Mama’s 101: Strategies to Prepare for Birth

Hey Readers!

Our next installment of Mama’s 101 is coming your way on September 19th! Join Rachel Clausen PT, DPT as she details how to optimize your birth! The class will be held at our Downtown location register  here.

Details: 

Dates: September 19th, at 6pm

Location: 156  Williams Street Suite 800, NY, NY 10038

Mamas 101 Flyer_Jpeg

Pelvic Health 101 is back! Come to Our First Class on September 18th

 

On September 18th, at 7pm we will be kicking off our fall semester of pelvic health education class, we call Pelvic Health 101 (PH101). In our first class we will be introducing you to the pelvic floor muscles, where they are, what they do, and how they relate to the health and function of your bowel, bladder, and sexual functioning. We will also be covering how things such as alignment, posture, muscle tone and nerves can affect your symptoms. This course is a great starting point to help you understand your pelvic floor and pelvic floor symptoms.

Please join us at our office at:

110 East 42nd Street, Suite 1504

New York, NY 10017
Register at: pelvichealth101.eventbrite.com

Here is our line up of this and future classes

Pelvic Health 101 Flyer-jpeg

 

What is Neater than your Peter? A Guide to Penile Health and Function Part 1: Premature Ejaculation

blur-blurry-burst-666013

Fiona McMahon PT, DPT

Ladies and Gentlemen, it is finally time to go for this blog and go on a deep dive to discuss at length (pun not intended), the physiology, health, and function of an amazing organ, the penis! A couple years ago we talked about testicles in our blog, All About Testicles, which remains one of our most popular blogs. Now it is time to travel north and talk about how people with penises can best care for them and how to address things that may go wrong from time to time. This blog will periodically cover different issues that can (ahem) arise with penises. Today we will go over premature ejaculation. But before we can do all that, lets review how the penis works.

As an organ, a healthy penis is an amazingly complex organ despite it’s seemingly simple exterior. It is the tail end of the urinary system, provides amazing sensation, carries sperm to the outside world, delivers a substance that can neutralize the acidity of the vagina in order to make it more hospitable to sperm, and is able to use the muscles around it to raise the blood pressure in the penis higher than that of the outside body, in order to maintain erection.

The penis is not one tissue all the way through. It has what’s called the tunica albuginea which is the wrapping for the erectile parts of the penis. This guy is really important because it closes off the vein returning blood flow from the penis to keep the penis erect during arousal. Inside the tunica albuginea is the corpus carvernosum and corpus spongiosum. No, these two tissues are not Harry Potter spells, but critical parts of penile infrastructure. The corpus cavernosum fills with blood during erection and helps make the penis hard. The corpus spongiosum keeps the urethra from getting clamped shut during erection so the sperm can get out.

How Does The Penis Get Hard?

Usually, in response to sexual stimulation, the smooth muscles (the involuntary ones, not the pelvic floor) will relax allowing the small blood vessels within the penis to fill with blood, the result is the tunica albuginea ( the wrapping of the erectile parts of the penis) will compress on the veins of the penis, thus preventing the blood returning back to the body. The trapped blood in the penis will cause the penis to get hard and stand up. The lovely muscles of the pelvic floor, specifically the ischiocavernosus will contract to further increase the blood pressure within the penis and keep the penis erect.

What Happens with Ejaculation?

Ejaculation occurs with orgasm. It is possible to have an orgasm without ejaculation if you have had a procedure like a prostatectomy. For a normally functioning penis, ejaculation occurs with orgasm and is what carries the sperm and other fluids to the outside world. The contractions felt in orgasm are what propel the sperm through the penis and to the outside world. The bulbospongiosus is responsible for these contractions and is part of the pelvic floor.

Premature Ejaculation

Here is where I would normally supply you a pithy little statistic like “ 1 in 4 men will experience premature ejaculation in their lifetime”. Unfortunately, I cannot provide any such statistic for this subject because so few people talk about this problem. The clinical definition of premature ejaculation is a little wonky too, and has not consistently been used in research, therefore prevalence data are likely inaccurate. The International Society for Sexual Medicine (ISSM) , in an attempt to improve the medical definition of premature ejaculation defines it as:

  • Ejaculation that always or nearly always occurs within about 1 minute of vaginal penetration from the first sexual experience (Defined as lifelong premature ejaculation)
    • OR
  • A clinically significant reduction in latency time, often to about 3 minutes or less (defined as acquired premature ejaculation)
  • Inability to delay ejaculation on all or nearly all vaginal penetrations; and
  • Negative personal consequences, such as distress, bother, frustration, and/or avoidance of sexual intimacy (Althof 2014)

If you are a gay or bi-man, or a man who does not have vaginal intercourse you are probably well aware how problematic this definition is. Currently, it is the ISSM’s stance that there is insufficient evidence to draw up criteria for men who have sex in ways other than vaginal intercourse.

