Today we are going to talk about urge incontinence, or the urge to urinate. also called the ‘key-in-the-keyhole syndrome’ (in English, the Key in Lock Syndrome). You have probably experienced it, but you were not aware of this.
For example, have you ever sat in a meeting, or concentrated on something difficult so that you didn’t realize you had to pee? After the meeting, you get into the car, absorbed in what was discussed during the meeting. You listen to music and think about the meeting until you get to your house and park the car.
Your thoughts finally return to the present moment when you get out of the car and take out your house keys. Only at that moment do you feel an intense urge to urinate and you feel like you are about to burst.
The 150 meters between your car and your house seems endless. You try to relax and walk a little faster, but sometimes you can’t. You start to get desperate when you put the key in the door of the building.
The elevator is of course on the 12th floor. So you have to wait a few more minutes. The thing is, when the elevator arrives and you get in, the urgency gets worse. Finally you arrive at your apartment. You turn the key in the lock of what is at that moment the gate to paradise.
You run straight to the toilet and your gaze is fixed on the only thing that matters in that moment: the throne that provides the immediate pleasure of finally emptying your poor, anguished bladder. And the best part? You didn’t pee your pants!
Why do you feel the urge to pee more when you get closer to the toilet?
The same thing happens with gastrointestinal motility. Everything is fine until you suddenly realize you need to go to the toilet and you don’t have one around. The longer you wait, the worse the sense of urgency becomes.
Your anxiety and tension instantly worsen as all your attention is focused on that particular physical need. In such situations, even the most obsessive of contamination, who would never use a public restroom in a million years, would happily go to any restroom, no matter how clean, dirty, disgusting, or unsanitary.
The desperation we described earlier and the example of the public toilet apply to both bodily functions (urine and defecate). However, the question we want to answer is: why do you feel a sudden urge to pee (or to run a big errand) as you approach your destination?
Which mechanisms increase the urge to remove waste products from the body? How do they activate? Let’s dive right into this topic.
Your mind and body are not separated
There is a profound connection between physiological need, organ function (bowel and bladder), the brain, where you focus your attention, your context and the emotions (fear, tension and despair) that make up the situations we described above.
We’re pretty sure if you made a list of the things you do when you get home, going to the bathroom would win big. This may seem obvious.
Or it may seem silly to think about, but it does have a scientific explanation. To be more specific, this phenomenon has a neurophysiological, biochemical, emotional and cognitive explanation.
It is important to keep in mind that society generally considers the mind and body as two separate and different things. That’s because the mind-body dualism, or Cartesian dualism, is an idea that persists.
Neuroscience, more specifically psycho-neuroendocrine immunology (PNEI), has proven that humans are made up of body and mind and that our systems do not function independently of each other. That’s why we have a scientific explanation for something as banal as using the toilet.
An explanation for the intense urge to urinate
A series of biochemical changes take place as you get close to your destination. First, your body recognizes your full bladder or bowel and sends an alert. The newly focused attention on that part of your body accelerates your urge to go. The more you focus on it, the more your body activates that need.
On the other hand, being close to home, the place where you feel safe and calm, also increases this urge.
This stressful situation, in addition to the physiological mechanisms that occur as a result of the fear of peeing your pants, triggers the release of adrenaline and cortisol. It also activates a tension and stress in the abs and a particular focus on one thought: the toilet.
This urge to urinate is also referred to as “key-in-the-keyhole syndrome,” as we mentioned at the beginning of the article. This name also applies to the urge to empty the bowels.
The phenomenon is a perfect example of the connection between the bladder, the gastrointestinal tract and the brain. Because while you can keep it up for a long time, your bladder associates urination with coming home. This activates an urge that is difficult to control.
When I think of the jingling of the keys as I try to open the door, I can’t help but think of Pavlov’s bell. Conditioned reflexes are responsible for this phenomenon, as in Pavlov’s experiment.
You’ve probably heard of Russian psychologist Ivan Pavlov, who conducted a now-famous experiment on a dog. When he fed the dog, he also rang a bell. After a while, he tried to ring the bell without offering any food. He noticed that the dog drooled even when no food was present.
The same thing happens when you have to pee or press. Hector Galvan, the director of the Institute of Psychology in Madrid says that we associate the toilet with our physiological need and that the awareness of our physical sensations activates our consciousness, which tells us to go to the toilet.
Environmental factors that contribute to the urge to urinate
Ghei and Malone-Lee identified four environmental factors that also trigger the urge to urinate.
- get up in the morning
- a key in the lock
- an open tap
- cold weather
They distinguish between urges, a feeling that you can’t hold it, and actual incontinence when you pee your pants. They also state that worry and fatigue can make the problem worse.
For example, the sound of running water sounds like someone urinating in the toilet. When you hear a sound similar to what it sounds like when you pee, your brain produces an association. They therefore cause an increase in the contraction of your bladder muscle (the detrusor).
On the other hand, three researchers from the National University of Colombia (Victor, O’Connell and Blavias) also conducted a pilot study. They evaluated the environmental cues that could be stimuli with conditioned reflexes in these conditions.
The results partially coincided with Ghei and Malone’s studies. The first thing was getting up in the morning. Second place (88%) was on the way to the toilet. In third place with 76% was a full bladder and in fourth place (71%) was the door of your house open.
Don’t think about the toilet
You start to notice that you need to urinate when you have 150 or 200 ml of fluid in your bladder. If your bladder is full, sneezing, coughing, or laughing can cause leakage. But you won’t lose everything because you can control the urge to pee.
All you have to do is stay calm. Reduce your anxiety, don’t think about the toilet and distract yourself. All of that will help you control your bladder. That said, it’s important not to resist the urge to urinate too often. This can damage your organs.
In the end, it’s all in your head. Your brain is the commander, modeling, building and deconstructing realities. Your mind, brain, emotions, cognitions and all the systems in your body participate in this incredible synergy.