Andrew Siegel, MD Blog #99
Ivan Petrovich Pavlov (1849-1936) was a Russian physician, physiologist and psychologist who won the 1904 Nobel Prize in medicine. Pavlov is best known for describing classical conditioning, summarized as follows: Pavlov recognized that meat causes dogs to salivate, an instinctual reaction called an unconditioned response. He used a metronome to call his dogs to their meaty meal and, after a few cycles of repetition, the dogs began to salivate just on the basis of the sound of the metronome. The reaction to the metronome is called a conditioned response, since it is a learned behavior.
Humans are little different from Pavlov’s dogs. Many foods literally elicit a “mouth watering” unconditioned response and certain specific contexts can exact a conditioned response in the absence of the specific food item. This can help explain the foraging for food that many of us undertake when the television gets turned on, or alternatively, the desire for snacks when we go out to the movies—I refer to this as the “media munchies.” Similarly, when we enter our homes and head into the kitchen, many food-associated context clues—the refrigerator, pantry, kitchen table, cookie jar, etc.—trigger our desire to eat via the classical conditioning pathway. The importance of classical conditioning with respect to eating is that food-associated context cues can elicit a conditioned response that can trigger eating and drive overeating, weight gain and obesity.
Let’s now shift gears to the bladder—I must admit that this is a strange segue! Many develop a conditioned response to cues that we associate with the act of emptying our bladders. Any source of running water—the kitchen sink, bathroom fixture, shower, etc.—can elicit a conditioned response in which exposure to such a trigger causes urinary urgency, defined as the sudden desire to urinate and need to get to the bathroom in a hurry. At times, it can even cause incontinence, leakage occurring before arrival to the bathroom.
When I was a wee lad (no pun intended!), I noticed that I consistently experienced the sudden need to urinate when I brushed my teeth. For years, I was perplexed about this, thinking it had something to do with the act of brushing of my teeth, only to realize years later that it had nothing to do with the toothbrush, toothpaste or act of brushing, but with the water running from the faucet!
For ages, parents have been trying to get their infants to learn to urinate on command by sitting them on the toilet and turning the bathroom sink on, creating and reinforcing an association between running water and urinating. It is truly a helpful tool in the effort to achieve toilet training; however, this conditioned response can come back to haunt us later in life, when exposure to running water triggers an involuntary bladder contraction (the bladder squeezing without our permission) and hence urgency and perhaps even urgency incontinence! Other common Pavlov-type conditioned responses that can elicit an involuntary bladder contraction are putting the key in the door to one’s home, arising out of a car, and getting closer to the bathroom. “Latchkey” incontinence is a very common condition in which simply placing the key in the lock is enough to cause intense urgency and the need to literally scramble to get to the bathroom on a timely basis. Any cue that reminds us of the act of voiding is enough to trigger this response.
What can we do about these maladaptive and annoying conditioned responses? If our bladders are truly full, nothing will help short of emptying them. However, if our bladders are not full, but are simply contracting involuntarily in response to the trigger, there is a simple and effective means of countering it. The answer is to deploy our pelvic floor muscles to counteract/prevent the involuntary bladder contraction. Whether female or male, by doing a few rhythmic contractions of the pelvic floor muscles (Kegel exercises), either after the urgency is triggered or preferably before exposure to the trigger, the involuntary bladder contraction can be terminated/obviated.
In fact, pelvic floor muscle exercises have a number of very helpful uses and benefits and will be the subject matter of my forthcoming book entitled “Male Pelvic Fitness: Optimizing Sexual and Urinary Health.” The female version will follow. In the meantime, if you would like information on the pelvic floor muscles, take a look at my YouTube video, which can be accessed at: http://www.youtube.com/watch?v=5IbliBiRzOw
Bottom Line: The mind-body connection is powerful beyond our understanding. Contextual cues can provoke responses and actions in the absence of the original stimulus.
Andrew Siegel, M.D.
Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com
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