Sunshine Beach 2015
I have been having the amazing opportunity this beach holiday to partake in the wonderful pleasure of just pure observing- observing the development of new behaviours. When my kids were little – we loved (and photographed with a camera not a phone) every new little skill they acquired and each new milestone they mastered. But now I am able to view these new skills in a different way, because but I am at a different stage of my life and my learning (I say learning instead of knowledge because thanks to the internet, Facebook and Twitter – all amazing sources of high quality journal articles- the more I learn, the less I realize I know – learning is infinite), and of course I am not constantly shattered with the exhaustion which brands you as a parent.
So what I see is, that when my beautiful grandson acquires a new skill- we the observer, realize its new and clap, laugh, smile and exclaim- and that is pleasurable for the baby and he does it again. We rewarded the baby with our praise; the skill has allowed him a different view of the world, further reinforcing its value as a new skill and so he lays down some building blocks of neural pathways and that new behavior gradually gets better and better until we can say- yep he’s mastered getting to sitting and back to lying without clunking his head on the floor.
So many of our good behaviours are learned, but so are behaviours which have negative impacts on our life. When we eat chocolate, there are many reward centres that are activated. The smell invokes the first of the pleasure memories, the taste is sensational and the thoughts of past pledges to abstain from eating the chocolate (because you hated yourself in the last Xmas photo and your tummy is actually saying you feel sick from over-indulging) get pushed to the back of the brain- and what’s more you find yourself eating a second or third (because they are a different flavor, shape or brand- ooh I haven’t had a cherry liqueur chocolate in years…).
If we apply this to the bladder- we turn on the tap, we may have quite a full bladder and we feel a twitch from the bladder as we hear the running water and it intensifies as we place our hands in the water. So we reward ourselves (our brain) by immediately going to the toilet and emptying the bladder. The relief of going is the reward, the anxiety that we could leak is relieved and so positive reinforcement happens. So this may continue subtly over days, weeks and years- the bladder capacities get smaller, the habits more entrenched, as no one points out that these behaviours can lead to an overactive bladder.
This can also happen if following childbirth there is a weakness in the sphincter mechanism at the neck of the bladder or damage to nerves or muscles in the pelvic floor. The woman may sneeze, again often with quite a full bladder, and a small leak can happen. That gives slight shock and surprise as this has never happened before- she thinks OMG what just happened? There are stories she has heard from her friends, from her mother; there is her grandmother in a nursing home and a memory of the smells associated with visiting the nursing home flood her brain. A little burst of adrenaline and cortisol accompanies that shock and as her bladder is actually quite full, she goes to the toilet. She rewards her brain/bladder. But she also loses a tiny bit of confidence. So ever so gradually, she starts to go to the toilet with smaller and smaller capacities and then she may even start to develop urgency and urge leakage as well.
This conditioning, reward-based effect can happen with chronic pain as well. There can sometimes be a ‘perfect storm’ of stress and anxiety that can coincide with an episode of pain in any part of your body. Chronic pain in the uro-genital region is a common presentation at my practice for both women and men and when I am teaching the ‘Explain Pain’ model of central sensitization, patients can almost always relate a tsunami of stress around the onset and escalation of the chronic pain. So if your brain, in it’s heightened state of alert (due to the cortisol and adrenaline constantly swishing around due to work, money worries, relationship issues) perceives that there is danger associated with an activity (such as intercourse), then the job of the brain is to protect you from danger and it ramps up the pain dial. Again we are training and learning – this time the rewards are not positive ones (clapping, smiling, laughing) but negative ones like stress and anxiety that play havoc with our sense of well being and safety and therefore are equally if not more powerful.
So what is the message from this blog?
There are some rules around the bladder- we call them the good bladder habits and we need to learn them, as much as we need to learn how to add up and what is the capital of France.
The next message is that chronic pain is very treatable, it’s almost ALWAYS associated with stress and anxiety and you will sometimes be surprised at how easy the treatment is (knowledge is empowering).
The final message is stop, breathe and relax – take just a couple of minutes 3, 4 or 5 times a day to just focus on something beautiful (a baby, a rose, a photo from a lovely holiday), take a slow, relaxed but deepish breath in and on the breath out- relax your shoulders, tummy, pelvic floor and inner thighs and then as you relax concentrate on the warmth flushing into your hands. Repeat 2 or 3 times and marvel at the calm that floods over you.
Enough for now- I have some more delicious baby-observing to do and some more chocolate-avoidance strategies to devise and implement so when I resume my New Years ‘challenge’ with Hannah in February, I am not actually heavier than when I started pre-Xmas. (Yes Hannah -I will be a good girl for the rest of my holiday!)