I Can’t Control My Urinary or Bowel Urges! What Can I Do?

pelvic

I have the urge to run to the bathroom

As a pelvic physical therapist one of the most common complaints I hear with continence issues is of the disruption and embarrassment caused by a frequent overwhelming urge to void. You run to the bathroom, void all of a few ounces and minutes later the urge returns. It may even be that the urge never goes away following voiding. Many women think the problem is that for some reason they are suddenly unable to fully empty their bladder hence the persistent urge however this is likely not the truth.

Your fight or flight response

The truth is for the most part this event is due largely to a protective response from your nervous system which gets started the first time you run to the bathroom feeling as though you will not make it, and it just spirals from there. I am speaking of your “fight or flight” responses. These responses are generated by a very primitive part of your nervous system- the part which is designed to protect you from harm. This part of your nervous system is designed to protect you and it will make an executive decision about whether or not you are in danger and act accordingly. So what does this have to do with bladder and/or bowel control?

Let’s start at the beginning. You get a sudden overwhelming urge to void or have a bowel movement. You have been feeling this with increasing frequency. You rush to the bathroom afraid you will not make it. The anxiousness you are feeling as you are running to the bathroom is the thing that wakes up your fight or flight system. When we become anxious about leaking before we can reach the bathroom (or in any panic situation) we change our behavior. We begin the move more quickly, in this case fearful of the embarrassment of losing control. Our breathing changes; we begin to breath more shallowly or perhaps even begin holding our breath. These changes in behavior are signals to this part of the nervous system that you might be in danger. If it thinks you are then it goes into action preparing you as quickly as possible to either outrun your danger or fight.  Your nervous system begins to shut down any systems which would not be required for survival in the moment to funnel energy to your muscles and brain. So what system is more useless in a moment of perceived danger than the system which is simply holding waste scheduled for removal anyway? We all have heard stories of people who in the face of something that truly scares them emptying their bladder in the moment. Animals do the same thing. And if the situation is truly terrifying you will also empty your bowels.  Rewind now to the moment you are racing to the bathroom. The more you race and the more anxious you become the more this part of your nervous system is actually trying to empty your bladder and bowels. The more you rush the less likely you are to get there without a leak.

What’s the solution?

Ideally you want to calm down, slow down and start breathing normally. The idea is to convince your nervous system that you are not in danger so it stops the preparations for fighting or fleeing. Most in the early stages of trying this strategy are not able to trust themselves to slow down and get there; at the very least you must control your breathing. Begin with taking deep slow breaths as you head to the bathroom. If you can also slow down your pace as you walk, even better. But at least breathe. As you start to trust that you can control the urge, start trying to delay heading to the bathroom. Now, pelvic floor strength is also important, but this strategy should start buying you time while you work toward gaining strength. I have had many patients with fairly weak pelvic floor muscles who were able to fully stop the frequency just by calming down, slowing down and breathing. So with these tips in mind, get going and stop going!

Written by Kathleen K Valentino, PT, Pelvic Physical Therapist at Aquacare Physical Therapy – Easton Office


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