Growing up we were asked by mom and dad before leaving the house “Do you have to go to the bathroom?” “No,” would be our reply which was then followed up by “Go anyway, it’s a long trip!” This is known in the pelvic physical therapy world as “” or “Just in Case.” Once we hit school age we then had to time our pee breaks between classes. Getting a lavatory pass was a privilege and often frowned upon and we were then told “can’t you wait until break?” Once we caught on to the routine we got better at it and would pee on the run as we went from class to class in middle school and high school, and even in college. We became very well trained as to when we could go to the bathroom. Reminds me of Sheldon from “Big Bang Theory” and his regimented routine for bodily functions! So what’s the big deal? Isn’t this just sage advice from our elders?

Remember the time when you were five and didn’t do as mom had asked and you had an accident in the back seat and then … oh, wait, that was me! Anyway, you have my point. Fundamentally it makes sense to avoid the discomfort of trying to hold your pee, the increasing pressure and eventual pain from trying to wait until you find a bathroom, to the point that it’s painful to even move! Go now and be sure you don’t have to go later.

Problem is, this is not how it actually works. Our bladders are very clever elastic muscles with special nerves for sensing pressure as well as coordinating when to hold and when to release urine. The lower back wall of the bladder has an area called the trigone, an area with special pressure nerves that tell us when the bladder is filling and getting full. The very bottom of the bladder becomes the urethra – including the valve/sphincter to keep it closed – and is automatic, meaning we do not have conscious control over this first internal sphincter. We have a second external sphincter that we do control. This is the one we tighten when we are trying to hold our pee.

This next part may get a little tricky so I will try to be as simple as possible. The trigone tells the bladder it is full based on the amount of pressure it detects, and then sends a signal to the top of the bladder telling it to start contracting to push the pee out, while at the same time sending a signal to both sphincters to tell them to relax and allow the flow of urine. When we are not ready to pee we intentionally tighten our external sphincter, which sends a signal back to the bladder saying, “Chill there skippy, we are not ready yet!” This signal from the sphincter tells the bladder to relax, which then allows the bladder to fill some more. Once the pressure goes up again, we get the knock at the door again with the urge to pee. Again, if we are not ready to pee we tighten our external sphincter and the bladder gets another signal which allows more filling of urine. By the third knock at the bladder door, we should be ready to pee. When we are really desperate, we will also use our pelvic floor muscles to hold back the tide.

So what is so wrong with going “just in case”? We train our bladders to empty at lower volumes, which leads to more frequent trips to the bathroom, day and night. How many times are you getting up to pee in the middle of the night? This can be disruptive to work not only because you are running to the bathroom multiple times during the day, but also because you are not getting proper sleep due to the interruptions. Once a night at my age (my license is a stone tablet) is normal. Two or more is not. The good news is that bladders can be trained in both directions and is easier than training your dragon! Contact me at Dudley Physical Therapy for more information.

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Charles Dudley
Charles Dudley
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