Triggers That Induce Urgency To Pee: No, You’re Not Crazy

Andrew Siegel MD  10/3/2020

Ivan Pavlov (1849-1936) was a Russian physician, physiologist and psychologist and the recipient of the 1904 Nobel Prize in medicine.  He is best known for his seminal work on classical conditioning. His famous experiment is summarized briefly as follows:

1. When he presented a meaty meal to dogs, their instinctual response was to salivate, an “unconditioned response.” 
2. Subsequently, he rang a bell to summon the dogs to their meal.
3. After a few cycles of repetition, the dogs salivated at just the sound of the bell in the absence of the meal, a “conditioned response.”

Ivan Pavlov

Now substitute the following: Humans instead of dogs; a full bladder instead of meat; urinary urgency instead of salivating; running water, key in door, etc., for the bell. And there you have it:

1. A full bladder induces urinary urgency (the desire to urinate), an unconditioned response.
2. Inevitably, there will be times when one has a full bladder and they are exposed to a running faucet or are trying to get to the bathroom and encounter obstacles such as locked doors.
3. After a few cycles of repetition, the urgency can occur with exposure to the running faucet or when putting the key in the door in the absence of a full bladder, a conditioned response.

Classical conditioning is as relevant to the human as it is to the canine and the human bladder is highly susceptible to such conditioning. A variety of triggers can induce a strong urge to urinate, sometimes so powerful an urge that involuntary urinary leakage may occur.  Triggers that induce an intense desire to urinate are the topic of today’s entry.

THE PROFOUND MIND-BODY CONNECTION

Although it is convenient to think of our minds and bodies as separate and discrete entities, our emotional and cognitive sides do not exist independently from our flesh and physical beings. Our minds and bodies are very much commingled, and our mind-body connection is extensive. Our bodies house our minds, and our minds control our bodies, but our minds are made of matter just as our bodies are, and our bodies have a vast array of neural networks running through them that essentially are peripheral extensions of our minds.

IT ALL BEGINS WITH TOILET TRAINING

In an effort to teach a young child to urinate in the toilet, parents often seat the child on the toilet and run the sink faucet, creating and reinforcing an association between running water and urinating.  Unfortunately, many years later this association can morph into a conditioned response with exposure to running water triggering an involuntary bladder contraction (the bladder squeezing without its owner’s permission), inducing urgency and sometimes urgency incontinence.

BRUSHING MY TEETH MADE ME WANT TO PEE

True tale: When I was a child, I often had the sudden desire to urinate when brushing my teeth.  For years, I was perplexed, thinking it had something to do with dental hygiene, only to realize much later that the urgency had nothing to do with the toothbrush, toothpaste or act of brushing, but with the running tap water…yet another reason to shut off the water when you are brushing your teeth. Save the planet!

SUMMER CAMP ANTICS

In sleepaway camp, we sometimes placed our sleeping bunkmate’s hand in warm water to provoke him to pee in the bed.  It was all giggles for us and little did we know we were triggering a bladder contraction by way of a conditioned response.

THE PSYCHOPHYSIOLOGY OF TRIGGERED URGENCY

Urinary urgency is often triggered by cues that remind one of the act of emptying the bladder, which generate a conditioned response. Common denominators for many of these triggers are the sight, sound or feel of running water and the mechanical barriers that stand between an individual and emptying his bladder. For many people, the nearer to the bathroom they get, the greater the intensity of the urgency.

The following are common triggers that may induce urinary urgency:

• Hand and dish washing
• Bathing or showering
• Hearing the sound of running water
• Cold or rainy weather
• Exiting one’s car
• Key in door to home (“latchkey urgency”)
• Approaching the rest room
• Opening the door to the rest room
• Positioning the toilet seat up or down

This bottle of wine from my local wine store says it all. (It was actually quite delicious!)

MY OWN UNIQUE TRIGGER

Since conditioned responses are learned behaviors, individuals may develop unique and personal cues.  I often develop an intense desire to pee after a tennis match or golf round when I open the trunk of my car to load my tennis bag or golf clubs.  This started a few years back when at the time I was placing my athletic equipment in the trunk I happened to have a full bladder that I should have emptied earlier. This repeated itself on a few occasions and ultimately an association was made between loading my trunk and the need to urinate.  Subsequently, the urgency is triggered when loading my trunk regardless of whether or not my bladder is full.

KEGELS-ON-DEMAND TO COMBAT TRIGGER-INDUCED URGENCY

(If your bladder is full, this will not work nearly as well as when your bladder is not full and you are experiencing urgency due to an involuntary bladder contraction. The only real relief under this circumstance is to empty your bladder.)

When you feel the sudden and urgent desire to urinate, snap (pulse) your pelvic floor muscles several times, briefly but intensively. When your Kegel muscles are so engaged, the bladder muscle reflexively relaxes and the feeling of intense urgency should disappear.

One step better is the proactive approach: prior to exposure to the specific provoking trigger—hand washing, key in the door, running water, entering the shower, cold or rainy weather, etc.—snap your pelvic floor muscles rapidly several times to preempt the involuntary bladder contraction before it occurs (or diminish or abort the involuntary bladder contraction after it begins).

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.  Counter conditioned urinary urgency with Kegels-on-demand, a trick that can be highly effective.

Wishing you the best of health,

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area,Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.  His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families. 

Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now on sale at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours). 

Dr. Siegel’s other books:

FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health

Video on THE KEGEL FIX

Tags: Andrew Siegel MD, classical conditioning, Ivan Pavlov, Kegels on demand, latchkey urgency, psychological triggers, running water, urinary incontinence, urinary urgency