Can Treating Your Pelvic Floor Beat the Bloat!?

time lapse photography of splash of water
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Fiona McMahon PT, DPT

Bloating is the worst. It hurts. It makes us feel uncomfortable in our clothes and can be super unpredictable. There is so much that can cause bloating and many times bloating can be caused by more than one thing: diet, gut flora balance (the ratio of good gut bacteria to bad), hormones, and your menstrual cycle/history, for those of us who menstruate. All these things can all play a part in bloating. Did you know the pelvic floor can contribute too? The truth is there are a lot of things that can contribute to bloating. In this blog we will give you a quick overview of where to start as well as explain how a tight pelvic floor can contribute to bloating.

Nothing fits and my belly really hurts! Help!

I’m so sorry! The first thing I would suggest at this point is get yourself an appointment with a trusted general practitioner. There really is a lot that can go into a rip roarin’ case of abdominal bloating, and having a good clinician to look through possible causes is worth their weight in gold. They are the first line to start sorting this stuff out. Go in prepared, if you notice any dietary contributors try and remember to tell your doc. Do you bloat at a specific time of day or after a specific activity? Does your bloating change based on your menstrual cycle, if you have one? Is there anything else amiss in your health, like fatigue, hair loss, overheating or feeling really cold? All of these details can be so helpful in the hands of the right clinician.

 

My Doctor did a bunch of tests, now what?

If your doctor found something on testing, hooray! You are closer than you were before, even if you have yet to see results. Samesies if your doctor didn’t find anything, because now you know the bloating isn’t caused by whatever they tested for. If you haven’t seen results OR didn’t receive a diagnosis at all, it’s time to look a bit deeper into your potential cause of bloating, the pelvic floor.

 

First of all, “The pelvic what?” and second of all, how can I tell if this is an avenue I want to go down?

Ah, the pelvic floor. If you are new to this blog, understand you are not alone if you have never heard of it. No one really talks about it, but it’s super important. The pelvic floor lives between the pubic bone in front and tail bone in back. No matter what anatomy you were born with, we all have one. The pelvic floor is a group of muscles that stabilizes the pelvis, regulates urination and defecation, and provides sexual function.

When people have pelvic floor dysfunction, many times the muscles are very tight and cannot move well to let stool out or keep urine in amongst other symptoms. A tight pelvic floor can affect your belly bloating by not moving down well to accommodate digestive gas. When we digest our food, the naturally occurring bacteria in our guts put off gas. In a healthy person, the pelvic floor will have some give to accommodate the bloat and allow you to expand like a balloon, up, down, side-to-side, and front to back. If you have a tight pelvic floor, much of the pressure is pushed out through your belly and you get that familiar and rather uncomfortable belly bulge. This is worsened if you have a weak transverse abdominis, which is the lovely little muscle that wraps around your belly and lies underneath to your six pack muscles. You may also find that you get heartburn along with the bloat which can be related to the pressure from the gas pushing up on your upper GI tract.

Signs the Pelvic Floor Could be Your Bloating Puzzle Missing Piece

Because the pelvic floor does so so so much for the body, we often see pelvic floor issues manifesting in many different aspects of our lives. Here are some symptoms that are caused by pelvic floor dysfunction. If you have these symptoms as well as bloating, pelvic floor physical therapy is very likely to be the right place to go.

  • Painful penetration
  • Painful orgasm/ejaculation
  • Painful sexual arousal
  • Urinary pain/burning
  • Urinary frequency (going to the bathroom more than once every 2 hours)
  • Urinary hesitancy
  • Urinary leakage
  • Urinary urgency
  • Bowel frequency (going more 3+ times a day)
  • Bowel urgency
  • Constipation
  • Bowel incontinence
  • Pelvic pain
  • Low back pain

How will Pelvic PT Help Me?

