This is something I wrote in 2011 but never posted. Does it get too sciency? Too gross? Should I cite research? Anyway, here it is. — Jennie 2019/06/20

How It Works

First of all, urine is produced by the kidneys, which filter blood and take out water-soluble waste products of the body’s metabolic processes, along with the water they’re dissolved in. They send the urine down through the ureters to the bladder, where it collects until it’s expelled.

The Bladder

The bladder is basically like a balloon – a balloon made of living tissue inside your body, but still it’s a lot like a balloon. Around the outside of the bladder are muscles that can contract to squeeze urine out; they’re the bladder detrusor muscles. At the bottom, where the bladder lets out, is the urethra – this leads to the outside of the body. In men, the urethra goes through the prostate gland and penis on the way out; in women it has a shorter path, coming out in the center of the clitoris. But at the point where the urethra and bladder meet is the urethral sphincter, a ring of muscle that can pinch closed to cut off the flow of urine or relax to allow it to flow again. The walls of the bladder are also full of nerve endings that can feel whether the bladder is full and send those signals to the brain. There are also nerves at the urethral sphincter, detecting how much pressure is there waiting to be released.

Forces

Let’s start with a little physics. Warning: Science Alert! Sir Isaac Newton figured out that if something’s not moving, it’s not going to move unless there is a net force acting on it – that is, unless whatever forces are trying to move the object (like your car’s engine) are greater than the forces trying to keep it in place (like friction, air resistance, your brakes, etc.). This works for anything, including urine in the bladder. It’s going to stay right where it is unless the forces trying to get it to come out are greater than the forces trying to keep it in. What forces are in play here?

First on the list of forces trying to push the urine out, there’s the familiar force of gravity. Gravity can cause urine to come out of the bladder, but only if the positioning is right – that is, if the exit is positioned under the bladder. Babies are very likely to wet their diapers when they’re moved from a lying-down position to a sitting or standing/upright position. This is because gravity isn’t helping when they’re lying down, so some urine’s collecting in the bladder, and then when they’re moved into a situation where gravity helps, out comes the urine. Most adults don’t wet themselves when they sit or stand up, but they can be lying down and not feel the need to pee, then sit or stand up and suddenly feel it.

Second, the bladder walls can exert a force, but only if the bladder is overfull. I said the bladder was like a balloon, and like any balloon, it’s got three states: less than full, full, and overfull. Balloons that are less than full are “floppy” – in terms of physics, the sides of the balloon aren’t exerting any force on the contents. But lightly blow the balloon up, just so it’s rounded out, and now it’s full – you’re not stretching the balloon, just filling out its rest shape, the natural shape the balloon takes when the pressure inside and outside are equal. Blow more air into it, though, and you’ll find that this takes more effort, because the sides of the balloon are now attempting to return it to its rest shape; they’re exerting a force on the air inside, meaning that the pressure inside will be greater than that outside.

And the bladder is just like that. When it’s less than full, and when it’s exactly full, the bladder walls aren’t exerting any force. But as soon as the bladder gets to be overfull, they stretch and start trying to return to their rest shape. This can force urine out, or at least make an adult feel the need to pee.

Third, the bladder can be subjected to outside forces – that is, it can be squeezed. Sitting up, bending over, wearing tight clothing, exercise or exertion, or pressing on the bladder can push urine out, or make an adult feel the need to pee.

Finally, the bladder detrusor muscles can contract, on order from the brain, squeezing the bladder and forcing urine out. More about these muscles later.

Then there are resistive forces – forces that prevent urine from escaping. One of them, always present, comes from the fact that the urethra is simply much narrower than the bladder – just as blowing through a straw is harder than blowing through the cardboard tube at the middle of a roll of paper towels. This small but fundamental force must be overcome or nothing will flow at all.

Positional forces can resist the flow of urine, especially in people who happen to have a penis, where the urethra has a longer path and can be pressed flat or bent double. The resistive force is easily relieved by shifting position, which is another reason why a baby who is dry can suddenly wet when all they did was change position.

Gravity can also work against the flow – if one is in a position where gravity is pulling the urine away from the urethral sphincter, it can make urination more difficult rather than less.