As you can tell by the definition, premature ejaculation is divided up into 2 subgroups, lifelong and acquired. The distinction is relatively new in the research and can help patients find better ways to treat their premature ejaculation.

Potential causes of premature ejaculation include:

  • Hypersensitivity of the glans( head) of the penis
  • Issues with serotonin
  • Erectile dysfunction*
  • Either stopping or starting drugs
  • Chronic pelvic pain syndrome*
  • History of rushing early sexual encounters
  • Prostatitis*

*These are conditions treated at Beyond Basics Physical Therapy

What to do about premature ejaculation?

Don’t ignore it. Performance anxiety and premature ejaculation can often become a vicious cycle, where one will promote the other. Regardless of how your symptoms started, there is a lot that can be done to improve your sex life.

If you have prostatitis or chronic pelvic pain come to physical therapy. Did you know 90-95 percent of cases of “prostatitis”/chronic pelvic pain are musculoskeletal in nature… ahem… this is one of the most common conditions we treat at Beyond Basics. Overactive muscles, those in the abdomen, legs and pelvis can contribute to symptoms of prostatitis/chronic pelvic pain, (i.e. burning urination, painful ejaculation, sitting pain, genital pain, defecatory pain, urinary or bowel frequency, urgency, retention, incomplete emptying, etc.,.). Physical therapy can go a long way to treating and curing these symptoms by relaxing and lengthening your overactive muscles and strengthening weaker muscles. Prostatitis is a vast subject that requires its own blog. Luckily for you, I already wrote one. Check it out here.

If you are experiencing erectile dysfunction along with premature ejaculation, get thee to a doctor. I already explained to you how amazing the penis is as an organ. Its function is reliant on blood flow, thus problems with erection, especially in younger people may be an early sign that something may be up with your vascular system. Once systemic causes have been ruled out, get thee to physical therapy. We spoke earlier about how the penis requires blood flow and muscles to work properly; pelvic floor physical therapy can restore the function and improve the vascular health of the muscles vital to erection. Erectile dysfunction is yet another subject that could use its own blog. Again, luckily for you, I already wrote one. Check it out here.

If you don’t think erectile dysfunction, prostatitis, or chronic pelvic pain is causing your premature ejaculation, there is still a lot you and your urologist can do. There is new work revealing that certain medications and psychotherapy can really help reduce premature ejaculation. You are not alone in this and you deserve to start feeling better.

Thank you so much for reading our blog, if you think physical therapy can help you. Please give us a call at either our midtown location 212-354-2622 or our downtown location 212-267-0240. We are offering free phone consultations at both offices for a short period!

fiona2018

Fiona McMahon PT, DPT is currently practicing from our midtown location

Check out our other Neater Than Your Peter Blog:

What’s Neater Than Your Peter (a series on male sexual dysfunction): A Bend in the Road: Peyronie’s Disease

 

 

Althof S, McMahon C, Waldinger M, et al. An Update of the International Society of Sexual Medicine’s Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE). Sex Med. 2014; 2(2) 60-90

Anderson R, Sawyer T, Wise D. Painful myofascial trigger points and pain site in men with chronic prostatitis/ Chronic Pelvic Pain Syndrome. J Urol. 2009;182(6): 2753-8

Anderson R, Wise D, Sawyer T. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005;174(1):155-60

Chronic nonbacterial prostatitis (chronic pelvic pain syndrome). Harvard Health Publications. Harvard Medical School. 2007. http://www.health.harvard.edu/newsletter_article/chronic-nonbacterial-prostatitis-chronic-pelvic-pain-syndrome. Accessed December 11, 2016

Dean R, Lue T. Physiology of Penile Erection and Pathophysiology of Erectile Dysfunction. Urpl Clin North Am. 2005; 32(4): 379-v

Herman H. “Male and Female Health Wellness and Sexual Function”. New York. 19-20 May 2018

Quinn P. A Multinational Population Survey of Intravaginal Ejaculation Latency Time. J Sex Med. 2005; 2(4) 492-497

Saggy Jeans and Tailfeathers: How Your Pelvic Positioning Affects Your Body

animal bird blue bright
Photo by Pixabay on Pexels.com

Joanna Hess PT, DPT, PRC, WCS

Wait! Marie Kondo has you throwing out your favorite jeans because the joyless saggy bottoms that your tushy cannot manage to fill out? We are seeing an epidemic flat butt among mamas, plumbers, barre fanatics, and office workers—all with strangely similar symptoms—pelvic floor dysfunction, low back and sacroiliac pain, and a tucked under pelvis. In this blog we will explore why the position of the pelvis, the maker of flat butts and the maker of less flat booties, is important and how to more easily move out of this position for benefit beyond your behind.