Pelvic floor physical therapy can help teach tight muscles contributing to bloating how to relax, normalize bowel movements, and strengthen the transversus abdominis, amongst many, many, other things. Learn more about how it can help, here.

There is so much that can be done to keep you from warring with your waistband and it may just start with pelvic floor PT.

Abraham S, Luscombe G, Kellow J. Pelvic floor dysfunction predicts abdominal bloating and distention in eating disorder patients. Scandinavian Journal of Gastroenterology. 2012. 12(6)

Pilates with Kiertsin! The Saw

Kierstin Elliott, Pilates Rehab Specialist

Exercise: Saw

Set Up: Seated with legs extended mat distance apart and arms extended out to the side.

Execution: Inhale to prep, exhale to rotate torso right as you flex forward (nose toward knee) reaching your left hand toward the outside of the right foot. Reach the pinky finger to the pinky toe a little further 3 times (creating a saw like action) before rolling up through the spine. Inhale as you pass through center and rotate left as you repeat the same actions on the left side. Complete 3 rounds.

Focus: Focus on anchoring the opposite hip to the mat while reaching toward the foot. Be sure to keep a flexed spine versus an extended spine while folding forward over the leg. Lastly, keep shoulders out of the ears (IE. Relax your shoulders) while reaching toward foot.

Importance: Spinal rotation and hamstring length! It’s so easy to track improvement with this one 🙂

Modifications: For extra tight hamstrings or hip flexors, sit on a bolster or a couple yoga blocks to elevate the pelvis.

Pilates with Kierstin! Thoracic Mobility

Kierstin Elliott

Exercise: Thoracic Mobility

Set Up: Set up your foam roller vertically (so it runs up and down your spine). Sit on a mat with the end of the foam roller placed right between the bottom tips of your shoulder blades. Lean back into the roller with arms stretched back so hands are gently placed on either side of roller. Place feet flat on the mat, parallel.

Execution: Inhale to prep, exhale to lift hips off the mat, finding extension through the psoas. Inhale to lower hips down. After about 3-5 hip lifts, reposition the roller a couple inches further up the back, mid shoulder blades. Repeat hip lifts. Pause here with hips on the mat and take a few lateral bends right and left, allowing the roller to become an extension of your spine. After about 4-6 reps on each side, reposition the roller one more time towards the top of your thoracic spine (upper shoulder blades), being careful not to place it on the neck. Repeat the hip lifts.

Focus: Focus on stabilizing your pelvis during lateral flexion and connecting to breath during the hip lifts.

Importance: Mobilizing the thoracic spine! This alone comes with so many benefits: deeper, expansive breath, more accessible spinal rotation, mobile shoulders, greater spinal extension and flexion, better connection to core, etc.

Modifications: Place a small pillow or towel roll under head if neck support is needed. Take a few moments after the lateral flexion for some snow angels to stretch the pecs and open the chest.

How to Stay Whole During the Holdiays

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Fiona McMahon PT DPT (She, her, hers)

It feels like it started early this year, didn’t it? The day after Halloween the Bryant Park Christmas fair was up and running. Little wreaths and twinkly lights adorn the downtowns of the tri-state area. Yesterday, (I am sitting down to write this blog on November 11th) I saw an adorable little boy absolutely losing his mind with joy over a Santa statue at my local drug store. It was excessively adorable. It’s a sweet time of year, filled with beauty and love, but it can also be a super stressful time of year filled with obligations, travel, shopping, expectations, and the bittersweet longing for those who cannot celebrate with us this year. In short, the holidays are loaded. There are elements of the holiday that will never not be stressful. It is stressful to fling yourself from event to event while trying to maintain some modicum of self-care, but in this blog, we will discuss practical tips to protect your holiday and better yet your peace of mind during this time of year.

