Relaxing

[growlycub]

I've heard many times about the importance of staying relaxed and not tensing up after peeing. For me at least though, it seems like I can do this and still have be tensed up enough to release later. It seems like my sphincter is completely open, but then, a while later, it needs to release itself and my sphincter opens again.

This obviously doesn't make a lot of sense to me. How can you be relaxing a muscle, and then it somehow manages to tense up again? Is that how it works? Does it always kind of close on its own after a while? Or does this have something to do with the internal and external sphincter?

[Baby Brian]

Your sphincters muscle is used to being normally closed, so even when relaxed it will slowly close back up again. Keep it relaxed long enough and it will start to stay open more and more. The key is not to clench it back down fully closed or you're strengthening it remain closed even more. This is just part of why it takes so long to become un-potty trained.

[kevindhca]

The sphincter muscles can operate in both directions.

They work independent of each other but reinforce each others hold power.

The inner is normally closed at rest. This is the primary continence mechanism providing passive control. The smooth muscles are under mostly unconscious control and primarily open by pressure from the bladder.

The outer is normally open at rest but has much more conscious control. When you squeeze it closed, it not only holds it also suppresses the bladder contractions.

You only need one to function to remain continent.

The inner will be closed when relaxed. It must be forced open, that's why incontinence is a symptom. The inner provides passive continence unless something is wrong with it.

[Baby Brian]

The sphincter muscles can operate in both directions.

They work independent of each other but reinforce each others hold power.

The inner is normally closed at rest. This is the primary continence mechanism providing passive control. The smooth muscles are under mostly unconscious control and primarily open by pressure from the bladder.

The outer is normally open at rest but has much more conscious control. When you squeeze it closed, it not only holds it also suppresses the bladder contractions.

You only need one to function to remain continent.

The inner will be closed when relaxed. It must be forced open, that's why incontinence is a symptom. The inner provides passive continence unless something is wrong with it.

[growlycub]

Very interesting stuff. So really, the goal is to change the outer sphincter' natural state to relaxed, which will make you leak just as often as your internal sphincter releases.

[kevindhca]

The info I got from the continence clinic seems to indicate a wide variation in how open or closed the outer sphincter is in different people while at rest.

If you can consciously close it when a bladder contraction occurs, excellent continence will happen.

A relaxed outer will perform better than one under constant tension.

Big surprise to me, the majority of male patients at the continence clinic are there for pain not incontinence.

The nurses try to teach them how to relax the outer sphincter as years of holding too much or too long can cause a very tight situation.

I know mine is open, and I'm not closing it. That just causes inability to stop the flow and a bit of dribbling after.

[Baby Brian]

Very interesting stuff. So really, the goal is to change the outer sphincter' natural state to relaxed, which will make you leak just as often as your internal sphincter releases.

[growlycub]

Alright. So do you guys disagree still about this? Tell me if I'm getting this right.

kevindhca: A relaxed outer sphincter could be open or closed, depending on the person.

Brian: A relaxed outer sphincter is always open.

[Baby Brian]

It's natural state is most certainly open when relaxed as this is most certainly how it starts out.

[Dill_Pickle]

I'll just back up what Kevin said about the statistics -- in the form of noting that, having celebrated my 39th birthday a few too many times, my prostate is enlarged...and, even with drugs, constantly feeling like I need to pee but being unable to go is irritating, and could clearly become painful.

[kevindhca]

Alright. So do you guys disagree still about this? Tell me if I'm getting this right.

kevindhca: A relaxed outer sphincter could be open or closed, depending on the person.

Brian: A relaxed outer sphincter is always open.

It doesn't matter whether it's open or closed for it to work.

At rest the outer has no pressure on it so it doesn't have to be fully closed at rest and there would be no way to tell without visual examination.

Full function depends on it being able to move in both directions.

Any muscle held in one direction for a long time won't want to go in the other direction.

Hold it open for years and it won't want to close, hold it closed and it won't want to open.

Probably not permanent though, as long as the connection is still there, muscle training can restore function. I'm not going to verify if that part is true.

[Baby Brian]

At rest the outer has no pressure on it so it doesn't have to be fully closed at rest and there would be no way to tell without visual examination.

[kevindhca]

Sure there would. Ask any person who has ever had a non-function internal sphincter, vet has a normal sphincter. Such a person might be someone with a blockage at the bladder neck or more commonly their prostrate. Every time their bladder automatically tried emptying (from too much pressure or a complete lack of pressure) they would automatically pee them selves quite a lot before they can consciously clamp down to shut their outer sphincter. This typically doesn't happen unless they are not fully potty trained (typical in toddlers for example), which means their outer sphincter is otherwise normally closed. Simple correlation really.

I guess I should have been more specific, I was referring to normal physiology.

Potty training has nothing to do with incontinence.

Toddlers are not incontinent, they have been trained to use a diaper.

The normal internal sphincter is closed at rest from birth, providing passive continence.

Potty training is about recognizing the signals that elimination is imminent, then delaying that until an appropriate location is available.

Conscious control of the outer is necessary to delay elimination, and by strengthening the outer, the inner strengthens as well while the bladder increases in capacity.

Most mammals are fully continent from birth, except for rodents. They have no sphincters and leak all the time.

[Baby Brian]

Potty training is about recognizing the signals that elimination is imminent, then delaying that until an appropriate location is available.

This is exactly my point though. When a person no longer or simply does not get that signal, that would would mean they would automatically pee them selves (at least a little) every time their bladder tries to start emptying. Yet this doesn't happen with people who otherwise have normal functioning external sphincters. Instead, the urine hits their already closed external sphincter and they get an immediate urge they need to go. Often their sphincter isn't strong enough to hold it and soon they pee whether or not they want to.

Seriously, I really do know this one from person experience - as does every other urge incontinent person out there. Please just trust me on this one, a persons external sphincter is normal closed even when at rest (the result of the muscle memory we get from Potty training).

[kevindhca]

I don't think it's quite that simple.

Everyone's a bit different.

Funny thing. A bunch of the people are at the continence clinic trying to learn/train to close it, the rest are there to learn/train to open it.

[Baby Brian]

I don't think it's quite that simple.

Everyone's a bit different.

Funny thing. A bunch of the people are at the continence clinic trying to learn/train to close it, the rest are there to learn/train to open it.

Well I can certainly agree to everyone being different. If you know of adults going to continence clinics just for learning to potty train again, they you may very well be right about there being both states of open or closed sphincters when relaxes.