Urge To Pee but Little Comes Out (Pregnant)

Morning sickness, back pain, sudden cravings or revulsion to certain foods or smells…these are all part of the journey of being pregnant. Also on the list is a frequent urge to urinate.

Frequent urination can occur in pregnant women due to:

• Increased pressure on your bladder: Your growing baby puts pressure on all surrounding organs, which may lead to decreased distention space for the bladder during filling, leading to increased and frequent urge to empty the bladder.
• Extra fluids in your body: When you are pregnant, your plasma volume increases by ~50%, so the increase in blood flow combined with filtration of fluid through the kidney results in increased bladder filling and urination.    
• Hormonal changes: Hormonal changes during pregnancy, like increased progesterone, cause your blood vessels to dilate. This allows for increased plasma volume and cardiac output due to the decrease in resistance to blood flow. Increased cardiac output means blood flow can get to and from organs (like the kidneys) more quickly and frequently.

What Happens When You Pee *Normally*?

Most of us don’t think twice about peeing until something goes wrong. When you pee, your brain and bladder work together. 

The bladder stores urine until you are ready to release it and the muscles of your pelvic floor and the urethra (the tube connecting your bladder to the outside of your body) contract and relax to keep the urine in the bladder. When those muscles are able to communicate consistently with the brain, keeping the bladder and the urethra in the correct position, you have control of your urine, and urine does not leak outside the body unintentionally.

When you are ready to pee, your brain lets the bladder know. This causes the pelvic floor muscles, the urethra, and the bladder to either relax or contract, which allows urine to exit the bladder and your body through the urethra.

What Can Cause an Urge to Pee (But Nothing Comes Out)?

Ok, so what about those times where you feel the urge to pee, but nothing comes out?

Increased Pressure on the Bladder

Your growing baby and uterus put pressure on all surrounding organs, which may lead to decreased distention space for the bladder during filling. This can cause increased and frequent urge to empty the bladder. Sometimes you may feel the urge to void, even if the bladder has only filled up a little bit. This is due to decreased space for the bladder to fill as your baby develops and your uterus grows. 

Urinary Tract Infection UTI

One of the most common causes of an urge, or constant urge, to pee is a UTI (urinary tract infection). UTIs can occur when bacteria have entered the urinary tract. This bacterial infection causes the bladder to become inflamed and irritated, which can trigger increased contraction frequency of the bladder muscle, discomfort with bladder distention, and pain with peeing.

Ways to prevent UTIs include the following:

• Drink plenty of water
• Urinate before and after having sex
• Wipe from front to back after you pee
• Wear breathable, natural underwear and clothing, changing your underwear daily
• Don’t hold your urine! (i.e., pee when you have to go)

Overactive Bladder

OAB occurs due to abnormalities in the nerves, muscle, and/or the lining of the bladder, which leads to the bladder muscle (detrusor muscle) inappropriately contracting during bladder filling. This causes urinary frequency and urgency and can occur with or without urinary incontinence (involuntary loss of urine).

What Can You Do About Frequent Urination During Pregnancy?

Pregnancy can come with many changes that often do not fully improve until delivery. This includes frequent urination.

If it isn’t time for delivery yet, there are some things you can do to help with urinary frequency during pregnancy:

Lean Forward or Try Double Voiding

The urge to pee again will be exacerbated if your bladder doesn’t fully empty when you use the bathroom. So, make sure you empty your bladder when you pee—leaning forward while on the toilet may help with this. 

Another option is to pee, then wait 10 minutes and pee again. This is known as double voiding. Double voiding might be especially helpful before bedtime if you’re experiencing nocturia (waking up because you need to pee during the night).

Maintain a Healthy (Pregnancy) Weight

Weight gain is a natural and healthy part of pregnancy. You should work closely with your doctor to determine the healthy amount of weight you should gain. Gaining excess weight puts additional stress on your organs and pelvic muscles. That increased pressure can further disrupt your urge to urinate, making you feel the need for more frequent urination.

Do Kegel Exercises to Strengthen Your Pelvic Floor Muscles

These exercises strengthen the muscles that support the uterus, bladder, and urethra, as well as other organs in the pelvis. Kegel or pelvic floor exercises can be done any time, either sitting or lying down. You can even do them when you are eating, working at your desk, or when you are resting.

In describing how to perform Kegels, some equate it to the same technique used to stop urine midstream, or trying to prevent gas from escaping the rectum.

You can assess whether or not you are using the correct muscles by either a) holding a hand mirror in front of the vagina and looking for the perineum to lift up when you contract, or b) by placing one finger inside your vagina and feeling that finger lifted and squeezed when you contract.

Kegels are typically performed by squeezing for 3 seconds and then relaxing for an equal amount of time (3 seconds). This is repeated 10 times, 3 times a day, with an eventual goal of 10 seconds per squeeze.

Typically Kegels can help with stress-predominant urinary incontinence (not overactive bladder incontinence) due to weak pelvic floor muscles, as studies have shown that ~50% of women are satisfied ~1yr after starting pelvic floor muscle training.

However, there are ~14 different causes of urinary incontinence, so if it is not stress urinary incontinence due to weakened pelvic floor muscles, Kegels may not be helpful – in some cases, they could even worsen symptoms. Seeking evaluation and care from your provider is always important and recommended.

Try Wearing Leakproof Underwear

Leakproof underwear will not prevent leaks, but it can help you better manage them. If “leakproof underwear” conjures images of bulky adult diapers, rest assured, they come in a wide variety of styles and are basically indistinguishable from your regular underwear. Plus, they’re great for managing all kinds of leaks - from light bladder leaks, to period blood and even sweat.

When to Seek Medical Advice

If you experience any of the following, check in with your doctor or healthcare provider:

If You Experience Stinging or Burning When Urinating

An increased urge to urinate is one symptom of a urinary tract infection (UTI). Another symptom is a stinging or burning sensation when you pee and a decreased or irregular flow of urine. If you experience this, you should visit your doctor. 

If you have a history of UTIs, you have greater chances of experiencing a UTI during pregnancy. UTIs are typically treated with antibiotics that are safe in pregnancy. However, untreated UTIs can lead to a kidney infection, which can lead to multiple undesired outcomes, including early labor.

Any Unusual Vaginal Discharge

You may have more vaginal discharge than usual when you become pregnant. But it’s also important to know what’s normal and when to seek medical advice. 

Normal vaginal discharge is:

• Clear and white
• Normal or mild smell (not strong or unpleasant)
• Sticky, slippery, or wet

Contact your doctor immediately if:

• You are experiencing vaginal bleeding at any time during your pregnancy
• There is an unpleasant smell from the discharge
• Discharge is yellow, brown, or green, thick, white, clumpy
• You experience itching, irritation, discomfort of the vulva/vagina

Outlook

Always update your healthcare provider on what's happening throughout your pregnancy, as your doctor may want to do further tests.

Urinary issues related to pregnancy usually resolve within the postpartum period. However, some may persist. In the weeks after delivery, pay heed to whether urinary issues begin to subside or increase. Giving birth can contribute to incontinence after pregnancy as muscles can be injured during vaginal delivery. If this happens, do talk to your doctor.

But for most women, some loss of bladder control during pregnancy is just one of the many temporary changes you will go through while pregnant. Rest assured, your body will begin to recover after the baby is born. Seeking pelvic floor physical therapy both during and after pregnancy is a great way to strengthen those muscles after the normal laxity of pregnancy.

Written by Jane Flanagan — Updated on January 30, 2023.

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.