Besides needing a new wardrobe, why should I care about my flat bum?

The flat bum or preference towards posterior pelvic tilting shrinks the distance between the front and back of pelvic outlet which changes pelvic floor muscle tension. The body needs access to the full range of the pelvis and pelvic floor muscles. Over time, this position could cause excessive pelvic floor activity to compensate for the loss of resting tension. Think of the pelvic floor muscles simplified as a rubber band between two points, the pubic bone and tailbone. When the distance between the two points decreases, the rubber band loses its stability from resting tension. Changes in pelvic position alters stability from the pelvic floor muscles. This posterior pelvic tilt position also decreases the accessibility for hip extension and therefore the upper glute muscles get sleepy. As the top of the pelvis moves back, the sacroiliac joint in the low back opens and decreases its bony stability. Translated into everyday life, the flat butt position increases the potential for incontinence, pelvic floor muscle tension, sacroiliac pain, and decreased efficiency in movement.

The Flat Bottom. Only in the eye of the beholder?

Pelvic floor and tilt

The disagreement of the “neutral pelvis” or zero-point causes confusion when describing pelvic tilt—anterior pelvic tilt, posterior pelvic tilt, and neutral pelvis. Some argue that the neutral pelvis is when the ASIS’s (front hip bones) are level to the PSIS (back butt dimples). Others say that the pelvis is neutral when ASIS’s are in the same plane as the pubic bone. Or for those with X-ray vision, pelvic tilt is the vector of the sacral angle at S2 in relation to the vertical axis. But often, neutral pelvic position is subjective to the observer and relative to other parts of the body—namely the spine/rib cage and thigh bone. Clinically, this “neutral pelvis” is hard to find because 1) pelvis’ are shaped very differently, 2) left and right pelvis on the same person can also be quite different, 3) feeling these bony landmarks have been shown to be remarkably unreliable, 4) the neutral pelvis should be on top of vertical thigh bones. See how the eyes can be tricked confusing spinal curve focusing on pelvic tilt without also including rib position.

Rib pelvic alignmentThe inability to move in and out of posterior pelvic tilt and anterior pelvic tilt decreases efficiency and possibly results in pain and instability. Anterior pelvic tilt is when the front part of the pelvis moves forward/down. Posterior pelvic tilt is when the front part of the pelvis moves back/up. A neutral pelvis on top of vertical femurs and happy rib cage should correlate with better muscle performance.

Do I have a flat butt?

Aside from the saggy jeans, the flat butts of the world have a few other correlations.

1. The Tailfeather Test: Stand comfortably and squeeze the gluts.

a. Neutral pelvis: Thigh bones rotate.

b. Posterior tilt-ing pelvis: The butt will further tuck under and mainly access the lower glutes.

c. Anterior tilt-ing pelvis: The pelvic floor muscles will do most of the work.

2. You bear weight more in the heels

3. Back of your rib cage is behind your pelvis

4. Your Thigh bones are angled so that your pelvis is front of your knees

5. Your lower belly pooch

6. You Sit with pressure more on the sacrum/tailbone vs. sit bone

7. You have Overactive and possibly overworking pelvic floor muscles—the front to back pelvic distance decreases with your posterior tilted pelvis and loses the resting tension from length. As described earlier, this is similar to tensile strength of a slightly stretched rubber band vs. rubber band without pull/tension. Therefore, your pelvic floor muscles have to work harder to keep some type of tension for purposes like continence, stability, etc. The inability for the pelvic floor muscles to work optimally can lead to incontinence, pain, and constipation.

9. You have Breathing and abdominal pressure problems

10. You have Sacroiliac joint pain. As the pelvis tips back, the sacrum moves away from the ilium decreasing the bony stability. The hip muscles have to work harder, but as felt in the Tailfeather Test, the glut muscles aren’t in a good place to work.

Is there a better fix than butt implants?

