Abstract
Toileting habits are established early in life, during the process of toilet training. Children who overuse their guarding reflex can develop voiding dysfunction and incontinence, which they typically outgrow. However, unhealthy behaviors, such as enhanced holding and straining to void, are common in the adult general population, suggesting the persistence of old habits that have the potential to create symptoms throughout a woman’s life. Women with poor toileting habits frequently ignore bodily sensations, and use voiding postponement and abdominal straining to eliminate, without relaxing the pelvic floor. Continuous pressure on the pelvic floor tissues during elimination can create structural changes in the pelvic anatomy, particularly after childbirth. Educating women about pelvic floor function, bladder retraining, and full pelvic floor relaxation during voiding and defecating are the goals of treatment. In this chapter, we review a simple and strategic process in which the provider teaches relaxation of the puborectalis muscle, with the aid of diaphragmatic breathing, so that coordinated elimination can develop. Although pelvic floor awareness and education may not benefit all cases, women should be warned that chronic pelvic muscle clenching and straining are potentially destructive to the pelvic floor and sphincter muscle function.