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!
I love the TV show Mythbusters, I have for the last 15 years, (yes ladies, gents it has been on for that long). If you aren’t familiar with this show, the hosts Adam and Jamie try to prove or disprove popular myths like, is shooting fish in a barrel easy? Spoiler alert: yes, but maybe not in the way you think it is. I’ll let you look that one up on your own. I loved how this show took everyday assumptions and applied real science to see if they were indeed true. In the same spirit of my beloved show, we are going to try and bust some pelvic floor myths. Since I don’t have the funding or ethical review board to conduct large-scale experiments on pelvic floor questions, I am going to the next best (albeit, slightly less glamorous thing) and see what I can find on PubMed, while applying known pelvic floor science to the question. Most of us have probably been told that holding in your pee for a long time can cause urinary tract infections (UTIs), but is it actually true? Can peeing at every single urge cause other problems? Through gathering the available evidence we will look at this time old axiom to determine whether it is true or false.
What is a UTI (Urinary Tract Infection)
A UTI occurs when bacteria colonize or grow in your urinary system, which is composed of your bladder, urethra, ureters, and kidneys. Usually, we see these infections in the bladder. Women tend to get UTIs more often at an 8:1 ratio to their male counterparts. This is because the male urinary system has a substantially longer urethra, as well as the fact that the female’s urethral position makes it vulnerable to bacterial colonization in women who have penetrative vaginal sex. Although it is more common for adults to contract UTI’s, children can too. UTI’s in children can be an indicator of possible bladder conditions, such as vesicoureteral reflux (when urine seeps back into the upper part of the urinary system and can cause infections in the kidneys). Any bladder infection in children should be followed up by imaging to rule this condition out. Untreated reflux can be harmful to the kidneys. Much of the literature I reviewed pertains to women with UTIs but it is possible to apply some of this information to males. That being said, at least half of women will report a UTI at some point in their lifetime.
We can further classify UTI’s by how often one contracts them. Recurrent UTI is defined as 3 positive cultures in 12 months or 2 positive cultures within 6 months. Uncomplicated infection occurs in people who have a normal urinary tract, whereas a complicated infection occurs in individuals with complications in the urinary tract, such as vesicouretral reflux.
Known Risk Factors for UTI
Our main question is, “does holding pee cause UTI’s?”, but what things do we absolutely know are risk factors for UTIs? First thing is having a female urinary tract. The female urethra (where the pee comes out) is shorter than the male’s, making it easier for UTI causing bacteria to get a foothold and cause infections. Along those lines, having receptive vaginal intercourse can make you more prone to get a UTI because objects inserted into the vagina can introduce bacteria to the urethra, which live nearby each other. Pregnancy, diabetes, and immunosuppression have also been shown in the literature to increase the chances of getting a UTI. Being post-menopausal can also increase your risk of developing a UTI as it may thin the tissue of the vulva and make it easier for bacteria to get to the bladder. Other factors include the use of spermicides, catheterization (both indwelling and intermittent), wiping back to front (ladies), diaphragm use, or incomplete bladder emptying (guys and gals, we will discuss this in detail below).
But Does Holding Your Pee Cause UTIs???!!!!!
Yes… and no. The data out there is pretty darn sparse, and what I’ve read has not provided any clear-cut studies examining the issue. Keep in mind it’s a pretty hard experiment to design to prove that holding your pee can cause UTIs. Peeing as a preventative to reduce UTIs works by flushing out the urethra, but you need a good amount of liquid (however don’t force or push out your pee) to clean it out. This is why I advise and will continue to advise patients to pee after intercourse. It flushes everything out.
Now, that being said, if you are peeing too frequently, and only a little bit comes out at a time, you may not be effective in cleaning out your urethra fully. Normal bladder frequency should be about once every 2-3 hours and that is if you drink 7-8 glasses of fluid a day (if you drink less than that then frequency will be less). And, obviously, things will pick up a bit if you’ve had a bunch to drink, (water or otherwise), but that’s the average. Another way to tell if you are on track is if you are peeing for 8-10 seconds (real “one-Mississippi” seconds) and it is a strong, consistent stream. If you train yourself to pee when you don’t have a large amount of pee in the bladder, you could actually be training your bladder to be more frequent, which can be a problem.
