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

alcoholic beverage bubble citrus
Photo by Pixabay on Pexels.com

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

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.

PH101: Ladies Session

By: Fiona McMahon, DPT
Hey Ladies!!! In the next installment of our Pelvic Health 101 course, we are hosting a ladies’ 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 30th . Please register at pelvichealth101.eventbrite.com

 

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Flyer-jpeg

Ph101 Men’s Only Seminar

Fiona McMahon PT, DPT

On October 23rd at 7pm we will be hosting our  “Men’s Only Seminar”. Join us as we discuss how pelvic floor dysfunction affects the male pelvic floor. Learn how your sex life can be improved by pelvic floor treatment, how to regain function after prostatectomy, and how to rid yourself of the pain of prostatitis, and avoid antibiotics for the most common type of prostatitis. This seminar is not to be missed!

For more reading on male pelvic health topics, check out:

All About Testicles

Navigating Life with Chronic Pain: Part 1

Navigating Life with Chronic Pain: Part II

Prostatitis What it is and What to do About it

Location:

110 East 42nd Street

Suite 1504

NY NY

10017

Pelvic Health 101 Flyer-jpeg

 

Pelvic Floor Mythbusters: Endometriosis Edition

Fiona McMahon PT, DPT and Amy Stein PT, DPT

Featuring excerpts from Beating Endo by  Iris Kerin Orbuch, MD and Amy Stein D.P.T.

Welcome back to our Pelvic Floor Mythbusters series! We have explored the effects of prolonged sitting and pee holding and now it’s time to move on to endometriosis. With endo, there are so many different myths, concepts, and sorta truths, that we figured we would address them lightning round style so we can cover as much ground as possible.

Endometriosis (endo) comes with a lot of misconceptions and because of this, the time from symptom onset to official diagnosis and treatment is long. The diagnosis of endo can often take in excess of a full decade to get, which delays further intervention and prolongs suffering. It’s a huge deal and is the reason why Dr. Amy Stein, PT, DPT and Dr. Iris Orbuch, MD. set to the task of writing a book where they bust endo myths right, left, and sideways. Beating Endo goes into much more detail than we do here. If you wish to purchase it, you may here

So without further adieu, here is a list of myths and truths taken from Beating Endo:Beating Endo Cover!

 

Common Endo Myths

The abdominal and pelvic floor muscles are rarely affected by endometriosis.

False: Constipation, frequent urination or retention, Pain with vaginal penetration from endometriosis causes tightening of the abdominal and pelvic floor muscles; So too does assuming the fetal position which is our go to pose when we are in pain. Both contribute to tight abdominal and pelvic floor muscles which causes pain.

The pelvic floor and abdominal muscles do not cause bladder, bowel, sexual dysfunction or abdominal-pelvic pain in patients with endometriosis.

False: Tight pelvic floor muscles caused by years of straining or reflexive tightening due to pain, often cause a severe amount of pain which results in further tightening and shortening of the pelvic floor muscles. Good news is that pelvic floor physical therapy benefits most people who have been experiencing abdomino-pelvic or sexual pain and/or are straining due to ongoing bladder and bowel symptoms.

Hysterectomy is a cure for endometriosis.

False: Hysterectomy is neither a treatment nor a cure. By definition endometriosis consists of cells similar to those in the lining of the uterus but found outside the uterus. Only surgical ‘excision’ removes endometriosis cells.

Medical menopause is a cure for endometriosis.

False: Explanation: Just because your medicines give you hot flashes doesn’t mean your endometriosis is going away. The best treatment approach is to meet with an Endo specialist to discuss options, and in most cases PT management. As well surgical excision has much better results than ablation of Endometriosis.

There is no correlation between quantity of endometriosis and severity of disease.

Truth: Even if you have a minimal amount of endometriosis, you can be in debilitating pain with lots of symptoms and in most cases dietary changes, physical therapy and mindfulness practices can help manage a lot of your symptoms.

Teenagers are too young to have endometriosis.

False: Teenagers can have endometriosis and their endometriosis can cause debilitating symptoms.

Pregnancy is a cure for endometriosis.

False: Just plain no. Pregnancy does not cure endometriosis.

Ablation surgery is the same as excision surgery.

False: Not even close. Excision surgery is the proper treatment for endometriosis. Ablation surgery, burns the surface of the endometriosis lesion but leaves the bulk of endometrial implants behind.

Surprising Endo Facts:

Fact: Physical therapy (pelvic PT) can help many suffering from the many pains and symptoms of Endo, including back, abdominal and pelvic pain, bladder, bowel and sexual function.

Fact: The majority of patients with Endometriosis require pelvic floor physical therapy. Pelvic floor PT can be instrumental in the healing process and can help abdominal-pelvic pain, bladder and bowel urgency, frequency, retention, incomplete emptying, and any sexual pain related to the musculoskeletal system.

Truth: Painful bowel movements, constipation, diarrhea and bloating are symptoms of endometriosis as well as symptoms of pelvic floor dysfunction .

Truth: Painful sex is a symptom of endometriosis as well as a symptom of pelvic floor dysfunction.

Truth: 40 to 50% of women with unexplained infertility is caused by Endometriosis.

Truth: Teens with endometriosis often have acyclic pain, that is, pain at other times of the month rather than only during their period, in addition to cyclic pain.

Truth: Back pain is a symptom of endometriosis.

Truth: If your ultrasound is normal you can still have endometriosis.

Truth: roughly 10% of women have endometriosis. That’s close to 200 million women worldwide. Endometriosis is much more than just bad period pain. 1 in 4 women have pelvic floor dysfunction.

Truth: Endometriosis commonly affects the musculoskeletal system, and in many cases can be a primary contributor to one’s pain and symptoms..

Mama’s 101: Recovering After Birth

On September 26th at 1 pm scoop up your baby and join us for our FREE educational seminar hosted by Dr. Joanna Hess as she provides the inside scoop on how to get back to leak free, bulge free movement.

Address:

Beyond Basics Physical Therapy – Downtown

156 William Street

Suite 800

New York, NY 10038

Date:

September 26th at 1 pm

Mamas 101 Flyer_Jpeg

PH101: Running to the Bathroom Again?!

Fiona McMahon PT, DPT

hd-wallpaper-macro-splash-67843 (1)
via Pexels

Bladder problems can be vexing, it may hurt for you to pee even though every 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 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 25th 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!

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Flyer-jpeg