Possibly, though, the most important among these is the force exerted by the urethral sphincter. Most adults contract this muscle when they feel the need to urinate coming on, then relax it when they’ve made it to a bathroom and are ready to pee. In adults, the sphincter muscle can counteract all the forward forces most of the time, and doing so is usually not a conscious decision – toilet training happens in early childhood and is well-ingrained by the time we’re adults.

Nature is simple. Add all the forward forces together, and add all the resistive forces together. If the resistive forces are greater than the forward forces, urine doesn’t flow. If the forward forces are greater, it does. Most of the time, for adults, the only time the forward forces win is when they relax their sphincter in a bathroom. However, it’s possible for the forward forces to overcome the strength of the sphincter – usually when the bladder is overfull and the detrusor muscles send a pulse. That’s going to cause what you’d call an accident. In babies, though, when the sphincter isn’t part of the equation at all, all it takes is enough forward forces to overcome the resistive, positional and gravitational forces, and the baby has a wet diaper.

Nerves

The detection system consists of two sets of nerves. There are nerve endings in the bladder walls, detecting how stretched the bladder is, and there are also nerve endings in the urethral sphincter, detecting how much pressure is awaiting release. Signals from both these places make it to the brain and can be felt both by the conscious mind and by the unconscious part that controls the autonomic system. The way the autonomic system reacts to them can’t be controlled, but the way the conscious mind reacts can.

Muscles

The bladder detrusor muscles are smooth muscles, meaning that they’re controlled by the autonomic system of the brain and aren’t under conscious control. The brain causes them to contract when you feel the need to pee. But they’re also sensitive to back pressure. If there’s more than a small resistive force (say, more than the back pressure from the urethra’s narrowness), the detrusor muscles will back off and try again later. However, if there isn’t enough back pressure, the detrusors will continue squeezing until the bladder’s empty or until a sufficient resistive force arises – a positional change, for example, or a clampdown on the sphincter.

The urethral sphincter is not a smooth muscle; it is under conscious control. However, it’s usually not something most adults think of consciously. That’s because its behavior is mostly controlled by habits learned during potty training. The habit is usually to close the sphincter when one consciously (or subconsciously) feels the need to urinate, and to close it more tightly the stronger those signals get.

Potty Training

Babies

When we’re babies, the sphincter muscle isn’t strong enough to retain urine – not that it matters, because we don’t know how to contract it yet; it’s a conscious muscle. And even if we did know how, we don’t yet know when to contract it and when not to. The detrusor muscles are pretty weak too – newborns’ bladders don’t really empty; they just leak urine when the baby shifts position or when gravity helps. Just enough comes out to lower the forward forces below the threshold where they overcome the resistive forces, and that’s it.

But the detrusor muscles, being autonomic, develop first, because the brain is always trying to use them – it’s hardwired, once the brain itself is well enough developed. So usually we spend some time as babies whose bladders just seem to know how to empty themselves completely, with no idea how to prevent that from happening as soon as our brains get the signal. Not that we know we’re supposed to at first.

Potty Training Time

Most of us figure out that adults don’t wear diapers. They use the potty instead. Some of us have parents who just start potty training as a matter of routine rather than waiting for us to be ready. But sooner or later, we learn that it’s bad to wet our diapers and that we should hold it until we can go in the potty instead.

We might already have experimented with our sphincter muscles ourselves by that time. We weren’t trying to stay dry; we were just flexing the muscles to see what they did. But they were still very weak and couldn’t produce much resistive force. With potty training, however, our sphincter muscles started to get stronger quickly. Soon we could stay dry for a short time after feeling the need to pee, sometimes even long enough to make it to the potty without the forward forces overcoming it. Sometimes not.

Eventually we’d strengthened the muscles enough that we could reliably hold it long enough to get to the potty, and we’d developed habits of holding it too – and since they were habits, they worked even at night. The feeling of having to pee would wake us up, but our habits kept the sphincter closed until we’d gotten out of bed and made it to the bathroom. Sometimes there were accidents, of course, but as with any kind of training, success only comes with lots of practice.

