Why You Shouldn’t Pee “Just in Case” (And What to Do Instead)
If your bladder feels unpredictable, it’s easy to assume something is wrong.
Maybe you’re going more often than you used to. Maybe you wake up several times a night to pee. Maybe you feel pressure even though you just went. Over time, many people start peeing “just in case” — before a drive, before a meeting, before exercise — just to avoid surprises.
That response makes sense. When your body feels unreliable, you try to stay ahead of it.
But here’s the thing: urinary frequency, especially in bendy bodies, is rarely just a bladder problem. It’s often the downstream effect of inflammation, fluid shifts, autonomic instability, hormone changes, or pelvic floor coordination. If we don’t identify the driver, we can accidentally reinforce urgency patterns instead of calming them.
Bladder training — spacing voids gradually and rebuilding tolerance — is well-supported as first-line treatment for urgency and overactive bladder. We know that emptying at the first hint of sensation teaches the bladder to signal earlier. Over time, that can lower your ability to hold more pee.
So the question becomes: what’s driving the urgency in the first place?
When It’s Irritation
Sometimes urgency really is bladder irritation.
The bladder lining is sensitive, and mast cells play a central role in bladder inflammation. Histamine and other mediators can create pelvic pressure that feels exactly like fullness.
Common bladder irritants include caffeine, alcohol, carbonated drinks, citrus, tomatoes, spicy foods, artificial sweeteners, chocolate, and high-dose vitamin C. These often overlap with mast cell triggers.
If urgency comes with burning, flushing, gastrointestinal symptoms, or flares after certain foods or stress, inflammation may be the dominant pathway. In that case, bladder retraining alone won’t fix it. Calming mast cell activity with treatments like antihistamines, and restoring tissue health, are more important first steps.
If estrogen is low — during perimenopause, menopause, breastfeeding, or while on masculinizing-dose testosterone therapy — the urethra and vaginal tissues become thinner and less resilient. Low-dose vaginal estrogen improves urgency, frequency, and recurrent urinary tract infections. Systemic hormone therapy does not replace vaginal estrogen for these symptoms.
When irritation is the driver, we treat the irritation.
When It’s Fluid Shifting
Many bendy patients live with dysautonomia, especially POTS, where low effective circulating volume and venous pooling are common. Connective tissue laxity allows blood to pool more easily in the legs. Mast cell mediators can increase vascular permeability (leakiness), allowing more fluid to move out of blood vessels and into tissues.
Hormones layer onto this.
Across the menstrual cycle, estrogen and progesterone influence vascular tone and fluid regulation. Perimenopause adds exaggerated swings. Instead of predictable rises and falls, estrogen and progesterone fluctuate unpredictably. That can destabilize vascular tone and autonomic regulation. Urgency may appear erratic, not cyclical.
If your ankles swell during the day and you produce large volumes of urine at night, nocturnal urination may be driven by daytime fluid accumulation that redistributes when you lie down. When pooled fluid returns to circulation overnight, the kidneys filter it and urine production increases.
In that situation, the focus is on circulation, not bladder capacity. Daytime compression garments, earlier leg elevation, and limiting fluids a few hours before bed can reduce nighttime urination.
When It’s Low Blood Volume and Autonomic Amplification
Some patients feel both dehydrated and urgent at the same time. They may feel lightheaded when standing, notice a fast heart rate, or feel internally “activated.”
In POTS, chronic low effective circulating volume triggers sympathetic activation. That heightened stress response can amplify urgency perception. The bladder may not be full, but the nervous system interprets internal signals as urgent.
Treatment here focuses on stabilizing circulation. Small, steady fluid intake works better than large chugs. Adequate salt intake (when appropriate) helps fluid stay in the blood vessels. Compression garments improve venous return to the heart. Graded exercise, often starting with reclined options, helps increase blood volume and strengthen vascular support over time. In more severe cases, medications such as fludrocortisone or midodrine may be used.
When volume stabilizes, urgency often improves.
