Urgency: What Pelvic Physiotherapy Can Teach Us About Our Reactions
A friend of mine is a pelvic physiotherapist. Recently, she was telling me about her approach to urinary urgency, that sudden feeling of I have to pee. I have to pee NOW.
As she explained her method, I started thinking about how closely it resembles the work I do with clients around emotional urgency. That feeling of I have to say something. I have to send that message. I have to resolve this right now.
There's a similar psychological loop between sensation, attention, and reaction. We notice an urge, focus on it, feel it more intensely, and become increasingly convinced that we have to act. The feeling starts directing our behavior.
Her approach is quite simple. When the urgency comes, she asks her patients to sit down, breathe in, then breathe out while contracting their pelvic floor muscles for ten seconds. Repeat three times. If the urgency persists, redirect their attention to something else. See if the sensation changes when they're no longer concentrating on it.
If the urgency returns, repeat the breathing and contraction once more, holding the contraction for ten seconds. And if they still need to pee, go to the bathroom. But: walk there. Take off your clothes slowly. Don't rush.
She's teaching them to separate the feeling of urgency from the necessity of immediate action. And I started thinking about how many other areas of our lives are governed by this same mechanism.
Think about the last time you were angry with your partner. Something happened, and you felt hurt, dismissed, or misunderstood. Almost immediately, another feeling arrived: I need to say something. I need to make him understand. I need to address this right now.
You might even recognize that you're unlikely to have a productive conversation in that state. But the pressure to do something feels almost unbearable. You start rehearsing what you're going to say, imagining his response, building your argument. The more you think about it, the more urgent it becomes.
The feeling and the need to act become almost indistinguishable. I feel it, therefore I must do something about it.
To interrupt that pattern, we introduce something different into the sequence. We stop, breathe, put down the phone, or step away from the conversation. We give ourselves a moment before doing what we would ordinarily do without thinking.
Can urgency change without being satisfied?
When my friend asks her patients to redirect their attention, she's giving them an opportunity to discover what happens to the sensation when they stop concentrating on it. Does it diminish? Does it disappear? Does it return?
We can do something similar with emotional urgency. You desperately want to send a message, but instead you go for a walk, return to your work, or do something that absorbs your attention. Twenty minutes later, perhaps the message no longer seems so important. Or maybe you still want to send it, but the desperate feeling that it has to happen immediately has subsided.
If we continually distract ourselves from uncomfortable conversations, we're avoiding something that may need our attention. But temporarily redirecting our attention allows us to discover whether the urgency actually requires immediate action.
This is related to what psychologists call inhibitory learning: developing new associations and expectations through experience. We can understand intellectually that we don't have to act on every feeling, but that knowledge often disappears when we're emotionally activated. It's through repeatedly experiencing an urge without automatically responding to it that we begin to learn something different.
We discover that we can tolerate discomfort, that feelings can change without our having to do anything about them, and that the consequences we anticipate may never happen.
The urge doesn't have to disappear for this learning to occur. We can still feel anxious, angry, or desperate for reassurance while discovering that we're capable of doing something other than what our immediate impulse demands.
Even when her patients need to go to the bathroom, my friend asks them to walk slowly. She's acknowledging the need while helping them break the association between that sensation and the frantic rush.
We can interrupt emotional reactivity in much the same way, simply by changing the speed of our behavior before we've managed to change how we feel.
You may still be furious with your husband. You may still need to confront him about something that hurt you. But you can walk into the room instead of storming into it. You can sit down, take a breath, and choose how to begin rather than immediately launching into everything you've been rehearsing in your head.
We sometimes get caught in the idea that we need to change how we feel before we can change how we behave. But we can slow down even while we're still angry. The feeling may change afterward. Or it may not. Either way, we've changed our participation in the pattern.
Pattern interruption describes what we're doing in the moment. But through repeated practice, something more fundamental begins to change: what we believe about our own internal experiences.
An urge that once felt commanding becomes something we can experience without necessarily obeying. We begin to recognize that the intensity of a feeling doesn't automatically tell us how quickly we need to respond to it.
When we try to control an urge, we can become preoccupied with making it disappear, frustrated when it persists, and increasingly uncomfortable with its presence. Changing our relationship with the urge means learning that we can allow it to exist without having to make it go away.
Sometimes we really do need reassurance, understanding, or a difficult conversation. Learning to tolerate discomfort shouldn't mean dismissing those needs or endlessly postponing addressing them.
But there's a difference between I need to talk to my partner about this and I cannot tolerate how I feel until we talk about this. One tells us something about what we need from the relationship. The other tells us something about our relationship with our own discomfort. And when we can begin to distinguish between the two, we have more freedom in how we respond.
Can I take my feelings seriously without treating their urgency as an instruction?