Bodies have and love variability for posterior, anterior and “neutral” pelvic positioning. The brain likes positions where muscles and nerves work with ease and stability—life shouldn’t be so difficult—but it needs the chance to choose and learn it. Folks working with bodies have traditionally “corrected” spinal curves by changing pelvic position. From what has already been discussed, spinal and pelvic position can be altered many different ways—from the changing weight-bearing area in the feet, to position of ribs and range of breath, and even head angles with visual and vestibular input. Consider these hacks into pelvic stability until the brain learns how to access this stability in many situations and positions.

1. Standing. Bring your chin down to your neck and keep looking down until you see the front of your ankles. You’ve just untucked your pelvis and brought your ribs over your pelvis. This one is courtesy of my colleague, Stephanie Stamas. Or check in to feel where the weight is going through your feet. The front to middle of the foot is a good place to start and then do the Tailfeather Test. You might have to toggle other parts of the body because of how the body will compensate in the chain.

2. Sitting. Get your hips as far back as possible. Or put a pillow in the back of the chair so that your hips can find the pillow and you are sitting on top of your sit bones. Then, relax the trunk into the seat back/pillow. Again, you’ve untucked your pelvis and brought your ribs over the pelvis.

3. Better squats/lunges/burpees/stairs/ab work. You can do 5 sets of 20 squats, but still no junk? Take care to see if your pelvis is tucking under in the movement. If so, use an inhale to keep the pelvic floor lengthening as your hips bend in movement. Later, the movement should be dissociated with breath pattern (as long as you are breathing.)

4. See a physical therapist. Often times, the habits of pelvic tucking are a little more complicated because it is a protective and compensatory mechanism for stability. A physical therapist can help with seeing the bigger picture and how different parts of the body relate to each other. They can also help facilitate better movement through manual therapy and specialized movement.

Good luck with the joy sparking!

Fight or Flight? Rest and Digest? Optimizing your Life with the Power of your Autonomic Nervous System

Yoga or Pilates

Fiona McMahon PT, DPT, She, her, hers

You aren’t a zebra getting chased down by a lion on the Serengeti. You know that. But your body might not. Our modern day stress usually doesn’t involve us having to defend ourselves against wild animals. It often involves chronic seemingly unrelenting stress of work, relationships, and life. Stress, our perceived threats, chemically elicit the same type of response whether that is fending off a tiger or stressing over trying to care for your child while simultaneously crushing the game at work. These stress responses are governed by the sympathetic autonomic nervous system of the autonomic nervous system (ANS). The ANS is a powerful system that governs virtually every function in our body to help optimize our responses to things we encounter day- to-day. It is essential to our survival. We can get into trouble if our stress response is perpetually turned on. You can’t fight or flight forever, we must transition out of that sympathetic nervous system back into our rest and digest system, the parasympathetic nervous system. In this blog we will go over the different parts of the ANS and how we can optimize it to live our healthiest and happiest lives.

Parasympathetic versus Sympathetic

In a perfect world our sympathetic and parasympathetic operate in concert to provide us with optimal functioning. When we go out for a run we need our sympathetic to quicken our heartbeat, stimulate glucose release from our liver, and allow us to sweat. After we finish our run and settle in for our post run snack, we need our parasympathetic to stimulate some saliva production, and get digestion started for us. See how the sympathetic and the parasympathetic can work perfectly together? Check out all the functions of the ANS below

Sympathetic Nervous System

  • Dilates pupil
  • Inhibits salivation
  • Constricts Blood Vessels
  • Accelerates Heart Rate
  • Stimulates Sweat Production
  • Stimulates Glucose Release
  • Stimulates secretion of norepinephrine and epinephrine
  • Inhibits urination
  • Stimulates orgasm

Parasympathetic Nervous System

  • Constricts pupil
  • Stimulates tear production and salivation
  • Slows Heartbeat
  • Stimulates digestion
  • Stimulates secretion
  • Promotes voiding
  • Stimulates erection

Health effects of stress

As you can see, the sympathetic nervous system provides us with some really important functions. But you can tell by looking at what it does for the body, that living in chronic sympathetic drive would be pretty uncomfortable. No one wants to walk around with their heart pounding and sweat pouring off their forehead. Beyond discomfort, chronic stress can deeply affect our health. Chronic stress can affect your immune system negatively making it harder for you to battle infections. Importantly for our pain patients, chronic stress can increase inflammatory chemicals called cytokines. This is important because that inflammation can actually make your pain worse. Chronic stress can also affect your digestion through a mechanism called the brain-gut-axis, which can affect how you absorb nutrients and the overall level of inflammation in your gut. You can listen to the details of how the autonomic nervous system can effect your gut on our Pelvic Messenger podcast.