When Signals Are Hard to Trust
Small fiber neuropathy has been documented in hypermobile patients with dysautonomia. These small nerve fibers carry visceral sensory information, including bladder stretch signals.
When those pathways are impaired, interoception (your internal sensation) becomes unreliable. You may not feel fullness building gradually. Or you may feel urgent at very small volumes. Orthostatic symptoms, pelvic blood flow changes, and mast cell flares can all mimic bladder fullness.
When signals are noisy, voiding early feels protective.
But repeatedly emptying at small volumes can lower bladder tolerance over time. That’s why timed voiding — starting at shorter intervals and gradually spacing them out — is recommended in international incontinence guidelines. It builds capacity gently and safely.
When sensation is unreliable, structure helps.
When It’s Pelvic Floor Coordination
In hypermobile bodies, the pelvic floor is often not simply weak. It may be poorly coordinated, overactive, or unstable.
If the pelvic floor doesn’t relax well, urgency can occur even when the bladder isn’t full. If urethral support is reduced, leakage may occur under pressure.
Pelvic floor physical therapy improves coordination and control. It’s about learning when to contract and when to relax, not just strengthening. When indicated, vaginal estrogen can also help rebuild urethral support.
So What About “Just in Case” Peeing?
Voiding early isn’t wrong. It’s understandable.
But if you always empty at the first hint of sensation, the bladder adapts. Over time, it may signal at smaller volumes. That’s why bladder training is recommended as first-line therapy for urgency and overactive bladder — it gently restores capacity and reduces frequency without medication.
The key is not forcing yourself to hold urine painfully. It’s gradually rebuilding tolerance while addressing the real driver behind the urgency.
Inflammation.
Fluid redistribution.
Hormone withdrawal.
Low volume.
Signal distortion.
Pelvic coordination.
Rarely just the bladder.
If You’re in Washington
If you’re local, head to our Resources Page.
You’ll find pelvic floor therapists that Vanessa knows and loves — she even shares clinic space with them. They understand hypermobility, dysautonomia, mast cell activation, hormone shifts, and how these systems intersect with bladder care.
Because urgency in Bendy Menopause deserves whole-system thinking.
Selected References
Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary Incontinence in Women: A Review. JAMA. 2017.
Funada S, Yoshioka T, Luo Y, et al. Bladder Training for Treating Overactive Bladder in Adults. Cochrane Database of Systematic Reviews. 2023.
Pinkerton JV. Hormone Therapy for Postmenopausal Women. New England Journal of Medicine. 2020.
Christmas MM, Iyer S, Daisy C, et al. Menopause Hormone Therapy and Urinary Symptoms. Menopause. 2023.
Porcari I, Uccella S, Casprini C, et al. Vulvovaginal Estrogen Therapy for Urinary Symptoms: Meta-Analysis. Climacteric. 2025.
Steinman MA. Alternative Treatments to Selected Medications in the 2023 AGS Beers Criteria®. Journal of the American Geriatrics Society. 2025.
Getaneh FW, Sussman RD, Iglesia CB. Nocturia: Evaluation and Management. American Family Physician. 2025.
Viaene A, Roggeman S, Goessaert AS, et al. Conservative Treatment for Leg Oedema and Nocturnal Polyuria. BJU International. 2019.
Bryarly M, Phillips LT, Fu Q, Vernino S, Levine BD. Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar. Journal of the American College of Cardiology. 2019.
Fu Q, VanGundy TB, Shibata S, et al. Menstrual Cycle Affects Renal-Adrenal and Hemodynamic Responses in POTS. Hypertension. 2010.
Mathias CJ, Owens A, Iodice V, Hakim A. Dysautonomia in the Ehlers-Danlos Syndromes. American Journal of Medical Genetics Part C. 2021.
Yonkers KA, O’Brien PM, Eriksson E. Premenstrual Syndrome. The Lancet. 2008.
This article is for educational purposes only and is not individual medical advice. Your symptoms, history, and medications matter. Always discuss changes to treatment with your own clinician.
