Should You Pee in the Shower with Physical Therapist Ashlie Crewe — Episode 123

I saw a TikTok about peeing in the shower and I knew I needed Ashlie to come on and chat about what is right/wrong about this — and what our bladder is thinking!

Today’s guest is physical therapist Ashlie Crewe. Ashlie Campitella attended Gannon University where she received her Bachelor’s in Psychology and her Doctorate of Physical Therapy degrees. She then began her specialized training in pelvic health physical therapy. While treating patients and training in pelvic floor therapy, she also attended courses regarding pain neuroscience, finding her passion in combining the knowledge from her pelvic health courses with the neuroscience of persistent pain conditions. She has developed pelvic floor programs in several of her company’s clinics and currently treats patients of all genders with pelvic health concerns, while providing mentorship to other pelvic floor therapists in her company, and educating her community about pelvic health rehab. She achieved her Board Certification as a Women’s Health Specialist in 2017 and is also a member of the International Pelvic Pain Society as well as the Global Pelvic Health Alliance. Additionally she has served as a teaching assistant in various Herman and Wallace classes, and serves as adjunct faculty for Lebanon Valley College. She is developing curriculum for her company to make inclusive and affirming pelvic health education accessible to clinicians within the large orthopedic physical therapy company she works for. Primarily, she treats in central Pennsylvania, traveling to several clinics in the area to mentor therapists and consult with patients. She is experienced in treating pelvic pain conditions, urinary and fecal incontinence, pelvic organ prolapse, post-operative gender-affirmation conditions, constipation, pediatric pelvic floor conditions, and prenatal and postpartum conditions. She is passionate about the multidisciplinary care of persistent pain conditions, and eager to work with experts in all fields of study to better help her patients have painfree and fulfilling lives.

Big thanks to our sponsor Family Routines — it looks like our bladders love routine as much as we do. 🙂

In this episode

Should you pee in your shower, and what is happening when your bladder is triggered by something you do?

How to stand when you pee.

If you feel great urgency, what you can do to stop it.

Other things that might interest you

Ashlie’s other episodes:

• Symphysis Pubis Dysfunction
• Bladder Leakage

How to know if you have a bladder infection

Producer: Drew Erickson

Transcript

[00:00:00.130] – Hilary Erickson

Hey, guys, welcome back to the Pulling Curls Podcast! Today on Episode 123, I’m bringing on my favorite physical therapist to talk about if we should pee in the shower and kind of more in relation to that. It’s not just about peeing in the shower, but let’s untangle it.

[00:00:24.330] – Hilary Erickson

Hi, I’m Hilary Erickson, the curly head behind the Pulling Curls Podcast, where we untangle pregnancy, parenting, home and even travel. We know there’s no right answer for every family, but hopefully we can spark some ideas that will work for yours. Life’s tangled, just like my hair.

[00:00:47.590] – Hilary Erickson

Hey, guys. I mean, I bring up the sensitive topics that everyone wants to talk about, and when I do that, I demand reviews. So go ahead and jump on over while you’re listening and leave me a review on Apple podcast. It really means a lot, and it’s going to help other people get valuable podcast information like peeing in the shower. Okay, this is my guest’s third time on the Pulling Curls Podcast. She has done another one about urinary incontinence. We’ve done one about symphesis pubis dysfunction. And today we’re talking about bladder triggers, peeing in the shower. I want to introduce today’s physical therapist of the day, Ashley Crewe.

[00:01:26.390] – Hilary Erickson

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[00:02:03.930] – Hilary Erickson

Hey, Ashley, welcome to the Pulling Curls Podcast.

[00:02:06.350] – Ashley Crewe

Thanks so much for having me on again.

[00:02:08.040] – Hilary Erickson

Yeah, this is time number three for Ashley.

[00:02:10.430] – Ashley Crewe

Yes, I’m going to be a frequent flyer.

[00:02:13.590] – Hilary Erickson

I think again, this is in my area of expertise. We talk about bleeding. I’ll be all over it.

[00:02:19.610] – Ashley Crewe

Great, because I’m not.

[00:02:21.690] – Hilary Erickson

Well, only bleeding from one area, because if my kids say they’re bleeding on their finger, I’m like, That’s not my area.

[00:02:26.780] – Ashley Crewe

Yeah, I tell my children to rub some dirt on that. So you’re probably more qualified than me.

