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  • -Christine Trumble PT, OCS, WCS

"Why are the ladies room lines always so long?"

There are two main types of incontinence - stress incontinence (SI) and urge incontinence (UI). SI occurs due to a sudden increase in intra-abdominal pressure ie. sneezing, coughing, laughing, and for those brave women- jumping on a trampoline. This happens because the pelvic floor muscles are unable to keep the urethral sphinter shut during these increases in abdominal pressure. This is due to a loss of strength, endurance and/or coordination of your pelvic floor muscles. ( We will cover this in depth later)

Urge incontinence is very different. An urge is a compelling need to get to the bathroom NOW! Sometimes you make it there in time and sometimes you leak a little trying to get your pants down or on the way to the bathroom. The other name for this is "key in the door incontinence." You just can't get that front door open fast enough.

Urge incontinence can develop over years. First we go to the bathroom "just in case." , or we try to go to the bathroom more often as an answer to our stress incontinence. Then we notice that we are going more frequently, and then it becomes more necessary to hurry up and get there and soon we are leaking on the way. Often we hurry up and get there only to find we only have a little bit of urine in our bladder and we think "THAT'S IT?!"

Unknowingly, we train our bladder to "have to go" in reaction to where we are- NOT how much urine is in the bladder. A healthy bladder can hold 2 cups of urine, hard to believe I know. Normally, your bladder sends you messages every 1/4 a cup or so to let you know it has enough in it to visit a toilet. You have the choice to go or not. If you are in the middle of the season finale of your favorite show, your brain will send a message to your pelvic floor muscles to grip a little harder on to the urethra - this added pressure sends a message to your bladder to wait until commercial. During the commercial you walk to the bathroom, you sit down on the toilet and your pelvic floor muscles let go of the urethra - this signals your bladder to empty and we urinate. We have no voluntary control over our bladder. I repeat - we have no voluntary control over our bladder. We use our pelvic floor to control it. So what goes wrong?!?

As previously stated, we start using the bathroom when we get in the house, before we leave the house, before we go to bed, leave work, before AND after that class, etc. etc. and soon your bladder is responding to time of day, where you are and what you are doing instead of how much urine is in the bladder. You get that sudden urge to go and you start hustling but start to leak while you are undoing your belt. What gives??

Remember- you trained your pelvic floor to relax when you get on the toilet. At some point in life it tries to be more efficient and starts to relax on the way to the bathroom. So while you are racing to the bathroom, your bladder is waiting for the signal to empty and unfortunately your pelvic floor starts relaxing. Not good. So you begin to leak. and/ or fully empty your bladder before you get to the toilet, because in actuality your bladder nor your pelvic floor cares if you are actually sitting on the toilet.

So, at the theater most women's bladders know exactly when that intermission is, the lights start to go up and hence the long lines. This can all be corrected with proper evaluation, bladder retraining and pelvic floor strengthening.

LADIES - let's shorten those bathroom lines- find a Pelvic Floor Physical Therapist and fix the problem.

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