“The Reflex”: Master it to Defeat Urgency

Andrew Siegel MD 12/26/2020

Happy Holidays! I am pleased to say that today’s entry is my 500th blog, composed weekly for the past decade.

In 2 minutes you can learn how to tap into “THE REFLEX” and inhibit annoying urinary urgency that can creep up on you at any time. This is the most practical and useful reflex you probably did not know about and a good one to have in your back pocket!

Since the pelvic floor muscles are muscles of function rather than form, muscles for “go” rather than “show,” they can be put into service in common real-life situations. Today’s entry explores the intimate relationship between the pelvic floor muscles and the bladder and rectum and how tapping into the powers of the pelvic floor muscles can be so useful on a practical basis when you suddenly experience urinary or rectal urgency. It’s one thing to work out your muscles in order to make them stronger, better toned and more durable, but it’s another dimension entirely when you can put that effort to practical use over the course of your day.

Note: The urinary bladder and the rectum share much in common: similar storage functions, similar nerve supply, similar sphincters, and both organs are supported and kept in position by the pelvic floor muscles. THE REFLEX is equally effective for inhibiting urgency that derives from either organ.

Overactive bladder (OAB) symptoms include the sudden and urgent desire to urinate, frequent urinating (commonly during both awake and sleep hours), and sometimes even urinary leakage. OAB symptoms are often due to involuntary contractions of the urinary bladder. In this circumstance, the bladder squeezes (contracts)—inappropriately so—without its owner’s permission, as if you were initiating urinating when your bladder is full. The bladder literally starts acting on its own, similar to an extra beat of the heart.

Although OAB symptoms can occur without provocation, they are commonly triggered by positional changes (such as standing upright from a sitting position), exposure to running water, approaching a bathroom, and when placing the key in the door to one’s home. Over time, involuntary bladder contractions can become Pavlovian conditioned responses, for example, causing turning on the faucet into a consistent inducer of urinary urgency.

Classic trigger of urinary urgency: Blame it on your mom who nurtured this reflex, turning on the bathroom faucet to get you to pee on demand, only to come back to haunt you later in life

Another key (no pun intended) trigger of urinary urgency: getting closer to the bathroom

Pelvic floor muscle (PFM) training is first-line therapy for OAB since voluntary PFM contractions can effectively inhibit involuntary bladder contractions and squelch the urgency and urgency incontinence. In similar fashion, PFM training can effectively inhibit involuntary rectal contractions and squelch bowel urgency and urgency incontinence.

In order to effectively tap into the powers of the pelvic floor, a basic understanding of bladder (and rectal) function is necessary. During urine storage, the bladder (and rectum) are in relaxed (non-contracting states) and the urinary sphincters (contributed to by the PFM muscles), responsible for urinary and bowel control, are engaged (contracted). During urine (and bowel) emptying, the bladder (and rectal) muscles contract and the sphincter muscles relax synchronously. This “antagonistic” relationship between the bladder (and rectal) muscle and the PFM can be used to the advantage of those suffering with OAB (and overactive bowel) symptoms.

The important point is that when the PFM are voluntarily engaged, there is a reflex relaxation of the bladder (and rectum).  Since those with OAB often have bladders that contract involuntarily, a means of fostering bladder relaxation is to intentionally engage the PFM to benefit from the reflex relaxation of the bladder that occurs. This is a useful and practical reflex that is easy to access.

Most reflexes are involuntary and involve the contraction of a muscle—think knee jerk reflex in which tapping the patellar tendon with a reflex hammer causes the quadriceps muscle to reflexively contract and the knee to jerk forward. Uniquely, the PFM-bladder reflex is engaged voluntarily (as opposed to involuntary) and involves the relaxation of a muscle (as opposed to a contraction). The same is true for the PFM-rectal reflex.

Anyone who has ever experienced an urgent desire to urinate or move one’s bowels will find this reflex of practical benefit.  When the reflex is so deployed, it will result in relaxation of both the urinary bladder and rectum and a the disturbing urgency will be tamped down.

When you feel the sudden and urgent desire to urinate (or move your bowels), pulse the PFM several times, briefly but intensively. When the PFM are so deployed, the bladder muscle reflexively relaxes and the feeling of intense urgency should disappear. Likewise, when the PFM are so deployed, the rectum relaxes and the feeling of intense bowel urgency should diminish.  This reflex is a keeper when you are stuck in traffic and have no access to a toilet. 

Left to right, first image: normal state of affairs during storage, bladder relaxed and PFM squeezed; second image: involuntary bladder contraction, bladder squeezes on own, PFM still squeezed; third image: when bladder squeezes there is reflex relaxation of PFM and leakage may occur shortly; fourth image: THE REFLEX–voluntarily squeeze PFM because of perceived urgency; fifth image: as result of PFM squeeze, there is reflex relaxation of bladder and urgency disappears

Even better than inhibiting urgency after it occurs is preventing it from occurring in the first place. In order to do so, it is important to recognize the specific triggers that induce the urgency, frequency or incontinence: hand washing, key in the door, rising from sitting, running water, entering the shower, cold or rainy weather, etc. Immediately prior to exposure to your trigger, rapid flexes of the PFM can preempt the involuntary bladder contraction before it has a chance to occur.

Exercising the PFM will help stimulate the inhibitory reflex between the PFM and the bladder muscle. PFM training will stimulate your awareness of the PFM and enable you to increase their strength, power and endurance. The inhibitory reflex will become more robust and you will develop an enhanced ability to counteract urgency, frequency and urgency incontinence.

FOR MEN: 3-D animated video on the male pelvic floor muscles. As the most expedient means of achieving pelvic strengthening, I highly recommend the following exercise programs (disclaimer: I am co-creator of this program): PelvicRx. Well-designed and easy to use, it is a follow-along and interactive pelvic training DVD that offers strengthening and endurance pelvic floor exercises. It provides education, guidance, training and feedback to confirm the engagement of the proper muscles and is structured so that repetitions, contraction intensity and contraction duration are gradually increased over the course of the program. This progression is the key to optimizing pelvic strength and endurance. If you would prefer the streaming version with digital access, it can be obtained at Private Gym. Supplement these videos with the Male Pelvic Fitness book to optimize your experience.

FOR WOMEN: Educational video on pelvic floor muscle exercises. 3-D animated video on the female pelvic floor muscles. Supplement these videos with The Kegel Fix book to optimize your experience.

Bottom Line: There are many management options for urgency. As a first-line approach, tap into the powers of your pelvic floor muscles and harness the natural reflex in which involuntary bladder or rectal contractions can be inhibited or prevented by engaging your PFM.

Wishing you the best of health,

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

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 is now available 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, overactive bladder, pelvic floor muscles, urgency inhibition