What if when you are peeing, you have to strain and only have a dribbly stream and not a lot comes out? This is a problem that could lead you to get UTIs. It is called incomplete emptying. Incomplete emptying happens when the bladder does not empty properly. Because of this, urine is not expelled out of the urethra at a rate that is sufficient to clean out the urethra and that means bacteria may have an easier time getting to your bladder. Symptoms of incomplete emptying can include post-void dribble, having to strain to pee, and or feeling like you have to pee again shortly after your first attempt to pee.
Does Pelvic Floor Health Have Anything to Do with UTIs
It can. Also, problems in the pelvic floor can commonly mimic symptoms of UTIs (burning with urination, frequency, urgency, etc.,.). The pelvic floor is a group of muscles between the tail-bone and the pubic bone, and they surround the urethra, bladder, anorectal opening, and genital region. For people with incomplete bladder emptying, a tight pelvic floor may be playing a role. The pelvic floor has many functions, but one of its functions is to open and close the doors (sphincters) that hold pee in and let it out. If the pelvic floor is tight, it’s hard for the muscles to relax and for the pee to exit. More importantly, when the pelvic floor is held in tension it prevents the detrusor (bladder squeezer muscle) from emptying the bladder well.
Additionally, tight pelvic floor muscles, specifically in the urogenital diaphragm layer (the superficial pelvic floor muscle layer), can feel a lot like a UTI when they are tight. Some women will experience irritation in this area after intercourse, which can feel a lot like a bladder infection. Women who repeatedly test negative for UTI’s but have symptoms could have pelvic floor dysfunction! It’s wild, I know.
Bladder Tips for us All
Wash yourself and your partner before sex
If you have a vagina, wash it with water before getting it on. The fact of the world, is we are covered in bacteria, if you wash your vagina and vulva before anything goes in it, you lessen the chance of bacteria getting pushed into your urinary tract. Your partner should also wash his or her fingers, toys, or penis as well to avoid infection. Using a USDA organic mild soap with no extra ingredients or additives is best.
Pee After Sex!
Pee after sex. It is so important. It’s better to have a bladder that’s more full than not, so you can clear out that urethra, but regardless try and pee relatively soon after having sex.
Wipe Front to Back
Please excuse me for being indelicate, but if you wipe back to front (anus to vagina), you are helping to drag poo bacteria up towards the urethra, which is something we definitely don’t want to do while we are trying to prevent UTI’s.
Test your Urine
If you have symptoms of a UTI, get yourself to the doctor, nurse practitioner, physician’s assistant, etc. He or she can see if you really do have an infection. The importance of this is two-fold. To nab an infection before it gets worse or goes to your kidneys, and to make sure you actually have an infection, not pelvic floor dysfunction. Making sure you get your urine tested also ensures you won’t have to take unnecessary antibiotics which can negatively affect yeast and gastrointestinal symptoms.
If you have symptoms and no infection or trouble emptying your bladder, come to physical therapy!
UTI symptoms that aren’t a UTI are often caused by pelvic floor dysfunction. A skilled pelvic floor physical therapist will be able to assess whether or not your pelvic floor is playing a role in what you are feeling. A skilled pelvic floor physical therapist will assess whether or not you can open and close your pelvic floor well in order to pee effectively as well as checking the pelvic floor for tightness and for any nerve irritation. If there is something not working well with your pelvic floor, your therapist will partner with you to help treat it and get you feeling better. You will be equipped with a home program and behavioral modifications to ease the bladder symptoms so you can go back to a pain and symptom-free life!
Wanna bust more myths?! Good, we’re working on that!
Wanna learn more about the bladder?! Be patient! We’re cooking up a brand new blog with everyday tips to help you better manage your pelvic symptoms! Stay tuned!
