If you've ever had a dog, the following situation might be very familiar to you:
You decide it's time to take your dog for a walk, so you head toward your front door and take the leash of it's hook. Your dog -- who seems to be always watching your every move for signals that it might be time for a walk, or time for dinner, or time for a game of rope-tug etc etc -- sees the leash in your hand and JUMPS to it's feet with excitement. He starts to vocalize, bark, run in circles, scratch at the door, in an excited effort to get this show on the road. In a matter of seconds, your dog's energy went form half-asleep to full throttle excitement and expectation.
Where did your dog learn to do this? Well, it's simple. It has developed an association between two things: the sight of a leash, and the act of going outside for a walk. This association didn't happen overnight; it probably took repeated exposures to the same pattern of activity that led him to formulate a learned expectation within its nervous system. "Leash = GO TIME!"
We can consider our nervous systems as having a similar tendency toward learning to make associations and formulate expectations between what we perceive in our immediate enviropnemnt, and what is "likely" going to come next. You might see a commercial on TV for a juicy cheeseburger and immediately start to salivate. You might remember you have a big presentation coming up and find your heart rate starts to increase. Thoughts, sights, sounds, and any other type of perception can trigger a response in our physiology that the nervous system has deemed logical based on previous experience.
So if you find that you consistently experience bladder urgency when you are exposed to the same triggers (opening your front door, hearing running water, walking toward the bathroom), consider that your nervous system has learned that the next thing to come is peeing, and it's spinning out in anticipation, just like your excitable dog. It's starting the process of contracting the bladder walls in anticipation of that pee. Not in response to the signals it should be waiting for (which is intentional relaxation and letting go of the pelvic floor muscles once you're seated on a toilet).
So what do we do about this? Well, let's return to the dog who starts to run in circles everytime it sees that leash in your hand. One thing we know for certain is that the way we behave in that moment will be important. If we start to move faster, jump up and down alongside the dog and scramble to get the leash on as fast as we can, we are almost certainly reinforcing this learned pattern of behaviour and it's pretty likely the dog will behave the exact same way tomorrow. The same is true with bladder urgency. If we respond by rushing toward that bathroom, and scrambling to unbutton our pants on the way, we're reinforcing this pattern of nervous system overactivity. Like pouring gasoline on a fire.
What might be a more helpful way to respond that is likely to promote a different outcome? In the case of the dog, you might choose to stand calmly and ask your dog to sit before taking another step toward the door. You might insist that the door does not open until everyone is calm and under control. With enough consistency and repetition, down the road your dog might even start to do this automatically. We see a similar learning effect within our nervous systems when we are working with bladder urgency. When urgency strikes, it's extremely important to slow down and keep your body relaxed. Take a few breaths and even lean against the wall. Resist the urge to rush, and use your "Urge Delay Strategies" to signal the bladder to remain relaxed.
Adjusting urgency behaviours this way is so important to get to the root of the problem, which is the learned overactivity within the nervous system and the muscles around the bladder. With consistency, we can train new associations and expectations, and overcome the experience of urgency for good.
There's a lot more to the picture when we are discussing urinary urgency, including hydration and bladder irritants, widespread nervous system activation, inflammatory status, hormone status and so on. Pelvic Health physiotherapists are trained to help you put these pieces of the puzzle together to make sure you're being as targeted as possible with your strategies for overcoming urgency. Start with practicing exposing yourself to your triggers (eg that running water, or the sight of your front door upon arriving home), and practice responding with calmness. Sit, bladder. Stay.
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