The main elements playing a role in micturition are the bladder, the urethra and the sphincters. The bladder is surrounded by smooth muscle (the « detrusor », under unvolutary control), which is divided into two functional parts, the dome and the area of the bladder neck, which plays the role of an « internal sphincter ». A little bit lower, the urethra is surrounded by the « external sphincter », a striated muscle that is classically considered as being under voluntary control. To see a diagram of this, click here.

During storage, the dome relaxes, the internal sphincter contracts, and the external sphincter contraction level increases more and more as the bladder volume grows. In case of sudden abdominal overpressure (cough, …) the external sphincter contracts under the command of a reflex pathway. We can also contract it voluntarily if necessary. All this allows the bladder to fill at very low pressure, and the continence to be complete. A normal voiding requires both the external and internal sphincters to relax, and the bladder dome to contract, so that the bladder expulses its content put under pressure, against a minimal resistance.

The external muscle is considered as being under total voluntary control. However, you know that voluntary muscles can tense up unvolontarily or at least « sub-voluntarily ». When we are stressed, we can for example hunch the shoulders. The external sphincter doesn't escape from that rule. It has been proved clinically that 50% of men void against a non completely relaxed external sphincter, when under observation.

It becomes very interesting when we come to the fact that there exists a reflex pathway between the command of the external sphincter and the detrusor : when the first contracts, the latter relaxes. This is a mechanism that plays an important role in the voluntary continence : it increases the urethral pressure (that acts against the outflow) and lowers the bladder pressure (necessary to create the outflow).

Considering the fact that other psychogenic urinary retention troubles have been proved to be due to a contraction of the external sphincter, the hypothesis is that such a sub-voluntary contraction of the external sphincter, reinforced by phobic mechanisms, could play a role in a certain number of cases of paruresis. So a therapeutic approach would be to learn to relax that sphincter consciously and quickly.

We can imagine different methods to achieve that result, but a very simple one would be to exercise to focus our attention on relaxing the external sphincter, like in Yoga. Try the following exercise :

1. Contract your sphincter strongly. To help you getting aware of the position of that sphincter : it is the sphincter we use to hold ourself voluntarily. Its control is completely associated with the control of the anal sphincter, so both of them contract simultaneously. Contract it the maximum possible.
2. Now, relax it
3. Now, try to relax it more. And more, and more. Concentrate your mind strongly on that task. Doing this you will probably notice that when you considered your sphincter relaxed, it wasn't completely.
4. Repeat that exercise many times, in many places, get aware of your sphincter, and try to get it more under control. You have to feel as if the base of your abdomen was a funnel, completely open.
5. Finally, practise this exercise while thinking to situations in which you would have difficulties to urinate. Increase the difficulty level mentally, and never forget your sphincter control

It can be a help for traditional desense. When then practising desense, try to think to only one thing : relax your sphincter (and your whole body), try to relax it a max, like in your exercises. And if the flow doesn't start spontaneously, you can try to « push » a little bit with the muscles of your abdomen : if your sphincter is totally relaxed, it can start a flow.