By Dr. Ariel Sernek, PT, DPT
Have you ever found yourself in a store or driving home and you get hit with an all encompassing need to pee? You can’t think of anything else and you use all of your power to control it to get to the bathroom drip free. You get right to the door of the bathroom and all your efforts fail … you peed your pants. You think, well this is great and there’s nothing I can do about it.
Well I’m here to tell you why this is happening and YES, there is something you can do about it. We need to start out talking a little nerd science, but it will make sense when I describe how to help you in the future.
We start with anatomy and physiology. Don’t worry I’ll make it easy to understand. Let’s start with the bladder. It’s a smooth muscle called the detrusor muscle and we don’t have voluntary control over it like we do our arm and leg muscles. The bladder is controlled by our autonomic nervous system, which means it functions automatically without us having to think about it. The parasympathetic nervous system allows the bladder to contract to start pushing out the urine through the urethra. Think Parasympathic = Pee. The sympathetic nervous system helps relax the bladder muscle to store urine and fill up the bladder. Think Sympathetic = Store.
The bladder works in the opposite fashion of the pelvic floor muscles. While one is contracting the other is relaxing. So in order for us to urinate, the bladder contracts and the pelvic floor relaxes. Any other time we are relaxing the bladder muscle to store urine and the pelvic floor is contracted to stop leaking.
The brain is also very important when it comes to using the bathroom. Our prefrontal cortex is in the front of our brain and helps us make decisions. This area of our brain can influence the ability to use the restroom or decide to wait.
First we NEED to know how often you’re going to the bathroom. Most people don’t realize that we should be going 6-8 times in a whole 24 hour period. If you are going 3 times a day, we may need to increase how often you go so you are not over stretching your bladder muscle. We may need to cue you to go less if you’re going 10-15 times per day. We also assess what your input and your output is, so how much you drink and how long it takes you to pee. To know how your bladder is functioning, we use a bladder diary or tracker.
Next, we have to identify and become aware of our triggers. These could be running water, warm showers, pulling into the driveway, touching a door knob/handle, or a simple thought about using the bathroom. Sometimes the triggers may not be environmental, but diet related. Carbonated, caffeinated, sugary, alcoholic, and acidic beverages can also trigger our bladder to want to contract and get that irritating fluid out as quickly as possible. These factors may be different from person to person which is why we have you fill out a diary, because no person is the same.
The next treatment step is to use our pelvic floor, prefrontal cortex, and autonomic nervous system to control the urgency and bladder contractions. First, you want to STOP moving and stay still whether you are sitting or standing. Next, you want to contract your pelvic floor muscles 5 quick times in a row. This will communicate to your bladder to relax and stop to fill. The third thing you will do is take 2-3 deep breaths making sure to exhale slowly. This will stimulate your autonomic nervous system to decrease stimulation to the bladder and decrease the bladder contractions causing urgency. The last thing you will do is to distract yourself with a to-do list, for example – counting backwards from 100 by 3s; something that takes your prefrontal cortex away from the thought of your bladder and onto another task. This is why urinary urgency and bladder control is better at work than at home. You are more distracted by work tasks and things to do that it’s easier for your brain to put off going to the bathroom. Again, we still want to maintain a 6-8x frequency throughout the day and night.
If you are still having issues or complaints with this, please reach out and I can create a customized program for You! You can reach me directly at email@example.com or check out our Pelvic Health page https://recoverrxpt.com/pelvichealth to learn more or set up a visit.