowel movements or difficulty passing hard stool in your lower intestine. This hard stool can put extra pressure on the bladder and potentially obstruct the bladder outlet, making it difficult to empty the bladder. This may result in you feeling like you need to push to pee.

Urethral scarring (stricture)

Scarring on the urethra (known as urethral stricture) may narrow the thin tube, making it harder to pee. Scar tissue on this thin tube may be caused by injury, previous catheter placement, infection (like some STIs) or surgery.

Pelvic organ prolapse

As mentioned, when the pelvic organs (like the bladder, uterus, or rectum) descend from their normal position, they can press on the bladder or urethra and can obstruct urine flow. Pelvic organ prolapse can be caused by factors increasing intra-abdominal pressure or weakening pelvic support, such as obesity, pregnancy, childbirth, chronic coughing, heavy lifting, and pelvic surgery.

Menopause

During and after menopause, women experience a significant drop in their oestrogen levels, which can cause the lining of the urethra and bladder to thin and become less elastic ( a condition called urogenital atrophy).. This, in turn, can result in a range of urinary issues, including difficulty urinating, or increased susceptibility to UTIs.

Associated Symptoms

If you're pushing while peeing, you might have other related symptoms, such as:

• Sudden urges to pee: Out of nowhere, you may experience intense urinary urgency.

• Urinary incontinence: Involuntary urine leaks (this could be stress, urge, overflow, or mixed incontinence).

• Burning sensation while peeing: Often linked to UTIs, but can have other causes like inflammation or irritation..

What Can You Do About It?

If you have trouble urinating and feel like you always need to push to pee, there are various treatment options and management techniques available to you, following proper diagnosis by a doctor.

See a doctor

The first and most important step should be to see your general practitioner as they'll be able to assess your condition, discuss your symptoms, perform an examination if needed, determine the likely cause and recommend appropriate investigations, medications, treatment or onward referral if needed. advice and recommend medications and treatment if needed. Many women feel ashamed to speak about their urinary issues, but bladder problems are very common and effective treatments are often available, so there is no need to feel embarrassed.

Perform pelvic floor exercises (if appropriate)

Under guidance, if appropriate for your specific condition (e.g. weakness rather than over-tightness, which requires different techniques like relaxation), pelvic floor exercises may help. If you want to strengthen your pelvic floor muscles and enjoy better control over your bladder, you may want to try the following exercises:

• Kegel exercises: Contracting and relaxing your pelvic floor muscles for timed intervals. For example: contract for five seconds then relax completely for five seconds and repeat, ensuring you breathe normally and don’t tighten your buttocks, thighs or abdomen. Correct technique is crucial and seeing a pelvic floor physiotherapist is recommended..

• Bridge pose: Lie on your back with your knees bent and your feet hip-width apart. Inhale and lift your hips towards the ceiling. Hold this pose briefly.

• Squats: Stand with your feet hip-width apart and lower your hips while keeping your back straight until you're in a "sitting" position. Come back into a standing position and repeat.

Note: while bridge pose and squats engage core and pelvic muscles, they may not directly target the specific issue causing difficulty urinating. Specific exercises should be recommended by a healthcare professional based on your assessment.

Surgery

If your urinary issues are caused by significant pelvic organ prolapse or certain types of bladder outlet obstruction, then various surgical procedures could help correct the underlying anatomical issue. Surgical options depend on the specific diagnosis and pros and cons should be discussed with a surgeon. Often surgery is considered after conservative options have been tried or if the problem is severe.

FAQs

What is acute urinary retention?

Acute urinary retention is a sudden and usually painful inability to pass any urine which is a medical emergency requiring urgent attention.

How can I strengthen my bladder muscles?

You can strengthen your pelvic floor muscles (which support the bladder and help with control) by performing Kegels. However, it’s crucial to ensure you are doing them correctly and that strengthening is actually needed (sometimes relaxation is more important). Consulting a pelvic floor physiotherapist is highly recommended for proper assessment and guidance. It is also important to keep in mind that it can take weeks or months of consistent, correct practice to strengthen these muscles.

What are the different types of urinary incontinence?

• Overflow incontinence (often related to retention)

• Urge incontinence (associated with urgency)

• Stress incontinence (leakage with pressure like coughing, sneezing)

• Functional incontinence (physical or cognitive barriers to reach the toilet)

• Mixed incontinence (usually a combination of stress and urge)

What does it mean if I have a slow urine stream?

A slow urine stream typically indicates some resistance to urine flow or reduced bladder muscle contraction. This could be due to a urinary infection, bladder stone, pelvic organ prolapse, nerve damage, or urethral scarring(stricture). It warrants medical investigation to determine the cause..

Final Thoughts

From leaking urine to difficulty urinating, almost half of women experience some type of bladder function problem at some stage of their lives. If you're struggling with difficulty emptying your bladder, urge incontinence, or some other type of issue, just know that you are not alone.

Here at Jude, we use our blog to share useful information about women's health topics we care deeply about. We also have our own line of specialised incontinence products, including pads, liners, and leak-proof underwear.

With appropriate diagnosis and many treatment options and management techniques available, you can work toward healthier bladder function and regain confidence in your daily life.