All of our bodily functions rely on water to work smoothly. It helps regulate temperature, flush out waste, and prevent constipation amongst countless other things like improving mood, energy, and overall performance! Many don’t drink enough fluids and are chronically dehydrated without even knowing it. Our bodies can start suffering from under hydration long before we even begin to feel thirsty.

In honour of International Haiku Poetry Day (April 17), I wrote a few verses on the urinary system:

What goes in must come –
Out ‘round like a spinnin’ wheel
Colours that inform

This poem was inspired by “Spinning Wheel” performed by the group Blood, Sweat, & Tears, which also happen to be three other bodily fluids that can affect / reflect our hydration status.

  1. Blood
    Trauma causing significant bleeding leads to hypovolemia (intravascular volume depletion from a loss of blood or salt and water); if severe enough, it can also result in hypovolemic shock. (Note: hypovolemia involves a loss of extracellular fluid unlike dehydration, which involves total body water loss and intracellular dehydration.) Further, sudden drops in blood pressure from postural changes (e.g., going from lying to standing) can create orthostatic hypotension whose symptoms resemble mild dehydration: weakness, dizziness, and fatigue.
  2. Sweat
    The ability to sweat not only allows for evaporative cooling and detoxification, it also hydrates our skin and helps maintain our electrolyte balance. However, excessive sweating where salt and water are not replenished can cause dehydration. When we become too dehydrated, our bodies stop sweating to conserve fluid volume and energy. We can quickly overheat when our internal cooling system breaks down and our core body temperature continues rising higher and higher.
  3. Tears
    Dehydration can also result in a lack of tear production along with thirst, dry mouth, headache, light-headedness, and decreased urine output. When eyes become dry from insufficient lubrication, eye strain and vision problems ensue.

Some medical conditions can cause chemical imbalances that increase urine output. For example, diabetes insipidus, which involves stifling of antidiuretic hormone (ADH) a.k.a. vasopressin, a chemical messenger that tells our kidneys how much water to conserve. Moreover, a class of drugs known as diuretics is intentionally used to get rid of excess water and salt via the kidneys. These so called “water pills” alleviate fluid pressure on our blood vessels, heart, liver, and / or kidneys. A lesser known, secondary effect of thiazide and loop diuretics is vasodilation (widening of blood vessels), which promotes blood flow. Most people on these drugs need to urinate within 30 mins of consuming them and again within a few hours, so it’s advised to take them at least four hours before bed.


There are differing recommendations for how much fluid we should consume. Some examples:
At least 8 glasses (~2.5 L) a day!

Women should drink about 92 oz (11.5 cups or 2.7 L) a day;  men should drink about 124 oz
(15.5 cups or 3.7 L) – Mayo Clinic

What’s really the right amount? My opinion is that it depends on the person, their lifestyle, and their body mass. I believe drinking the equivalent of half our weight (in lbs.) in fluid ounces is a great start! There is consensus that active and athletic people as well as those exposed to hot climates should drink more than these baselines. And, if you calculate that you drink far less than what is recommended, make sure to increase your intake gradually to give your body time to adapt. Our bodies can absorb about 500 mL (2 cups) every hour and up to 1 L under the most extreme heat and humidity. Drinking more than this also increases your risk of water intoxication, a situation where your electrolytes become too diluted and salt levels becomes dangerously low.

As for what you should drink, the answer is mostly water! Most herbal teas, a small amount of real juice, and watery foods also count. If you drink a lot of caffeinated beverages and pop, which have a mild-moderate diuretic effect, make sure to increase your water intake in and around them.

The Kidneys

To really understand and appreciate the bladder, we need to first talk about the system that comes before and is inextricably connected to it. The kidneys are our primary organ of water balance. Our kidneys filter out waste (150-190 L of blood  / day), manage water distribution, help maintain our acid / alkaline balance and regulate our electrolyte balance. In Traditional Chinese Medicine (TCM), the kidneys are represented by the water element and seen as the root of our bodily energy. When dehydrated, kidney filtration and regularity of elimination suffers (both urine and stool output decrease) causing waste to accumulate in our cells. This can lead to worsening or triggering of headaches, fatigue, joint pain, brain fog and digestive problems.

Bladder & Stress Incontinence

The bladder’s main function is to serve as a muscular holding tank, to collect urine released by the kidneys. According to TCM and Mind-Body Medicine, it also stores emotions. Individuals who are “pissed-off” are more prone to getting urinary tract (urethra, bladder, ureter, kidney) infections from held-in emotions, especially anger. Further, emotions such as fear (governed by the TCM kidney / bladder) and anxiety (governed by the TCM spleen / stomach) are associated with strong urges to pee, bedwetting, and incontinence. Being overweight and pregnancy puts extra pressure on our abdomen and bladder and aging and childbirth can weaken the urethral sphincter muscles. These things can lead to stress incontinence, a loss of bladder control when doing everyday activities, like jogging, jumping, coughing, sneezing, or laughing, that increase intra-abdominal pressure.

Kegel Exercises

The best activity to strengthen the pelvic floor muscles and prevent bladder leakage and uterine prolapse is Kegels. It’s easy to practice while sitting on the toilet, but we can do our pelvic floor exercises anywhere anytime! Just squeeze the pubococcygeous muscle–this is what stops the flow of urine and passing of gas. Start at the Beginner Level and increase the time of the contraction every few days as your movements become sharper and stronger.

Beginner: Contract for 3 sec, then relax for 5 sec. Do 3 “sets” of 4 reps (contract + relax = 1 rep) throughout the day

Intermediate: Contract for 7 sec, then relax for 5 sec. Do 3 “sets” of 5 reps throughout the day

Advanced: Contract for 10 sec, then relax for 5 sec. Do 3 “sets” of 5 reps throughout the day

Pro Tip: avoid contracting your stomach, thighs or buttock while practicing Kegels. We are not trying to work out our abs, glutes, or inner thighs here!

In health and hydration,
Dr. Vanessa