[00:02:34.110] – Hilary Erickson

Okay, so today I was on TikTok, and of course, I saw somebody like, do not pee while you’re in the shower. And then suddenly and I was like, oh, because every time I turn on the shower, I feel like I need to pee. And then, of course, somehow I hit it somehow and then could never get that TikTok video to come back. So I was like, Ashley, are you not supposed to be in the shower? Because it was a physical therapist. It wasn’t just like random Dulah saying, don’t be in the shower, right?

[00:03:00.080] – Hilary Erickson

So is it okay to pee in the shower? Is it okay to pee when you turn the shower on? Tell me more.

[00:03:05.880] – Ashley Crewe

The short answer is it depends. So one of the things that we know about how the bladder works is so much about how the bladder works is reflexes. So it’s happening in your spinal cord without us really thinking about it. But because we can always be in super control of some of those reflexes, we want to be very cautious about what we’re trading our body to associate. And so everybody who’s ever talked about this kind of triggers when it comes to the bladder, we talk about the Pavlov dogs experiments, and I feel like everyone knows it.

[00:03:38.500] – Ashley Crewe

But in case you didn’t, Pavlov was a researcher. He fed his dogs and rang a Bell every time he fed his dogs, and he measured their saliva output, which is a job I don’t want. But eventually, after repeated exposure to food plus Bell, he could take away the food element, just ring the Bell, and the dogs would start to salivate. That’s pavlovan.

[00:04:00.010] – Hilary Erickson

I have Pavlov’s bladder, right?

[00:04:03.390] – Ashley Crewe

We can name it that condition, Pavlov bladder. And so we as human beings. We have all of these ingrained things that have that are have loving trained in us. So I tell, like, medical professionals who work in hospital settings, you hear a code blue, and immediately your nervous system kicks on and says, I gotta run. I got to do this because that’s what we do in the same way if we train our bodies, if we repeatedly hear water running and you think about if we sit or stand and we urinate and we hear that sound of urine going into the toilet, it sounds pretty similar to water running.

[00:04:37.880] – Ashley Crewe

And so if we continue to associate that with not just peeing, but also running water in the sink because I run the water in the sink. And now it’s a similar sound. So I’m going to empty my bladder or I’m going to turn my shower on. And it’s a similar sound. So now I’m going to empty my bladder. I’m more training those reflexes to respond to all running water instead of just the sound of pee going into the toilet. I’m very gracious in my job. It’s not bad, but it’s just that we don’t necessarily want you to be watching TV and watching some sink commercial and thinking like, oh, my God, I have to go to the bathroom because my bladder is like contracting, going crazy.

[00:05:21.910] – Ashley Crewe

And so that’s one of the theories on why it’s not a great idea. The other thing is, and I kind of joke because some people say you’re not supposed to pee standing up. But about 49% of the population historically stands to pee. And so it’s important that we talk about how to stand to pee if you want to stand to pee. So this is things I never thought I’d be talking about in my profession. But here we are. The biggest thing is if we stand with a perfect posture to urinate, our pelvic floor muscles have to be a little bit active to stabilize everything and to hold us up.

[00:05:54.320] – Ashley Crewe

If our pelvic floor is completely relaxed, we would probably fall down. And so the problem with that is that for all these lovely reflexes to work, the pelvic floor muscles are supposed to fully relax so that the bladder can contract and empty. When we’re contracting our pelvic floor muscles, it actually gives our bladder the signal to not contract and not empty. So you have to figure out how to stand and not contract your pelvic floor muscles and not fall down. So there’s a couple of things here.

[00:06:19.390] – Ashley Crewe

So typically, I would say a lot of people who have penises, they tend to stand and kind of like arch their back a little bit and maybe lock their knees a little bit when they pee. I’ve done extensive research on my husband and my two small children, and the reason that a lot of folks do this, we think, as medical professionals, is that in doing that, they kind of stack all of their bones on top of each other so that they can relax their pelvic floor muscles effectively and give their bladder that signal to contract.

[00:06:48.090] – Ashley Crewe

But if you are standing with perfect posture and your pelvic floor muscles are contracting, your bladder doesn’t get that same signal, so it could create some dysfunction. So I say it’s important to talk about if you’re going to pee in the shower, we don’t want to give you a Pavlov ladder, but also we want to make sure that you’re standing with appropriate mechanics in order to pee effectively. And so the other way, I said, if you’ve got to pee in the shower, pee in the shower, if you got to do it, you have to do it.

[00:07:11.620] – Ashley Crewe

But then I also tell people, if you get into a really deep squat, I’m not talking like a squat like we’re doing like power squats, I mean, but almost to the floor so that your leg muscles aren’t doing the work. So if you’re in a shower that has a handlebar somewhere, I tell people, hold on to that handle and hang down in that squad so that your arms are holding you up. And that’s a good way to let your pelvic hormones just relax and open so that you’re giving those the appropriate signals as far as should they be contracting, should they be relaxing?

[00:07:37.990] – Ashley Crewe

What’s on the bladder and all of those things? So that’s my official recommendations. You’re going to pee in the shower either stand and arch your back a little bit, maybe lock your knees. So try to relax your pelvic floor or hold on to something and hang down into a deep squat to let your public floors relax. There you have it.

[00:07:53.930] – Hilary Erickson

There you have it.

[00:07:55.080] – Ashley Crewe

Okay.

[00:07:55.630] – Hilary Erickson

But I noticed my bladder has all these triggers, like, as soon as I’m okay, I’m going to go to the bathroom. Now.

[00:08:01.390] – Ashley Crewe

I have to go to the.

[00:08:02.380] – Hilary Erickson

Like, 2 seconds ago, I was 100% fine. But when I’m like, okay, I’m going to go. And now I have to go so bad. So is there anything we can be doing if that’s our problem? Because I don’t think I can jump on a trampoline. I can do jumping Jacks. But if I’m doing jumping Jacks and then decide, I’m going to use the restroom, then it’s all over, right.

[00:08:21.320] – Ashley Crewe

As soon as you make that decision in your brain to say, oh, I’m going to go to the bathroom. Then your bladder is like, okay, we’re going to the bathroom. And so many people talk about, we call it key in the door kind of bladder urgency where they put into their driveway. And then all of a sudden, their bladder says, Here we go. And so a lot of that is because of these trained responses. Is that for some reason, if your bladder knows as your bladder has cognitive functions.

[00:08:49.660] – Hilary Erickson

I feel like my bladder knows. And I should name it.

[00:08:52.000] – Ashley Crewe

You’re right. Historically, as soon as you get into your garage, you walk right into your house and go to the bathroom. Every time your bladder starts to form that Association, every time you walk into your house or every time you walk into the grocery store or whatever it is, if your brain and your bladder start to associate those things together, then your brain and your bladder start to anticipate that. And so then if you’re pulling into your driveway, pulling into your garage, whatever you’ve got, your bladder is already starting to see all these signals to say, okay, bathroom is coming, get ready and starts to do some contractions because it just knows that it’s almost time to do that.

[00:09:29.700] – Ashley Crewe

And the problem is that lots of problems here. Time back. But one of the biggest problems is that it’s so hardwired into our system. Again, we’re talking reflexes. We’re talking about what I call the caveman nervous system, the caveman brain. Right. And so I kind of joke and say, if you’re a caveman and you’re sitting in your cave and the Sabertooth Tiger comes the door of your cave, the opening, no door of your cave. And you’ve got a full bladder, it’s time you’ve got to make a couple of choices here.

[00:09:59.770] – Ashley Crewe

And a lot of people’s bladders just say, fully contract, peat your pants, your loincloth and get away or fight, right. And so a lot of times when people have a little bit of anxiety about, like, oh, I’m going to make it in time or, oh, I have to put all these things down or whatever. I mean, it’s not a safer suit, Tiger in most situations in 2021. But if it’s oh, my phone is also ringing.

[00:10:20.410] – Hilary Erickson

Or I’ve got armfuls full of bags or kids calling kids in. Exactly.

[00:10:24.110] – Ashley Crewe

I’ve got to finangle my two year old and the child seats while they’re fussing.

[00:10:29.020] – Hilary Erickson

Right.

[00:10:29.290] – Ashley Crewe

Your bladder is just like Sabertooth Tiger. Just contract and get it over with. And so that becomes a big problem. One of the things that I encourage folks to do if it is something like that, if you can change the stimulus. So if somebody is saying, I walk into my front door and I put the key in my front door, and then my bladder contracts, I say, Can you try to walk to your back door just to see what would happen? Because it’s a different stimulus. Your brain doesn’t have that association, and it’s a good way to help break them.

[00:10:55.940] – Ashley Crewe

So that’s where my patients and I can be super creative about how we can change all the different stimuli. Obviously, if you got to get a shower, you got to get a shower. It’s hard to change that stimulus. But the other thing that’s really important to do is if you’ve got that significant urgency because you are exposed to a trigger, then one of the most important things you can do is sort of stop moving. First of all, because as we rush and we jostle things around, that just feeds into that contraction of the bladder.

[00:11:23.390] – Ashley Crewe

And so I tell people, stop moving. If you can sit down. If you’re in a situation where you can sit, that would be ideal. Take a couple deep breaths would be great, because we want to give that caveman nervous system caveman brain a chance to just calm down and say, there is no Saber tooth Tiger here. So that’s important, too. And then I tell people, try, like, five to ten, five pelvic floor contractions squeezing as hard as you can, because again, we’re talking these reflexes, and the way we’re hardwired is that the pelvic floor is contracting.

[00:11:52.470] – Ashley Crewe

It should shut down the bladder contraction. Okay, so the way normal urination works is we decide to pee and we release tension on our pelvic floor muscles. And then those muscles work in opposite of the bladder. So release the pelvic floor makes the bladder contracts. And so the opposite is also true. If we contract the pelvic floor, it tells the bladder to shut up. You’re not actually need to go just yet. Like, hang in there. And then the bladder can continue to stretch and fill with urine.

[00:12:19.550] – Ashley Crewe

So if you squeeze those public hormones a couple of times, it tells that bladder, hey, shut up. I’m in my car. I got 17 bags from the grocery store in my hands and the toddler and the other. It’s not time. And then I tell folks, once you feel like that severe urgency has decreased, then it’s an appropriate time to start walking calmly to the bathroom to then go ahead and make that decision to go to the bathroom. And that’s usually how it starts. And then I usually tell folks, as you get better and stronger and more coordinated, you’ll be able to get longer gaps of time in between.

[00:12:54.180] – Ashley Crewe

That like, I’m going to do my contractions, and then I’m going to walk to the bathroom. I tell folks it would be great to do something distracting as well. So that’s the other big cool thing is that if we’re really involved, I feel like every person has done this right. If we’re doing something and like, oh, I got a pee, right? And then something happens. Phone call or I get wrapped up into TikTok or whatever. Then all of a sudden it’s like, oh, it’s 20 minutes later, and I still haven’t pee.

[00:13:21.350] – Ashley Crewe

And that’s the way our body is designed to work. So I tell folks, I want you to have potentially something to go to. That, you know, is going to suck you in a little bit and get you distracted. And so it can be simple things like doing your I don’t know, seven times tables or counting backwards from 57 by threes, like something just to keep your brain occupied and using that part of your brain again, if we’re running from a saver tooth Tiger, we are not trying to count backwards by threes from 57.

[00:13:50.590] – Ashley Crewe

That’s not the way we’re wired. And so it tells our nervous system, well, I must be safe, because the only time I have to do that kind of critical thinking is when I’m relatively assured that there is safety. And so it can really help shut down some of that urgency to empty your bladder as well. In summary, then we want to stop moving a couple of deep breaths, maybe some pelvic floor contractions just kind of squeeze release, squeeze release a couple of times, then something distracting.

[00:14:14.970] – Ashley Crewe

If you’ve got a book on your phone, read, if you like I said, TikTok, you know, the tick tocks are only going to be a minute. So one tick Tock you have a minute at most. And then when your urgency has subsided from then get to the toilet to empty those are the big takeaways there.

[00:14:30.160] – Hilary Erickson

Okay. So it’s kind of like a toddler that you don’t want to give in every time it whines right. Because then you’re just showing it every time you whine, I’m going to run like crazy.

[00:14:39.090] – Ashley Crewe

Exactly. Do you have a toddler pavlop ladder?

[00:14:43.170] – Hilary Erickson

A toddler pavlop? Yes.

[00:14:45.020] – Ashley Crewe

Exactly.

[00:14:46.050] – Hilary Erickson

Okay. How common is this? Is it very common? Because I would look up the different kinds of bladder, and I’d be like, well, mine is just when I decide my brain is way too tied to this bladder.

[00:14:56.070] – Ashley Crewe

So super common. And I would say if we ask enough questions, we would find that everyone has some sort of trigger. And it’s perfectly okay if we have a little bit of a trigger to say, like, OOH, this makes me kind of pee or makes me kind of want to pee. Experience and urgency. I think everyone’s got that a lot of people say, go out in cold weather. They’re like, oh, I got a pee or running water or somebody was saying, even just seeing a waterfall that makes them want to go to the bathroom.

[00:15:22.110] – Ashley Crewe

So urgency is super common. I mean, we all have the urge to go to the bathroom, but urgency with some triggers is pretty common. Urgency with incontinence also super common. But that’s when we really start to get to the abnormal side of things.

[00:15:35.520] – Hilary Erickson

Okay.

