Plumbing Failures, Part II
In my last post on this topic, I started whining about the annoyances the accompany the deterioration of my 70-year old plumbing. I described the most common, and least embarrassing of my attendant problems, the ones caused by my aging prostate and by a plumbing system so badly designed, that if some smart law firm could figure out who was responsible, they could file a class action suit on behalf of all the country’s old men and win with the largest settlement in history.
The problem I’ll next whine about appears when my deteriorating mental abilities meet my deteriorating urethral sphincter, which is probably a contributing cause for the urinary hesitancy and increased frequency I complained about in my last post, in which I now believe that I may have unfairly placed the entire blame on my poor, aging prostate.
What can you do when you wonder whether a belief that you hold is well-founded? In the old days I would have had to suck it up and live with ignorance and ambiguity. But now, cogito ergu google, I have discovered that peeing is a a complicated process with many moving parts. The fact that anyone can pee now seems a minor (though necessary) miracle.
We all know that it’s our kidneys’ job to fill our bladders with pee and our bladder’s job to hold the pee until it’s time to shoot the pee out of whichever pee hole we happen to have. (By the way, Wikipedia links the term “pee hole” directly to this page.) Some of us know that there’s a muscle called a sphincter that normally keeps our pee from leaking out. From personal experience we know that our brains tell us when it’s time to pee and that once we’ve listened to our brain and removed ourselves to an appropriate venue and placed ourselves in an appropriate position, lo, the pee pours forth. Unless you’re old, in which case, sometimes, lo, the pee dribbles forth.
But most of us don’t know how that happens. Or care. But I did and here’s what’s I’ve learned goes on behind the scenes.
Your bladder is a small bag surrounded by several layers of muscle. So is mine, of course. When our bladders get about half full, they send a warning signal to our respective brains. If the higher centers are occupied with more important things, like finishing this blog post, they’ll try to ignore the signal. But ultimately the executive functions of the brains listen and must decide.
To pee, or not to pee. That becomes the question.
If we we decide to pee later, our kidneys will continue to fill our bladders. Our bladders will send increasingly urgent signals to our brains. My bladder has been telling my brain to take a break from blogging and do a little peeing for a while, and it’s now telling my brain that if my brain doesn’t listen it will escalate. It says it will resort to pain, if necessary, to get my brain to do its bidding. That’s not an idle threat. It’s done it before. So excuse me for a minute.
Finally, like just then, the brain gives in and makes a conscious decision to start to pee. Then stuff gets interesting. Part of the brain, the pontine micturation center, responds to that conscious decision. The pontine micturation center fires, and that excites of the sacral preganglionic neurons which then cause the wall of the bladder to contract, and that raises the intravesical pressure. At the same time, the pontine micturation center inhibits Onuf’s nucleus. That results in the external urinary sphincter relaxing. See, there are two urinary sphincters, not one like I thought. The outer one is under volitional control. The inner works on automatic. Once the outer one relaxes urine will be released from the urinary bladder when the pressure there is great enough to force urine to flow out of the urethra. (Partly translated into English from the Wikipedia Article, “Urination.”
So prostate! I’m sorry. It’s not your fault. Or not our fault entirely. If I had to point a finger it would be at the pontine micturation center, which I’ve never liked, or Onuf’s nucleus, which I swear has been plotting against me for years.
Back in the day, before my body started going rogue on me, once my bladder was nearly empty I’d contract my abdominal muscles, pressing them on my bladder, to squeeze out the last bit of pee that I could. Then my pontinue micturation center would stop inhibiting Onuf’s nucleus which would then clamp down my external sphincter and that would be that. But the some of the neurons in the pontine micturation center, or perhaps the ones in Onuf’s nucleus, have reached retirement age, or died, and the new ones that have enrolled haven’t been properly trained. In practical terms this means that periodically, after I’ve finished peeing, and after I’ve put away my equipment, I drip.
That’s my second problem. And once it happens it’s solved only by training some new neurons by consciously, deliberately and intensely closing off the lower sphincter, and focusing my attention on keeping it closed until I’m sure that some up-and-coming neurons have taken over the job.
Focus was never a great skill of mine, and it’s worse now. So periodically, about once a year for several years, I have to suffer minor indignities until the new crew takes over.
So I dribble from time to time.
But I’ve never peed on the floor. Before.
See my next post in this series for the full, embarrassing story.