Boundaries

Oh the B-word. Boundaries. Much like a fence, boundaries can be protective and can provide your friends and family with a clear set of expectations for how you want to be treated and what they can and cannot expect from you. Sounds a tad harsh, but what’s harsher is getting upset with your loved ones when they do things that they had no idea would bother you. Boundaries should be clear cut and judgement free. A good example, for most families is discussing politics. If political discussions, especially if your family’s views vary greatly from yours, are stressful, you may want to set up some boundaries around it. You may say, “ I would prefer not to discuss politics tonight at the holiday table, if we do discuss politics, I will excuse myself to the living room”. Excusing yourself to the living room is not meant to be punitive. You are not punishing your relatives for discussing politics, you are simply excusing yourself from a potentially divisive and argument starting topic that will upset you. You cannot control the actions of others, but you can control how you react to those actions, hopefully with kindness while keeping your boundaries intact.

Another way to set boundaries is setting boundaries with your time. For most of us with the crazy schedule of the holidays there are certain rituals that fall by the wayside. It’s okay to have some elements of your routine be non negotiable, like your 30 minute jog or morning meditation session, Holding onto the activities that bring you peace can best allow you to show up and be present for all of the holiday festivities.

Planning

You don’t have to do it all. Not every party requires your attendance, not every bake sale requires your dessert, and you can allow some things to slide. At the beginning of the season decide what is really important to you. Is the “coats for kids” fundraiser really meaningful? Put it up on your list, but could you let your work friend’s party slide? Cool, buy yourself some extra time. Look at your weeks and decide what is not only realistic, but healthy for you. Maybe if there are a few parties you want to go to, you could give yourself a day or two off from your workout routine and (here’s the important part) be kind to yourself about taking a break. You can say no. I believe holiday cheer to be a finite resource so save it up for what matters to you.

Diet

Loaded, loaded, loaded topic. But the holidays are where we can fall into some really unhealthy eating habits, which can make us feel really crappy. Try to mix in some healthy food with your holiday treats. I’ve quoted this Oscar Wilde quote (which I have misattributed to Mark Twain, full disclosure), “everything in moderation, including moderation.”, which I think is an excellent mantra to take into the holidays. Sometimes you gotta have a little fun and indulge, but being mindful of how much and how often, can help us to feel our best during the holidays. Make sure along with your cookies you are getting some vegetables and lean protein to keep your blood sugar stable. Limit alcohol to the best of your abilities as it can decrease the quality of your sleep, to avoid the trap of over caffeination and requiring a nightcap to sleep.

Self care

Leave time if you can for exercise and movement and time just for yourself. It allows you time to check in with yourself and see how you are doing as well as time to sit back and reflect/appreciate the holidays.

Self Kindness

The holidays and year’s end can be a time when we look back at our year and evaluate how far we have come. It can be easy to dwell on our shortcomings, and although they can provide important direction for our future goals, it is also a brilliant time to reflect on your achievements. You have successfully gotten yourself through another year, Heck! Another decade, where you have grown and learned valuable lessons, which makes you all that more deserving of some good ol’ holiday cheer.

Happy Holidays from the Beyond Basics Family.

hollerday!

 

 

Pelvic Floor MythBusters! Don’t eat lemon to avoid bladder pain, true or false?

alcoholic beverage bubble citrus
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Fiona McMahon PT, DPT

Hey guys!  If you have bladder pain, you probably have done some reading about bladder irritants. Lemon, dairy, spicy foods have all been rumored to spike bladder pain. But is this really the case? With everyone? Before you put down your lemon water, let’s dissect the truths, and kinda truths about bladder irritants in this month’s Pelvic Floor Mythbuster’s.

Truth be told there are a lot of different ways the bladder can go sideways. You can experience an urge to urinate that is so frequent it disrupts your everyday tasks. You can experience strong urge that feels impossible to repress. You may experience leaking. You may experience pain in your bladder while it fills, while you empty it, or immediately after emptying it. Can diet cure all these ills? In some cases, maybe. But in many cases, it’s a bit more complicated than that. Read on as I run through why we consider diet with bladder issues, what else may be at play, and some practical advice on how to manage an unruly bladder.

