The ‘Pee Symphony’: Why No ‘Kegels’ on the Toilet!

Urination is like a symphony; the bladder, spinal cord and pelvic floor muscles play in perfect harmony. The brain is the conductor.  These individual instruments understand their place and timing to produce the most beautiful piece, “Blissful Urination.” Now, imagine an electric guitar stepping in and playing out of time…it would confuse the entire piece! Suddenly, the timing is off and the production falls apart. Some of our ‘peeing’ habits are like the electric guitar creating neurological confusion leading to peeing dysfunction. In this week’s blog post, let’s examine why doing Kegels on the toilet can interrupt the micturition reflex and lead to bladder dysfunction. These adverse bladder habits are summarized and explained in ‘The Bladder Book;’ a collection of educational handouts for the medical practitioner.

Electric Guitar #1: Kegels during Urination

Have you ever been told to strengthen your pelvic floor muscles by stopping the flow of urine? Let’s examine why this may not be the best advice ever…

There is an intricate relationship between your pelvic floor and bladder muscles …simply put:

• when your pelvic floor muscles are turned on the bladder relaxes to fill.
• when your bladder muscle is turned on the pelvic floor muscles let go to expel urine.

Storage phase:

During bladder filling, your pelvic floor muscles receive a signal to maintain some tone. This is necessary because the pelvic floor muscles are like the doors to the urethra; contracting them just a little keeps you continent or prevents leakage. Neurologically, Bradley’s loop 4 in the micturition reflex dictates: “my sphincter is shut so my bladder will fill.”

At some point your urgency will increase, until it reaches a crescendo that gives you an undeniable urge to find a bathroom. This conscious awareness registers in an area of the brain called the frontal lobe. Neurologically, when Bradley’s loop 1 is intact (no cognitive impairments present), you can decide, “hey, I need to go to the bathroom” and plan next steps.

Urination phase:

You’ve made it to your pee place and now it’s time to let her rip. The micturition reflex kicks in reversing the storage phase. Now, the bladder muscle (detrusor) contracts and the pelvic floor muscles relax to open the door to the urethra. Neurologically, Bradley’s loop 3 in the micturition reflex dictates: “my bladder is contracting so my sphincter will relax.”

Great! So, your unconscious micturition reflex is doing its job! Woohoo!!! Smooth sailing…

Where the confusion comes in:

But, WAIT! “Whu oh! What’s this?!  Pelvic floor muscle contractions?! You’ve got to be kidding me!” the conductor say, ”abort mission urination? I’m confused.”

Although your Kegels on the toilet are well intentioned, they are like an electric guitar interrupting the well-tuned ‘pee symphony’. Without knowing it, practicing pelvic floor muscle contractions or ‘Kegels’ on the toilet can confuse the reflex loop of micturition. Neurologically, Bradley’s loop 2 distinctly says, “my bladder will contract for as long as it takes for me to void” but, rogue pelvic floor muscle contractions muddle the message about whether to store or void.

Typically, one Kegel to confirm if you are contracting your pelvic floor properly is not a problem, but after doing it repeatedly, you may notice the following:

•  difficulty starting the flow of urine
•  slow or light stream
• frequency
• feeling like you haven’t completed urinated
• urinary tract infection

Alternatives to pelvic floor awareness and strengthening:

If you want to confirm you are doing a pelvic floor muscle contraction appropriately, I would suggest other feedback mechanisms like:

•  inserting a finger into the vagina and feeling the pelvic floor squeeze around your finger
• watching the pelvic floor lift in a mirror
•  sitting on a towel for proprioceptive feedback

These techniques are outlined in the handout ‘Tuning-in with your Pelvic Floor’ in ‘The Bladder Book.’

In the next exerts of ‘The Pee Symphony,’ learn about other bladder habits which are like electric guitars to the micturition reflex such as, ‘power peeing,’ going to the bathroom ‘just in case,’ and ‘hovering.’

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Attribution of symphony photo: By PersianDutchNetwork (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons