The habit of “pushing” or “straining” to urinate involves actively contracting the abdominal muscles to force urine out, rather than relying on the body’s natural mechanisms. This deliberate use of abdominal pressure is common, often employed to speed up the process or overcome difficulty starting the flow. Urologists and pelvic floor specialists strongly discourage this technique because it interferes with the coordinated muscle relaxation necessary for healthy voiding. This straining forces the bladder to empty against resistance, setting the stage for various short-term dysfunctions and long-term health issues.
The Body’s Natural Urination Process
Healthy urination is a precisely choreographed reflex involving several muscle groups and the nervous system. The bladder is lined with the detrusor muscle, a smooth muscle tissue not under conscious control. As the bladder fills with urine, stretch receptors signal the brain, creating the urge to void, typically when holding between 300 to 400 milliliters of fluid.
When the time is right to urinate, the nervous system initiates a coordinated event known as micturition. The detrusor muscle contracts rhythmically, increasing pressure inside the bladder to expel the urine. Simultaneously, the internal and external urethral sphincters, which normally keep the urine contained, must relax and open.
The process should be passive and relaxed, allowing the detrusor contraction and sphincter relaxation to work in harmony. Gravity and the internal pressure created by the detrusor are sufficient to empty the bladder completely. Urination is an involuntary, coordinated muscle effort where conscious focus should be on relaxation, not active, skeletal muscle forcing.
Acute Physical Stress and Dysfunction
Introducing abdominal straining disrupts this precise neuromuscular coordination, creating immediate physical stress. When a person pushes, they contract their abdominal muscles, which increases intra-abdominal pressure and causes the pelvic floor muscles to tense. The pelvic floor is meant to relax and open the urethra during voiding. Straining forces the pelvic floor to work against the pressure, leading to muscle dysfunction.
This interference with the relaxation of the urethral sphincter can create a paradoxical result: incomplete emptying of the bladder. Instead of the urine flowing freely, the forced pressure works against a partially closed or tensing pelvic floor, leaving residual urine behind. This residual urine is a breeding ground for bacteria, significantly increasing the risk of urinary tract infections (UTIs).
Repeated application of this unnatural pressure causes mechanical stress on the tissues and nerves surrounding the bladder. Straining trains the body to rely on the wrong set of muscles, which can weaken the natural reflex over time and make it increasingly difficult to urinate without forcing it. The body essentially loses the ability to initiate and sustain the detrusor-driven voiding reflex.
Chronic Conditions Resulting From Straining
Persisting in the habit of straining leads to serious, long-term health issues. The bladder wall constantly works against a closed or partially obstructed outlet. This prolonged resistance causes the detrusor muscle to thicken and become bulkier, known as trabeculation. A thickened bladder wall is less elastic, which can reduce the bladder’s overall capacity and lead to symptoms like needing to urinate more frequently.
The chronic, excessive intra-abdominal pressure generated by straining stresses pelvic connective tissues. This force can push organs downward and weaken support structures, potentially leading to pelvic organ prolapse in women. Chronic straining is also a significant factor in the development of hemorrhoids in both sexes, as the downward pressure engorges the veins in the rectum.
Over time, the detrusor muscle can become fatigued or the nerves controlling it disrupted, resulting in chronic urinary retention. This long-term inability to fully empty the bladder can cause significant damage to the urinary system, including infections that can spread to the kidneys and, in severe cases, lead to kidney damage. Avoiding the urge to push is a simple yet effective measure for preserving long-term urinary health.