Undoing Potty Training

If the definition of toilet training is being trained or even conditioned to only use the toilet for urinating, then anytime you pee anywhere but in the potty is going against that – voluntary or involuntary. For some people it can be surprisingly hard to even voluntarily wet their pants, while for others that doesn’t pose a problem. At the extreme, entirely undoing your potty training would mean complete bladder incontinence, which is forced upon some people by accident or illness, but there are some who might want this, most notably adult babies. Whatever the reason, this is written for those who want to undo their toilet training to one degree or another, and there’s no reason why those who don’t would need to do any of this.

The pattern of a toilet-trained adult has these elements: closing the sphincter as the bladder fills, getting up and going to the bathroom when you consciously feel the need to pee, undressing enough to be able to pee without getting your clothes wet, putting yourself into the right position to use the toilet, and finally releasing your sphincter muscles so that the next detrusor contraction can go to completion. At one end of the continence spectrum are people for whom all of these are deeply ingrained habits. At the other end are people whose sphincter muscles stay relaxed at all times for whatever reason, anywhere, in any position, in any state of dress or undress – that would be my definition of complete bladder incontinence. In between are various stages, one of them being a state of freedom from taboo – that is, the stage where you can always choose whether to wet yourself or not, no matter where you are or what you’re wearing. But I’m going to look at each of these elements separately: position, clothing, location, and sphincter control.

Location, Part 1: The Toilet

The easiest taboo to break is the idea that peeing should only happen in the potty. Probably the easiest place to urinate other than an actual toilet is in something like a toilet. During toilet training most of us probably used potty chairs – some of them might have even had a detachable upper part that could be placed on top of the actual toilet so as to ease the transition from the potty chair to the real potty. As a very first step to undoing potty training, one could reverse this process, transitioning from using the potty (sitting down, of course, but neither men nor women will probably have trouble doing this) to using the potty while sitting on the upper part of such a potty chair that has been placed on the toilet. Once accustomed to that, you could then transition to using the actual potty chair. This might be useful if you’re trying to acclimate yourself to urinating into any sort of container, such as portable urinals used on wilderness expeditions.

There are adult-size potty seats, mostly for the use of people with physical disabilities, and of course there are things like bedpans and such used in hospitals for patients who can’t get out of bed. Some people can have a really hard time using such devices because of their potty training, to the point where they can’t bring themselves to use them, even when they have to.

Location, Part 2: The Room

Some might find it difficult to urinate at all if they’re not in a bathroom – indeed, some find it difficult to urinate anywhere but in their own bathroom at home, especially in a public bathroom with strangers around. To reduce this difficulty, one might try the potty seat method mentioned in the previous section, but with an additional step: first become accustomed to using the potty seat inside the bathroom, then try moving it out of the bathroom and become accustomed to using it there. Once you’re used to it in one room, try another room. Try putting the potty seat in different places in the room each time, facing different directions. Try this for a while, then see whether it’s easier to pee in a public restroom or not.

Clothing

Just wetting one’s pants is a very difficult thing for some, even for some who strongly want to. It’s possible that people who had bedwetting problems as children (or who still have them) would have less trouble than those who didn’t, but I’m not sure. But the habit of only releasing the sphincter when there aren’t any clothes between you and the toilet can be really hard to alter.

One thing that can help is to make sure that you won’t wet and possibly ruin any of your clothes or furniture: wear diapers. Both cloth and disposable adult diapers are available and are made to effectively absorb urine from wetting accidents. With a diaper on, you have knowledge that when you pee, the urine won’t go just anywhere; this can be very reassuring, especially since most of us wore diapers very early in life and thus have experience, however rusty, with wetting in diapers. After wetting in a diaper a few times, you will probably start feeling more reassured that the diaper will do its job of protecting your clothes and furniture, so you will probably feel safer about wetting yourself. If you’re truly trying to break the conditioning that prevents you from wetting yourself if you want to, you might want to wear diapers all the time, or at least put one on when you need to pee, then put your clothes back on over it.

Position

Most women almost always sit while urinating, and men will sometimes sit while urinating (usually when they also need to defecate) but usually stand. Standing and sitting are both positions where gravity provides a forward force, assisting the flow. But also, when one habitually pees in the same one or two positions, it can be very difficult to pee in any other position – lying down on your back, lying sideways, lying on your front, reclining, on hands and knees, (for women) standing up, etc. Using your imagination and visualizing yourself in a more familiar position can help. Again, you might want to wear diapers, if not all the time, then at least while trying this exercise, because you can’t really use the toilet in positions other than standing and sitting, but with diapers you can change your position to the one you’re trying, and the diaper will move with you.