Common Bladder Conditions

Before we go over bladder irritants, lets go over some of the most common bladder ailments we see here at Beyond Basics Physical Therapy.

Urgency: Urgency can best be described as having a sudden need to urinate which is either extremely difficult or impossible to delay

Frequency: In most people, going to the bathroom every 2-3 hours is normal going more frequently is considered frequency. But keep in mind, you may experience more frequency after drinking a lot of water all at once or after having caffeine, alcoholic and carbonated beverages.

Hesitancy: Hesitancy is difficulty starting the stream of urine.

Pain: Pain seems pretty simple, but if you visit us at BBPT we usually will ask you more questions than “do you have pain? Yes or no?” We will ask where the pain is, and if you have pain with bladder filling, emptying, or urgency which can tell us a lot about what to do about the problem. We will ask what makes the pain better or worse?

Nocturia (nighttime bathroom trips): Unless you have had a ton of water right before bed, it is generally accepted that getting up 1 or more times a night to pee if you are under 65 and more than 1 time a night to pee if you are over 65 is considered nocturia.

Stress incontinence: Stress incontinence refers to the involuntary loss of urine usually associated with activity, like running, lifting, coughing, laughing and sneezing.

Urge Incontinence: Urge incontinence is the loss of urine with a strong urge to pee.

Mixed Incontinence: As the name would imply, mixed incontinence is a combination of both urge and stress incontinence.

How Can What We Eat Affect our Bladders?

The science community isn’t really sure yet what causes certain foods to irritate certain people’s bladders, but they have some good hypotheses. In the case of pain, some scientists have proposed that people who are affected by food may have linings of the bladder that are less protective from the irritating material found in pee, especially pee that contains irritants from certain foods. Some evidence supports “cross talk” between different organs in that things that irritate the bowel, may irritate the bladder. Also it is believed in cases where the nerves are more sensitive, which can happen in cases of chronic pain, diet can more easily cause symptoms to spike.

So What to do About Irritants?

There is a saying I say a lot. Everybody is different and every body is different. This saying could not be more true when it comes to bladder irritants. Not everyone’s bladder is irritated by the same thing. You can find a list of common bladder irritants here . Did you click it? Totally overwhelming, am I right? The thing is my bladder irritant may not be your bladder irritant. The best way to find out what is your irritant, is to eliminate items you may suspect as being irritants for three to four days and add them back in to see if they bother you. If you find that you are really unsure what is bothering you or you have a history of disordered or restrictive eating. I would highly recommend doing this with the guidance of a trained nutritionist. Not only can a good nutritionist help you detect irritants more efficiently, they also can provide you alternatives, so you have plenty of yummy things to eat during your quest to determine if your diet is bothering your bladder as well as keep you safe if you have had or are currently struggling with disordered eating.

The Bladder and The Pelvic Floor

All of the conditions listed earlier in this blog can be caused entirely or in part by the pelvic floor. Hopefully experimenting with eliminating bladder irritants improved your symptoms at least somewhat. But if it hasn’t, it may be time to consider the pelvic floor. Both pelvic floors that are weak and tight and weak and loose can contribute to the symptoms outlined above. Often times combining dietary changes with pelvic floor rehab can provide the right synergy to get over the hump and to start feeling better again.

Practical Bladder Tips

  • Normal voiding frequency is once every 2-3 hours. If you find you can not make it that long and don’t have pain, try lengthening the time between “goes” 10-15 minutes at a time and practice deep diaphragmatic breathing in the interim.
  • If you experience sudden urge, DON’T PANIC! Rushing often makes it worse. Breath slowly and calmly make your way to the toilet.
  • When hesitancy strikes, breath deeply. If you have male reproductive organs, try sitting on the toilet to relax the pelvic floor and make peeing easier.
  • Avoid drinking water 2 hours before bedtime if you are experiencing nocturia.
  • If you are constipated, work on managing that problem. The bladder lives right in front of the rectum. A large backup of stool will press on the bladder, irritating it and reducing its holding capacity.