Treatment

So you’ve read this far. You may now be feeling stress about being stressed, which definitely was not the intention of this blog post. Stress is part of life. Parents get sick, our kids get into trouble, money gets tight, life can be stressful. We simply cannot control events and the actions of other people that contribute to our stress. I call these things exogenous stressors, or stress that is occuring outside of ourselves. What we can attempt to control is how we react to those exogenous stressors.

That’s where mindfulness can be so helpful. Mindfulness can allow you to look at a problem without spiraling into extra stress. Let me give you an example. Say your boss gives you some negative feedback about a project at work. You can take the feedback at face value and use it as a tool to improve future projects or you can go down the rabbit hole. You can tell yourself that your boss not only didn’t like your performance on your project, but also doesn’t like you. You can create a narrative that you are inherently bad at your job, are on the verge of being fired, will not be able to afford to live in your house and so on and so on. The place you can take yourself in your mind can be so far from what actually happened. Travelling to those places can allow you to stress about things that haven’t happened or may never happen.

A way I personally learned mindfulness was through a smartphone app. I personally used Calm but 10% Happier, Buddify, and Headspace are also great. Getting into the practice of mindfulness takes… well… practice. I suggest giving it a full three weeks before throwing in the towel. There is no one cure for everyone and it is not a reflection on you, yourself personally if mindfulness is not your cup of tea.

Exercise is another great way to blow off some stress. Honestly, any exercise you do is good but throwing in some meditative movement practices to your repertoire can help up the returns you get from exercise. Meditative movement practices like Pilates, Yoga, Qi Gong, and Tai Chi have been shown to offer a host of benefits for the body and soul.

Here’s the thing. Sometimes we can shake the weight of stress ourselves. That’s when having a professional help can be so life changing. Mental health professionals can not only lift the burden of how we react to stress, but by teaching us to manage our stress responses, they can help set the stage for real and profound healing to take place and augment your treatment at someplace like Beyond Basics Physical Therapy.

As I wrap this blog up, I ask you to make time for you. Your health and sense of well-being are one of your life’s most valuable commodities and you are worth it.

Sources

Low P. Overview of the autonomic nervous system. Merk Manual Professional Version. https://www.merckmanuals.com/professional/neurologic-disorders/autonomic-nervous-system/overview-of-the-autonomic-nervous-system Accessed May 23, 2019

Mariotti A, . The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication. Future SCI OA. 2015 Nov; 1(3): FSO23

Won E, Kim Y. Stress, the autonomic nervous system, and the immune-kynurenine pathway in the etiology of depression. Current Neuropharmacology, 2016, 14 665-73

How to Improve Bladder Health

bladder-cherry-chinese-lanterns-ornamental-plant-433076

Fiona McMahon, DPT

The bladder, not super complex right? Just a tupperware for pee, holding your urine until an opportune time to go. The bladder is so much more than that, integrating information from the brain, muscles of the pelvic floor, and responding to stretch to efficiently serve its purpose. We never think of the bladder until something goes wrong with it.

In this blog, we will be exploring the anatomy of the bladder, what is normal for the bladder, what can go wrong with the bladder, and how to best take care of your precious and hard working bladder.

Bladder Anatomy/ Physiology

 

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:

People with male anatomy 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 benign part of aging, cancer, or infection, will restrict the flow of urine out of the urethra, resulting in weak stream, painful, burning urination, and difficulty urinating (the same thing happens with tight pelvic floor muscles). A prostate that has been surgically removed, most often has occurred for treatment of prostate cancer can reduce support for the bladder and lead to leaking. For more information on prostate cancer click here  and for more info on prostatitis, click here!

Another important difference between people with female and male anatomy are the respective length of their urethras. Male urethras are a lot longer than female urethras. This is one of the reasons people with female anatomy 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.

Conditions of the Bladder

Incontinence

Incontinence is the involuntary leakage of urine. There are many causes of incontinence. It’s important to know why you are leaking in order to know how to appropriately remedy it. It is possible to have more than one type of incontinence, and when that occurs we call it mixed incontinence.  Let’s go through the types together.