Fiona McMahon is currently seeing patients at our Midtown Location
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)
Al-Badr A, Al-Shaik G. Recurrent Urinary Tract Infections Management in Women. A Review. Sultan Quaboos University Med J. 2013(13) 359-67
Scholes D, Hootman T, Roberts P, et al. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000;182:1177-82
Any persistent pain or chronic back or pelvic pain can be tough. It is tough to have and often times it can be extremely isolating. Many of our patients have to go through a number of clinicians before they even get a diagnosis of pelvic floor dysfunction. If you are reading this blog, you probably have some questions about pelvic floor dysfunction and if physical therapy is right for you.
We are here to help. If you are living in the Greater New York Area and have some questions about orthopedic, sports or pelvic floor dysfunction and if physical therapy is right for you, I encourage you to call our office. For a limited period of time, we are offering free 15-minute phone consults with our licensed physical therapists to patients in the greater New York Area. For those of you living outside this area, a fee may apply to the consult but can be applied towards payment for a PT visit if you chose to visit us. Don’t miss this opportunity to learn more about your pelvic floor and what PT can do for you.
The Physical Therapists at Beyond Basics also treat orthopedic (sport and joint injuries), pediatric pelvic floor dysfunction and orthopedic injury, and much more. Give us a call to discuss how PT can help with any one of these issues!
By: Fiona McMahon, DPT
Hey Ladies!!! In the next installment of our Pelvic Health 101 course, we are hosting a women’s only session to allow for a safe and non-threatening place to discuss many issues that can affect the health of your pelvic floor. This class one of Stephanie Stamas’s (the founder of PH101’s ) favorites and is definitely not to be missed. Hear more about it in her video below! Join us at 7pm on October 25th, 2018. Please register at pelvichealth101.eventbrite.com
Sex should feel good… really, really good. But when it doesn’t, you may start to wonder, what’s wrong with me? Am I broken? Am I a prude? Am I frigid? Painful sex isn’t something we talk about. No one would look at you twice if were complaining of pain in your elbow, but in your genitals is a different story.
On October 18th, we at Beyond Basics are breaking down those taboos and having an educational seminar, followed by an optional question and answer session at the end. We will discuss the many causes of sexual pain and how physical therapy can help. The event will be hosted by one of our expert therapists, Stephanie Stamas. Stephanie will give a detailed seminar about pelvic health and take time to clear up some common misconceptions many people have concerning their bodies and sexual function.
Gluten free, soy free, low FODMAP… It’s amazing how many diets there are out there that really can provide people with symptom relief. If you are suffering with chronic pain you may be confused on where to start, or what is right for you. You also may have tried out a bunch of different ways of eating, not seen results, and got really frustrated. If this sounds like you, I highly encourage you to come to our next pelvic health seminar on October 4th at 7pm “Does my diet really matter”.
This seminar will be hosted by a special guest speaker, nutritionist Jessica Drummond, MPT,CCN,CHC. Jessica Drummond is a former pelvic floor physical therapist who now specializes in nutrition for those suffering with pelvic floor dysfunction. This seminar has been a huge hit and is a great starting point for those considering adding nutrition as part of their healing journey.
Bladder problems can be vexing, it may hurt for you to pee even though ever test for infection you’ve taken has come back negative. You may find yourself incontinent after surgery or childbirth, or for no reason at all. You may find yourself waking up countless times to go, or needing to memorize every bathrooms’ location in the city because you go too often.
The bladder and the pelvic floor are intimately related and often times problems with the pelvic floor can cause real trouble with the bladder. Pelvic floor dysfunction can cause you to suffer from bladder frequency, urgency, incomplete emptying, slow stream, stream that stops and starts, bladder or urethral pain, or leaking. By the way, it’s not just a female issue. Men and children can also have these symptoms. Learn from one of our experts, Stephanie Stamas, about how exactly the pelvic floor is related to bladder function and dysfunction, what you can do about it, and about common medical conditions affecting the bladder. Join us for this great seminar on September 27th, at 7pm . Register here: pelvichealth101.eventbrite.com
And for those who can’t wait to learn about the bladder, check out our blog on bladder health here!