Conclusions

Are bladder irritants really a thing, yes for some people and we are still trying to figure out why. If you are having trouble tackling your bladder problems. Come give us a visit at BBPT so we can get you feeling better! Also check out Amy Stein’s book for more ways you can deal with bladder pain.

Friedlander J, Shorter B, Moldwin R. Diet and its role in interstitial cystitis/ bladder pain syndrome (IC/BPS) and comorbid conditions. BJUI. 109. 1584-91

Molly completes the NYC Marathon!

On November 3rd 2019, Molly Caughlan completed the New York City Marathon for the very first time! We at Beyond Basics are so proud and overjoyed for her! She ran to raise money for multiple sclerosis research. Read her last update before the big race, here!

I sit here writing this blog with just 6 days left to go before the big race. I’ve been tapering down milage, taking time to rest, stretch, and strengthen. The forecast, fingers crossed, is looking very ideal with highs in the mid 50s and looking like sunshine all day. I’m nervous, excited, and feeling confident that I’m going to cross that finish line.

Since my last blog, I’ve hit just a few bumps in the road with my training. In September right before a critical long run (my first 18 mile run), I had an acute onset of posterior tibialis tendonitis that made it difficult to even walk on. I was devastated and had to hold on running any distance all together. I was feeling incredibly anxious because of how close I was getting to the big day and at the thought of skipping such an important training notch. While I was healing, I did a Hot Vinyasa class that I hadn’t done in a while that help me hit a reset button and set up a strategy to manage these symptoms. I took a whole week off from running and had two sessions with Tina as well as doing some self treatment with modalities (ice/heat). I also had an acupuncture treatment with something called dry needling to my calves with a treatment for chi energy deficiency. With ALL of these treatments combined, the first run I did I was FLYING! I had so much energy and was going at such a fast pace that I shaved a few minutes off of my traditional 5 mile run. Things have been looking up since that week in September and looking back now, resting was the most important treatment I could have done.

As part of my training, I ran the New York Road Runner’s Brooklyn Half Marathon October 19 and had such an amazing time. The end of the race was in Prospect Park, which is essentially my back yard and where I’ve been doing a lot of my training. This helped me to finish strong and break my own personal record for a half marathon with a time of 2:07.

As the days wind down, I’m looking forward to having some of my family members come visit just so they can support me on Sunday. I’ll have support from my local friends on the sidelines and, with the help of modern technology, will have the spiritual support from friends across the country. I’m eager to see all of the other anonymous supporters with their signs and I’m excited to have all of this energy boost me across the finish line.

Last but not least, I must say that I am still working on my $5000 fundraising goal and I’m 71% of the way there. I’m sponsored by an organization called Team Tisch MS​ that performs groundbreaking research to discover the cause of Multiple Sclerosis, understand disease mechanisms, optimize therapies, and repair the damage caused by MS, as well as offering patient access to the best and most advanced treatment possible. Support Team Tisch MS by donating to my fundraiser!

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Pelvic Floor Mythbusters: Is kegeling the one true way to a healthy pelvic floor?

Pelvis Drawing

Fiona McMahon PT, DPT.

Is kegeling the one true way to a healthy pelvic floor? Not always. We can end the blog here. Just kidding, of course there is nuance to be considered here. But as pelvic floor physical therapists, nothing is more cringe inducing than hearing the phrase “just do your kegels” thrown around for myriads of ailments from low libido, to pain, incontinence, and erectile dysfunction. While it is true the pelvic floor muscles can be involved in all of these conditions and in some cases kegels may help, there are many cases where kegels are the EXACT opposite of how you should be treating these muscles.