  • Urge incontinence occurs when you leak urine  after a sudden urge to urinate. We call it, lock in key syndrome, because certain events like unlocking the door to your home can cause urge incontinence.  This is the type of incontinence, which should be treated first in cases of mixed urge/stress incontinence.
  • Stress incontinence is the result of pelvic floor weakness that prevents the closure of the external urethral sphincter with activities that increase the pressure on the bladder, like coughing, laughing, lifting or sneezing. Pelvic floor weakness can occur if the muscles and or connective tissues are too loose to create an efficient contraction and more commonly, especially with athletes, too tight or imbalanced, to fully close the external urethral sphincter. Read more about incontinence in athletes here.
  • Functional incontinence occurs when you physically can not get to the bathroom in time to urinate. This is common in the elderly or disabled, who may have trouble ambulating to the bathroom, removing clothing, or transferring from a chair into standing. It is imperative that this type of incontinence is treated aggressively by a physical therapist or occupational therapist as it increases the risk of potentially fatal or disabling falls.

Incomplete voiding

Incomplete voiding is when the bladder does not fully empty.

In a normally functioning patient, volitional effort should not be required to empty the bladder.  A pelvic floor that is unable to relax, will have a smaller opening for urine to pass through or the voluntary muscles involuntarily contract because of muscle spasming, resulting in hesitancy, or incomplete bladder emptying.

Bladder Pain

Pain is our body’s way of telling us there is something wrong. With a new onset of bladder pain, it is important to rule out infection or an organic condition. Often times musculoskeletal conditions or general bladder irritation can mimic bladder infections.  In our practice, we often see patients who had been convinced they had an infection only to find out all of their tests for infection, where in fact, negative and the source of their pain was a tight or shortened pelvic floor.

It is important to understand the character of your bladder pain. Does your bladder hurt as it fills with urine and then feels better only shortly after voiding? If your answer is yes, you may have bladder irritation from urine that isn’t dilute enough (you are not drinking enough water), or you are consuming something irritating like spicy food, caffeine or alcohol. You may also have a condition known as painful bladder syndrome/interstitial cystitis which is contributing to your symptoms. It is important to get a handle on bladder filling pain right away, because it is the first step in treating other conditions such as frequency, urgency, incomplete emptying and retention.

If you have pain and burning during urination with no infection, it is likely the pelvic floor muscles and tissues cannot relax enough to allow urine to flow out without burning, (the pelvic floor also plays a role in bladder filling pain as well). Burning with urination that is not caused by an infection, is treatable with pelvic floor PT.

Frequency:

Everytime I hear someone say “I have a small bladder”, I have the uncontrollable urge to say, “No, you have a sensitive bladder, which can be trained to be better”. Saying you have a small bladder is 95% of the time fatalistic and just untrue. Most bladders, with few exceptions can hold 400-600 mL. Holding capacity can be diminished in cases of constipation, pregnancy and some neurological conditions, but most everyone is working with similarly sized equipment (the exception, being growing children).

Average intervoid interval, aka times between pees, is 2-3 hours, unless you chug a liter of fluid or cups of caffeine in one sitting. An example is being able to make it through James Cameron’s, Titanic, without having to excuse yourself. The trick with the bladder is it’s antsy. It informs you with the first urge to urinate when it is approximately 40% full. Over time, if you listen at that first urge, the bladder will begin to inform you earlier and earlier until you are going once every 20 minutes. Training your bladder to hold more is achieved with ignoring the urge or practicing various behavioral strategies, like deep diaphragmatic breathing with pelvic floor drops, to allow for longer intervals until your bladder capacity is within normal limits. This can be a longer process for those with a more sensitive bladder.

Bladder training is complicated by pain. Pain usually must be treated simultaneously in order to truly get the most benefit from bladder retraining. It is also important to realize that substances like caffeine and alcohol increase urgency and make bladder training more difficult.

How to Manage Bladder Issues:

Fortunately, there is a lot you can do, RIGHT now to manage your bladder symptoms. I find that in my practice and everyday life, there is a certain fatalism about bladder conditions. I can’t count how many times I’ve heard phrases like, “ I just have a small bladder”, “People my age after babies just leak”, “I am older so I pee more at night” and “it’s always been like this”. The bladder is a trainable organ and the muscles influencing it can be stretched and strengthened like any other muscle in the body. The best part is there is so much you can do for yourself at home. It’s totally worth trying and in many cases is a life changer.

Diet and fluid intake:

It may sound counter intuitive, but drinking plenty of water is good for almost all bladder conditions. Yes I am talking about leaking, urgency, incomplete emptying and frequency. Drinking lots of water keeps your urine nice and dilute, minimizing the irritation of the bladder wall as well as the reactive spasm of the detrusor muscle. You should drink approximately half your bodyweight in ounces of water a day. For example: a 150 lbs person should consume 75 ounces of water a day. You should increase this amount if you are exercising, or experience a lot of sweating or drink a lot of caffeine and or alcohol, which are both dehydrating. It is also important to be mindful of bladder irritants which can worsen bladder issues. Big irritant culprits are alcohol, caffeine, citrus, and spicy food. In children, dairy milk is a common bladder irritant.  Keep in mind that one person’s bladder irritant may not be your bladder irritant. It’s easy to look at lists of bladder irritants and get overwhelmed. Try eliminating a suspected offender for two to three days. If you feel better when you aren’t consuming that item and worse when you add it back in, consider eliminating that item from your diet.  It is also important to eat in a way that prevents constipation, as this worsens bladder symptoms and puts extra pressure on the bladder.