[00:15:36.070] – Ashley Crewe

So that urge from your bladder should be a signal that like, hey, at some point, I’m feeling kind of like, I have to go, but it should not be an immediate, decent assist everything you’re doing and get to a toilet or too late. Like, we’ve gone. It should be more of a gentle like, sometimes we’d like to get to a toilet as opposed to a demand to urinate right now, but super common to experience these symptoms, but definitely something that we could be doing something about.

[00:16:02.860] – Hilary Erickson

Okay. So helpful. And again, guys, be honest when you talk with your doctor about these kind of things, because maybe somebody could have told me about this 700 years ago, right? I mean, I’ve worked with probably five urinary incontinence companies in my blogging lifetime, and no one has mentioned it’s always like, the jumping Jacks or other things. And I was always like, no, that’s not me. That’s not me.

[00:16:25.640] – Ashley Crewe

I do.

[00:16:26.290] – Hilary Erickson

But if I turn on my shower, it’s over, right.

[00:16:28.490] – Ashley Crewe

It came over. And I think because I think probably what you’re talking about, the stress incontinence when there’s a stress to the system, like a physical stressor, like the jumping sneezing, coughing, super common. And I think becoming really normalized a little bit in mainstream media or say, de stigmatized, which is great. I’d like to not be normalized, but I think so many of my patients come to me and say, Well, I just always had a small bladder, and I’m like, no, you probably haven’t. The statistical likelihood that you actually have an anatomically small bladder is really low versus how many patients have told me.

[00:17:04.630] – Ashley Crewe

I just have a small bladder. I’m like, you don’t have a small bladder. You have a bladder that you have trained to not stretch because you’ve given in to that Pavlovian toddler all the time. And so the other flip side of this is that I appreciate that the rehabilitation for this is not necessarily super fun, right? Like, we’ve got to be honest about that. And some patients are just like, I can’t do that where I’m sitting here saying, experience that discomfort for a second. Let’s give you some coping strategies, and we’re going to gradually say, I need you to wait two minutes, two minutes before you compete, and now we can do that successfully.

[00:17:38.950] – Ashley Crewe

Great. Now I need you to wait five minutes, and then nobody wants to sit in discomfort for five minutes.

[00:17:44.540] – Hilary Erickson

That’s where TikTok comes in.

[00:17:46.080] – Ashley Crewe

Right? Exactly. That’s what I always say. Like, God bless TikTok, because I’m, like, just scroll through a couple of videos on TikTok, look at some viral stuff. It doesn’t matter. But, yes, I think things like that are so, so helpful. But I think the more we do that, the better our symptoms get. And so it is fixable. It’s just not necessarily the funnest thing to rehabilitate from a patient, because I’m saying, yes. You’re going to feel that urgency, and I need you to deal with it. I’m going to give you tools, but I need you to deal with it.

[00:18:14.900] – Hilary Erickson

Yeah.

[00:18:15.400] – Ashley Crewe

Okay.

[00:18:15.820] – Hilary Erickson

Super helpful. Thanks. Probably not the podcast everyone’s like, oh, I’ve heard this podcast six times. Yeah.

[00:18:21.860] – Ashley Crewe

Something new and different.

[00:18:23.490] – Hilary Erickson

All right. Thanks for coming on and telling us about our pee parts, Ashley.

[00:18:27.230] – Ashley Crewe

Anytime. Thanks for having me.

[00:18:29.670]

Okay. I hope you guys enjoyed that episode. It was just something that was like scrolling on TikTok, and I was like, that’s what I have. Does that ever happen to anybody else? Maybe it’s just me, but I think the more we’re open about what exactly is causing our problem, then we can find a fix. Mine is not jumping Jacks. It’s not jumping on the trampoline. Like a lot of my friends. Is it was this okay? I’m going to pee, and now I need to pee. It is on fire.

[00:18:51.900] – Hilary Erickson

My brain is in charge of everything. I wish my brain could be like, I’m going to make a million dollars, and then, boom, I make a million dollars. I wish it was that tight, like it is with my bladder. Anyone else?

[00:19:03.040] – Hilary Erickson

Okay. Stay tuned for next week’s episode. We are talking about important things that can help you stay alive after you have your baby, which is obviously very important. So stay tuned for that one.

[00:19:11.560] – Hilary Erickson

Thanks so much much for joining us on today’s episode. We know you have lots of options for your ears, and we are glad that you chose us. We drop episodes weekly, and until next time, we hope you have a tangle free day.