Sphincter Control

You can lose the three previous elements of potty training without becoming what most people would consider incontinent, because you don’t lose the ability to control your bladder. In fact, you gain the ability to urinate wherever and whenever you have to. But once you start to change your sphincter control habits, you start to enter the realm of incontinence.

Unlike the other elements of potty training, retraining your sphincter habits will require constant effort. You will always have to immediately address the question of what happens when you feel as if your bladder is full, so you will always have to wear diapers and change them frequently. Basically you will have to live as if you are already incontinent.

The first key to retraining your sphincter habits will be to make an effort to wet your diaper whenever you feel the need to pee. Never hold back at all – no exceptions. This will have two effects. The first one you will notice will be that in just a few days, you’ll be feeling the need to pee more often. This is not because you’re peeing more – it’s because you’re getting used to your bladder being emptier. Your brain is always receiving signals from your bladder about how full it is; it’s just a question of when they become strong enough to notice. You’re peeing the same amount as you ever did, overall, just in smaller installments. It’s important to change your diaper on a regular basis – you’ll have less trouble wetting it if you’re certain it’s not going to leak. You also don’t want diaper rash. Trust me, you don’t.

The second effect, which you won’t notice at first and which will take a long time, is that you’re retraining your sphincter to let go instead of to hold back. The problem is that training yourself not to do something is difficult, more difficult than training yourself to flex a muscle. What will happen at first is that you’ll follow the old habit of tightening your sphincter when your bladder signals are too weak to consciously notice, but then releasing it a little while later, when you consciously realize what’s happening. As time goes by, though, the time between these two events will shorten, and eventually there won’t be anything to release, because you never tightened your sphincter – it might take a long time, however. But it will eventually happen, and in the meantime, you’re living as if you’re incontinent, so when it actually happens, you won’t have to change anything.

Wetting while asleep is difficult to control – but if you’re trying to retrain your sphincter habits, you’re going to end up wetting both day and night, so stay diapered and keep that diaper changed. Change before bedtime so you won’t have subconscious worries about leaking. You might want a bed pad of some kind to handle any leaks; not only will this make handling leaks easier, it will also make you feel more reassured that you won’t ruin the bed if you wet. Initially, your habits will take over at night, holding the urine in, but eventually the signals of bladder fullness will be enough to wake you up, at which point you can just let go into your diaper and go back to sleep. In time, your increased sensitivity will have you wetting in bed more and more often, and your habits will change to wetting your diaper without waking up.

Bladder Fullness Thresholds

• Zero: Your bladder is empty. This is actually never quite the case. There are always at least a few drops of urine in there. But as far as your brain is concerned, it’s empty. There are no signals telling your brain that anything’s in your bladder.
• Signal Threshold: There’s enough urine in your bladder for signals to go to the brain. In the case of some disorders, there can always be some signaling, even at “zero fullness.” Note that the brain doesn’t necessarily detect the signal yet, let alone do anything about it.
• Subconscious Threshold: The signals are strong enough that some part of the brain does something about them. This is likely to be the autonomic system that starts to lightly contract the detrusor muscles, but it might be that the subconscious detects them first and starts to tighten the sphincter because of habits developed during toilet training. For some people there might not be a subconscious threshold; if you’re really good at detecting your bladder’s signals, the conscious threshold might come first. If you’re completely incontinent, your bladder won’t ever fill past this stage unless there are some artificial resistive forces, because your detrusor muscles will empty it, and there will be nothing you can do to stop it. But actually, gravity and motion might even keep your bladder from even reaching this stage at some times.
• Conscious Threshold: The signals are strong enough that you consciously notice them. If you’re a potty trained adult, this is the time when you first get the urge to get up and go to the bathroom. If you’re working on retraining your sphincter muscles, this is the time when you should relax your sphincter and empty your bladder, no matter what, no exceptions. Note that if you’re asleep, reaching this threshold might result in your waking up.
• Fullness: The bladder is full but not stretched; the pressure inside and outside the bladder is equal. There’s enough urine in it to fill it to its rest shape, but not enough to cause the bladder walls to exert a force yet. Now, for some people the conscious threshold may not have occurred yet, but once we get to fullness and beyond, the signals sent to the brain begin to get much stronger, so it’s much more likely that they’ll be consciously detected.
• Elastic Limit: Between fullness and the elastic limit, the bladder walls will exert a stronger and stronger force, and the signals to the brain will grow more and more intense, and at some point the sphincter will probably not be able to hang on if the bladder doesn’t get emptied. Usually this results in an equilibrium state, where you involuntarily let enough pee go that the bladder wall forces decrease to the point where you can hold your sphincter shut again, and then the bladder fills some more, etc. It can be unhealthy, because the valves that keep urine from going back up the ureters into the kidneys are stressed by this. But if it’s held all the way to the elastic limit, something will have to give. This is extremely unhealthy, because the bladder can burst, which can be fatal. Not everyone’s sphincter muscles are actually stronger than their bladder walls, so this usually results in what is in this case a life-saving accident. Having an accident (sphincter failure) won’t kill you, but tearing your bladder can.