Posture

If you are having problems fully emptying your bladder or you have post void leakage (dribbles 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.

Bladder Training

If you have bladder frequency or leakage  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, 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.

Physical Therapy

Physical therapy is considered a mainstay and top treatment for musculoskeletal causes of bladder disorders and bladder pain.  Expert pelvic floor physical therapists 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. PT’s can work to relax spasmed muscles, treat constipation contributing to bladder issues, improve your toilet posture, reduce tightness 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 see us.  There is so much we can do to help!

Sources:

Berghmans L, Hendriks H, Van Waalwijk, et al. Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials. BJU Int. 2000; 85: 254-63

Chancellor, M, Yoshimura N. Neurophysiology of stress incontinence. Rev Urol. 2004; 6(Suppl3)S19-S28

Chang H, Lynm C, Glass R, et al. Urinary incontinence in older women. JAMA, 2010; 303(21): 2208

FitzGerald M, Brensinger C, Brubaker L, et al. What is the pain of interstitial cystitis like?. International Urogynecology Journal Including Pelvic Floor Dysfunction. 2005

Shafik A, Shafik I. Overactive bladder inhibition in response to pelvic floor muscle exercises. World J Urol. 2003 May; 20(6):347-7. Epib. Apr 4

Pilates, Moving from Injury Back to Peak performance

Julia Rosenthal PT, DPT

Julia Pilates

As an avid high intensity exerciser, I am always looking to push myself in my workouts. When pain gets in the way of my progress, it can be extremely frustrating. For years, I have been struggling with chronic hip and sacroiliac joint (low back) pain. These symptoms intensified about two and a half years ago when I fractured a lumbar vertebra weight lifting. Recovery was hard, and during that time I was told by doctors, friends, and family that I could not or should not return to the things I loved: lifting heavy weights and running outside. I was devastated. I tried swimming, biking, the crazy looking stair treadmill at the gym, and while I was able to get some exercise in, I still felt like I had lost one of the things that brought me the most joy.

Months after my injury, I finally started listening to my body and my physical therapist friends rather than the limiting and negative advice I had gotten. I started returning to weight lifting and running and began trying not to judge myself for the strength I had lost. The more I did, the better I felt. I was scared, but I felt liberated at the same time. But despite making some initial progress, I started to hit a wall. I couldn’t deadlift as much as I could before, I couldn’t lift as much overhead, and I was too afraid to run on concrete or to get in a squat rack, which was where I had hurt myself all those months ago. I started to feel that hip and sacroiliac (SIJ) pain again after every workout, and I knew I had to change something about what I was doing.

Enter: Pilates. Pilates and weight lifting are both forms of resistance training, but there are key differences between them that make Pilates an effective form of cross training for a weightlifter. When you do any singular form of exercise, your body is learning how to complete a task one way. Introducing a different form of exercises gives you variability, and teaches your body to work under lots of different conditions using different muscle groups. The more options our bodies have for how to complete a task (like a deadlift), the stronger we become.

Here at Beyond Basics Physical Therapy, I had the opportunity to work with Kierstin Elliot,a certified Pilates instructor with a wealth of experience working with clients who struggle with orthopedic issues, including pelvic floor dysfunction. “In Pilates,” Kierstin explained, “subtle nuances matter and you have to be a stickler for form and alignment.” Weightlifting athletes, on the other hand, generally focus more on larger, more powerful movements. Because of these differences, Pilates can make a big difference when it comes to increasing strength and decreasing injury in people who typically exercise with high resistance. In the months that I spent working one on one with Kierstin, I achieved personal bests in my squat and my deadlift and could feel that I was much more steady in any single leg weight lifting activity.

