Be a Bladder Whiz! Healthy Bladder Tips for All!

Fiona McMahon PT, DPT and Amy Stein PT, DPT

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So we busted some myths in our last Pelvic Floor Myth Buster Blog, where we discussed whether or not holding your pee causes urinary tract infections. If you haven’t gotten a chance, check it out here. People living with bladder conditions, like pain, hesitancy, frequency, post void dribbling, and incontinence know that an unruly bladder can be really disruptive. In this blog, we are going to take some time to discuss some practical tips and tips you can employ right now to tame an unruly bladder. Many of these tips come from Amy’s book, Heal Pelvic Pain, available here.

So what are we working with?

Male or female, we all have the same basic structure of the bladder, with a few exceptions. Here’s what everyone has in their lower urinary tract.

Detrusor Muscle: Forms the body of the bladder and is responsible for squeezing the bladder to empty its contents. It spends most of its time relaxed in order to allow for bladder filling.
Trigone Muscle: Forms the neck of the bladder, and is a powerful sensory organ. When the trigone stretches in response to the filling of the bladder, it sends a message to the brain that it’s time to pee.
Internal Urethral Sphincter: Smooth muscle (involuntary) which seals off the exit of the bladder and allows for continence.
External Urethral Sphincter: Striated or voluntary muscles which also seals the exit of the bladder.
Urethra: This is the tube that leads out of the bladder and is the pathway for urine into the outside world.

Sex differences:
Many men have a prostate. The prostate is a sex organ and is responsible for keeping the semen at the right pH to fertilize a waiting egg. It wraps around the urethra and lives just under the bladder. It also provides a mechanical buttress or support for the bladder, lessening the load on the pelvic floor. Because of its proximity to the urethra, problems with the prostate can cause problems with the bladder. An enlarged prostate, which can be a part of aging, cancer, or infection, will restrict the flow of urine out of the urethra, resulting in a weak stream, painful, burning urination, and difficulty urinating (however, the same thing happens with tight pelvic floor muscles with or without prostate involvement, which makes bladder issues super confusing).

Another important difference between guys and gals are the respective length of their urethras. Male urethras are a lot longer than female urethras. This is one of the reasons women are more prone to bladder infections. In a female, bacteria have a lot easier time making the trek to the bladder because of the shorter urethra.

So how do I help my bladder?

Posture

If you are having problems fully emptying your bladder or you have post void leakage (dribbling following going to the bathroom) consider your toileting posture. People with bladder issues should sit on the toilet (even dudes), to allow the pelvic floor muscles to relax and allow the bladder to fully empty.

Stretch!

Here’s a great stretch from Amy Stein’s book, Heal Pelvic Pain available here in hard copy and digital download.

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Here’s how to do the stretch

1. Lie on a firm surface-on a mat on the floor or on a hard mattress. Bring your knees up to your chest and then let them relax and rotate out to the side so that they flare outward. Use your hands to hold your knees in this position.

2. Stretch as you deep-breathe for six to eight breaths. Do not bounce, and do not push hard. Just gradually and progressively fill and empty your lungs.

3. Hold the stretch for 30 to 60 seconds. Do three repetitions, two to four times a day. 

Bladder Training

If you have bladder frequency or leakage with urge now is the time to try and train your bladder to hold more urine. Keep in mind you should start treatment to address pain with physical therapy and in certain cases, with medication, to allow you to be successful with bladder training. I always tell my patients to start their bladder retraining at home, where a bathroom is available to take the stress out of possible leaks or not being able to find a bathroom. Start by simply waiting to go to the bathroom 5-10 minutes past your first urge to urinate. Use behavioral strategies, such as deep breathing and pelvic floor drops, mindfulness, gentle stretches, distraction, and others. If you don’t have to go after 5-10 minutes, Great! If you do, go to the bathroom. As waiting 10 minutes becomes easy, stretch your time to 20 minutes and so on until you are able to go 2-3 hours in between urination.

 

Diet

This can make such a huge difference. My boss and Beyond Basic’s founder, Amy Stein, writes in her book Heal Pelvic Pain, that we should really try to get eight 8-ounce glasses of water a day, and try to finish them at least two hours before bed, to reduce your chance of needing to go at night. We call this symptom, nocturia.

As far as things we chew on, many foods can irritate the bladder, but not all foods bother everyone in the same way. It’s all about experimenting to find your triggers. Some common foods include food high in sugar, spices, acid (like tomatoes and citrus), tannins (like in wine). John’s Hopkins has a really good list, which you can access here. This list is totally overwhelming at first blush, but remember my bladder irritant may not be yours. Typically you will know shortly after eating the offender, on the same day. So the best thing to do is to try the suspected bladder irritants one at a time to see if you can identify a triggering food or drink.

Manage Constipation

The bladder does not have a lot of space, where it lives. In front of it lies the pubic bone, behind it lies a vagina for some of us, the rectum, and then the sacrum bone. The bones sandwich the bladder like bookends. Although these bones have some movement, which we treat, it’s not enough to allow for much more space for the bladder if your rectum is full of poo from being constipated. With an overfilled rectum, the bladder gets squashed against the pubic bone. With a squashed bladder, you may not empty it as well, feel urgency, or even experience bladder leakage. Therefore, avoid constipation at all costs! We advise our patients to drink more water and eat more soluble and insoluble fibers.