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Stages of Physical Incontinence

Here I’m defining “physical incontinence” as incontinence caused by weakness of the urethral sphincter muscles. This is distinguished from “neurological incontinence,” which is caused by damage to the nerves controlling the sphincter or the sensory nerves that report sphincter or bladder wall pressure back to the brain, and “psychological incontinence,” which is simply caused by inability to recognize the nerve impulses and/or being unaware of how to contract the sphincter or of the need to.

• Overflow Incontinence: This is where your sphincter muscles are strong enough to resist the detrusor muscles’ exploratory pulses, but aren’t strong enough to hold back against the bladder wall pressure that results from an overfull bladder. You will have an accident when your bladder gets full or sometime shortly after that. This will reduce the bladder wall force to the point where your sphincter can hold the pee in again, but you will have another accident soon unless you take action. You could avoid having to wear diapers by using the toilet frequently, making sure your bladder never gets full.
• At this stage you can’t resist weaker forces such as detrusor muscle contractions, or possibly even stresses or gravity. You might not feel the need to pee before an accident happens, either, if the contractions occur before your bladder has reached your conscious threshold. Using the toilet very frequently could still conceivably prevent you from having to wear diapers, but you might find wearing them more convenient at this point.
• Trickle Incontinence: Your sphincter has no muscle tone whatsoever, and any force at all is sufficient to cause urine to escape. This is the ultimate form of physical incontinence. If you are at this stage for some reason, you will either need to wear diapers or stay on the toilet constantly. Exercising the sphincter muscles will be necessary in order to have any hope of becoming toilet trained again.

Stages of Psychological Incontinence

This is the form of incontinence where everything is based on habits, or the lack thereof. Obviously what is considered “normal” is the habit of getting up and going to the bathroom when one feels the need to urinate, or at least when the need to urinate becomes urgent.

• You wet yourself because you wait too long to get up and go. Your sphincter muscles’ resistive force is overcome, probably by bladder wall forces from an overfull bladder. If this happens often, you might want to wear diapers or training panties just in case, but you can also try to train yourself to get up and go earlier.
• You forget to hold it when severely distracted. This could be when you are under some sort of physical stress, like being tickled, or it could be when your conscious mind is just very distracted, such as when you’re watching TV or sleeping. Your sphincter just doesn’t contract when you reach the conscious threshold sometimes. Wearing diapers or training panties might be a good idea until you’ve mastered this level of the habits.
• Only a slight distraction is required to cause you to relax your urethral sphincter.
• You know how to contract your sphincter, but you don’t know why. Typically this stage is only experienced by babies who are only in the beginning stages of toilet training. Diapers are almost always necessary at this stage, although training panties might be sufficient.
• You don’t even know how to contract your sphincter. There’s no way to avoid diapers at this point. This is usually only experienced by babies who have not yet begun toilet training.
• You don’t recognize the signals coming from your bladder telling you that it’s full, or at least that it’s time to empty it. This could actually happen at any of the above stages of sphincter control, but usually occurs alongside not knowing how or why to contract your sphincter.