If you like to lift weights and you want to see your performance improve, here are 5 specific ways that Pilates can up your weight lifting game:

  1. Eccentric Strengthening
    1. While weight lifting certainly helps to develop core strength, Pilates does so using lighter weights and more eccentric contractions. Eccentric contractions require muscles to work and lengthen at the same time. Typically, weightlifting and other forms of exercise will strengthen the core in a concentric way, meaning the muscles are asked to shorten and tighten in order to build strength. While both are effective, the best option is a combination – variability is key. Eccentric contractions are also a great way to increase mobility.
  2. Increasing Mobility in the Spine and Extremities
    1. The demands on the spine are very different in weight lifting versus Pilates. Lifting heavier weights requires you to maintain a certain amount of stiffness in the spine to protect it against a heavier load. While that is an important skill (think about how hard it can be to lift a heavy suitcase, stroller, car seat, etc.), it is also important to be able to manage resistance at times when our back can’t be in a “neutral” position, like when you’re putting a baby in a crib or digging things out of your storage unit. Pilates exercises are done at lower resistance and in various different spinal positions: flexion, extension, side-bending, and rotation. This allows you to learn to move well under tension in lots of different positions.
    2. Pilates is also a great way to increase your hip and shoulder mobility, both of which are important for weight lifting. Squatting, deadlifting, and overhead movements were the things I was having the hardest time progressing back to, and these all require good shoulder and hip mobility. Pilates exercises are often done with the trunk supported, and with resistance applied to the limbs by springs. This means that there are more eccentric contractions involved (working and lengthening at the same time), which can be a great way to improve strength and mobility at the same time.
  3. Increasing Stability
    1. Weightlifting focuses on powerful movements. These types of movements will require increased work from our larger “global” muscles which tend to be longer and move lots of joints at the same time. While strengthening these muscles is important, using Pilates to strengthen the smaller “stabilizing” muscles is a great way to enhance the strength of the global musculature. When we do a big, powerful movement, we need the smaller stabilizing muscles to automatically fire too – this enhances our overall strength, improves our balance, and makes us less prone to injury.
  4. Increasing Endurance
    1. Training for increased endurance means training at a lower weight and performing more repetitions. In weightlifting, the goal is to work at a higher percentage of your 1 rep maximum, meaning the greatest amount of weight that you would be able to lift once. In Pilates, on the other hand, lighter resistance is used for more repetitions.
  5. Increasing Body Awareness
    1. Proprioception is the sense that allows us to know where our bodies are in space. Exercises that are done in a closed chain – meaning one of your body parts is in contact with a fixed surface – enhance this sense. Because reformer Pilates includes spring tension with your feet or hands in contact with a surface, almost all exercises are done in a closed chain. This can be a really great way to ease into a movement after an injury. The support of a closed chain exercise allows you to tailor the movement to your current level as you progress back towards more traditional open chain (no contact with a surface) weightlifting movements.

Thanks for reading! I hope this blog post helped you understand how you can take your training to the next level. If you are interested in experiencing what Pilates can offer or how physical therapy can maximize your athletic potential, please call our midtown (212-354-2622) or downtown office (212-267-0240) today!

 

Check out what Kierstin has to say about Pilates here!

The Benefits of Pilates While Healing Diastasis Recti

Pilates with Kierstin! Standing Side Splits

Pilates with Kierstin! Bridges with Stability Ball

References:

  1. Ahearn EL, Greene A, Lasner A. Some Effects of Supplemental Pilates Training on the Posture, Strength, and Flexibility of Dancers 17 to 22 Years of Age. Journal of dance medicine & science : official publication of the International Association for Dance Medicine & Science. 2018;22(4):192-202.
  2. Di Lorenzo CE. Pilates: what is it? Should it be used in rehabilitation? Sports health. 2011;3(4):352-361.
  3. Phrompaet S, Paungmali A, Pirunsan U, Sitilertpisan P. Effects of pilates training on lumbo-pelvic stability and flexibility. Asian journal of sports medicine. 2011;2(1):16-22.
  4. Queiroz BC, Cagliari MF, Amorim CF, Sacco IC. Muscle activation during four Pilates core stability exercises in quadruped position. Arch Phys Med Rehabil. 2010;91(1):86-92.
  5. Valenza MC, Rodriguez-Torres J, Cabrera-Martos I, Diaz-Pelegrina A, Aguilar-Ferrandiz ME, Castellote-Caballero Y. Results of a Pilates exercise program in patients with chronic non-specific low back pain: a randomized controlled trial. Clinical rehabilitation. 2017;31(6):753-760.
  6. Why Pilates and Lifting Weights Aren’t Mutually Exclusive – Girls Gone Strong. Girls Gone Strong. https://www.girlsgonestrong.com/blog/strength-training/why-pilates-and-lifting-weights-arent-mutually-exclusive/. Published 2019. Accessed May 26, 2019.