 

Physical Therapy Can Help Cure!

Physical therapy is considered a mainstay and the number one treatment for musculoskeletal causes of bladder disorders and bladder and urethral pain. Expert pelvic floor physical therapists (PFPTs) are clinicians who can find the cause of your bladder issues and provide you with a customized plan that will provide you with the best results possible. PFPTs can work to relax spasmed muscles, treat constipation contributing to bladder issues, improve your toilet posture, reduce tightness and shortening of tissues around the bladder, abdominal and thigh region that can contribute to bladder dysfunction, as well as strengthen weak muscles. If you are experiencing bladder issues, please come to see us. There is so much we can do to help!

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If you have questions about orthopedic, pelvic, or sports physical therapy, BBPT is offering free phone consults to those living in the greater NYC area for a limited amount of time!

Beyond Basics Physical Therapy

212-354-2622 (42nd Street Location)

212-267-0240 (William Street Location)

Pilates Move of The Month with Kierstin! Lat Pull and Triceps

Kierstin Elliot

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Goal: To IMPROVE Posture!

Exercise: Lat Pulls and Triceps

Set up: Lie facedown on the box with naval pulled up towards the spine, chin tucked in with neck lengthened (as if you are holding a tangerine under your chin), glutes engaged, and legs extended. Pull yourself to back bars of the reformer and hold onto the poles with both hands. Use one blue spring for resistance.

Execution: Inhale to lengthen elbows, exhale to bend elbows.

Focus: The main muscle group targeted here are the lats. Think about pulling down from the armpits while the elbows bend and extend. This action will help stabilize the shoulders, keeping them out of the ears. Also, focus on releasing the upper traps and lengthening the back of the neck. The more work we can get from underneath the shoulder blades, rather than above, the better!

Importance: Improves posture! Strong back extensors lead to better posture, especially in this day in age where phones and computers are constantly pulling our shoulders forward and weakening our backs. Incorporate a few lat pulls into your routine and feel taller almost instantly!

Modifications: To make it easier, drop tension to one yellow spring. To make it harder, place a squishy ball between ankles and add hamstring curls or pulses between lat pull sets!

Here I am, demonstrating the lat pull!

World AIDS Day

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Today, December 1st, 2018, is World AIDS Day. World Aids Day has been held on the first of every December since 1988. World AIDS Day works to spread awareness of the disease and to remind the general public that AIDS and HIV still must be taken seriously and that there is still a lot of work to do in order to prevent the transmission of new cases, as well as to better care for those who are infected with the disease.

What is AIDS/HIV?

AIDS (acquired immunodeficiency syndrome), is caused by a virus called human immunodeficiency virus (HIV). HIV can be treated in order to prevent AIDS, however, there is currently no cure for HIV.

HIV causes AIDS by attacking the immune cells of a person’s body, which can leave a person vulnerable to infections that otherwise would not have made them sick. These infections are referred to as opportunistic infections, an opportunistic infection is a signal that someone’s HIV may have progressed into AIDS.

As we said earlier, HIV doesn’t always have to progress to AIDS. Antiretroviral therapy (ART)  can work to help keep the immune system healthy, as well as lower the risk of transmitting the virus to others. People on ART have dramatically improved lifespans. It is imperative to get on ART as soon as possible to lessen the effects the HIV virus has on your immune system.

HIV Testing

1 in 7 people infected with HIV does not know they have the virus. Testing is necessary to start treatment and reduce the harm done to your immune system as well as the risk of transmission to others.

According to HIV.gov, you should be tested if:

  • “you a man who has had sex with another man
  •  you had sex—anal or vaginal—with an HIV-positive partner
  •  you had more than one sex partner
  • you injected drugs and shared needles or works (for example, water or cotton) with others
  •  you exchanged sex for drugs or money
  •  you been diagnosed with, or sought treatment for, another sexually transmitted disease
  •  you been diagnosed with or treated for hepatitis or tuberculosis (TB)
  • you had sex with someone who could answer “yes” to any of the above questions or someone whose sexual history you don’t know?

Taken directly from HIV.gov, click here to learn more

 

HIV/ AIDS and Physical Therapy

Physical Therapists do not treat AIDS or HIV, rather, they can treat some the symptoms of AIDS/HIV and HIV/AIDS treatment, to allow patients to live as fully and independently as possible. Both the disease itself and the treatment for it have effects like increasing fatigue, decreasing strength and endurance, and increased pain. Physical therapy can help by tailoring programs to help with pain, ability to perform everyday tasks, improve heart health, balance, endurance, strength, and flexibility.

You can mark today by doing a number of things:

Wear a red ribbon to spread awareness

Donate to groups that work to help people living with AIDS and help to prevent its transmission:

United Nations (UN AIDS)

https://donations.unaids.org/

UNICEF

https://www.unicefusa.org/donate/support-unicefs-hivaids-programs

 

Resources:

HIV/Screening:

National HIV Testing database: https://gettested.cdc.gov/