Physiology

To understand kegels we must first understand the pelvic floor. To understand the pelvic floor we must also explain the muscles at a very basic level. Bare with me readers, this will help us as we bust through this myth. Muscles, all muscles do what they do, by contracting and getting shorter to produce force. This is easy to see on a bodybuilder doing a bicep curl. As she curls her hand up you can see these muscles shortening into a little ball. Not only is this a great way to show off your gains in the gym, the shortening of these muscles are providing the strength to perform this task. We call this shortening a concentric contraction. Kegels are concentric contractions too! A good kegel will cause the pelvic floor to shorten and provide strength. Let’s go back to our body builder for a second. She has done her lift now she needs to lower her dumbbell back to the floor. In order to lower that dumbbell back to the floor in a controlled way, she needs what’s called an eccentric contraction, which is the controlled lengthening of the muscle. If she did not have a good eccentric contraction she may not be able to lower that weight effectively after she curled it. What if she couldn’t lower her bicep at all or just very slowly after her bicep curl? Maybe her weightlifting wouldn’t be as effective, she’d tire more easily, or she could develop pain. Would you tell this woman that more bicep curls would help? Or might you suggest a program of stretching first? Telling someone to do kegels, when you don’t know the status of their pelvic floor and how well it can relax is similar to telling the bodybuilder with the non relaxing bicep to just do more bicep curls. At best it certainly won’t help the situation and at worst it could cause more pain and dysfunction.

“But Fiona, I have incontinence, so that definitely means I have weaknesses, so it’s good for me to do kegels, right?”. Maybe… but in my experience, probably not. Let’s agree on one thing, it’s completely intuitive that people would think that kegels would help incontinence. The muscles of the pelvic floor are responsible for continence… so they must be weak if one is experiencing incontinence. You are right! When we think weak with muscles, we often think weak and loose, which is one form of weakness, but we rarely think weak and tight. Let’s go back to our body builder lady. She deserves a name at this point. Let’s call her Kendra. If Kendra has a tough time moving her lifting her arm from fully straight to a full bicep curl, we could guess she is weak and loose. But if Kendra could not fully straighten her arm out she would be considered weak and tight. Both of these versions of Kendra would have trouble curling heavy weight. One Kendra due to frank weakness another Kendra because she simply does not have enough room or range of motion to generate enough force to curl that dumbell.

Tight and weak pelvic floors are a lot like second Kendra with the poor ability to lengthen her arm. Tight pelvic floors have less range of motion to generate force. You need a good amount of force from the pelvic floor to counteract the pressure of activities like lifting, coughing, laughing and sneezing and stay continent. Over loose and over tight pelvic floors can’t really do that.

If you have pain in your pelvis not from a medical condition, (although tight pelvic floors present with many medical conditions), your pelvic floor is probably tight. A tight pelvic floor may also have trigger points which can send pain to various locations in your genitals, back, legs, and abdomen. Continuing to tighten can cause this pain to get worse.

Treatments

So how do you know what to do? This is where a skilled pelvic floor physical therapist can come in handy. They can assess the muscles by touching them either externally or internally to determine what course of action is right for you. If you are loose and weak, HAPPY DAYS! Strengthening can help them get better. If you have tight and weak muscles, HAPPY DAYS again! Gentle lengthening, stretching and down training of the muscles can help them get better. Did you know, because a tight pelvic floor can cause weakness itself, returning the proper length to the muscles can restore strength, without actually needing to kegel?! Wild! Regardless of the situation happy days can be ahead.

Skilled PT

Really knowing the pelvic floor is a skill and requires advanced expertise.  Kegels should not be initiated, unless the physical therapist has carefully examined your pelvic floor. Not all therapists are trained to do that technique so it is important to inquire about their background before starting pelvic floor PT. There are a lot of different ways to treat the pelvic floor, to read more What is Pelvic Floor Physical Therapy . If you are interested in learning more give us a call at 212- 354-2622 for a free consult if you live in the greater NY/NJ/CT area.