Demystifying Persistant Genital Arousal Disorder (PGAD)

PGAD photo

Fiona McMahon PT, DPT

Hello, everyone. Today I want to discuss a condition called Persistent Genital Arousal Disorder (PGAD). PGAD is an often sensationalized, painful, and disruptive condition that causes unwanted genital arousal, which doesn’t typically get better with orgasm and if it does, orgasm only brings relief for a short period of time. The key feature of this disorder is the genital arousal is unwanted and can cause deep psychological distress.

Typically when I write blogs, I will spend the lion’s share of my time sifting through scholarly articles, health articles targeted at the general public, and maybe I will read one or two essays or editorials written by people with that particular condition. The process of writing this blog went a bit differently.

I was researching a condition that had only been first classified in 2001. There really was a small pool of articles from which to pull. I also had to sift through a lot of garbage. There were titles like “ Woman has 100 orgasms a day”, click bait, on click bait, on click bait. I thought of my patients and women and men, who are just starting their journey, not knowing where to start. Frankly, I was sad. I can’t think of a more eloquent way to say it: the web can be a real garbage pit sometimes. I can imagine how hopeless it might feel scouring the Internet for answers.

The good news is, I did not end my research sad. I ended up finding some great articles, but most importantly I listened to a fabulous Pelvic Messenger podcast with our very own Stephanie Stamas PT, DPT with guest Dr. Irwin Goldstein, MD, on PGAD. I ended my research feeling empowered, and it is my hope through this blog and additional resources I have provided, that you will too. If you have found your way here because you have or think you may have PGAD, please, do yourself a massive favor and give this podcast a listen. I will be breaking down some of its points in this blog, but what the podcast does so well, is give hope.

Let’s go ahead and read on, and learn more about PGAD and how to manage it.

What Causes this Condition?

PGAD can affect people with both male and female anatomy. As Dr. Goldstein explains in the pelvic messenger podcast, It is more common in individuals with female anatomy, secondary to the fact the people with female anatomy have a shorter refractory period after orgasm. The term refractory period refers to the interval of time that is required between an individual’s first orgasm and when they are able to become sexually aroused again. People with male anatomy tend to have longer refractory periods, allowing them some relief between bouts of arousal.

There are many factors that are thought to contribute to PGAD. It used to be considered more of a psychological disorder. Over the past 17 years, researchers have found that the development of PGAD can be influenced by stress, but there usually is some sort of anatomical or physiological factor contributing to the development of this condition.

The Role of the Brain

Like we discussed before, stress is a contributor and trigger to PGAD symptoms. Additionally, one of the criteria in diagnosing PGAD is that the genital arousal causes distress. Examining stress triggers and managing the stress of the disorder itself is paramount to effectively managing PGAD, especially if it is taking time to determine what physiological intervention will help treat the symptoms.

There also is some discussion that the sensations that trigger PGAD are processed differently in the brain. Disruptions in the vulvar, penile, or scrotal tissue, nerve compressions, pelvic congestion, etc may be processed in the “action” areas of the brain and may be interpreted as or cause arousal, when in fact, there is a physical condition irritating that delicate tissue that must be addressed.

Studies have also found a connection with PGAD suffers and individuals with restless leg syndrome. In a 2008 study, PGAD and restless leg syndrome were found to be correlated. Restless leg syndrome bears some similarities to PGAD in that sufferers often feel they need to take action, like moving their legs, adjusting their position, and in individuals with PGAD, obtain orgasm for momentary relief. These findings amongst others support the theory that the brains of individuals with PGAD may interpret sensory signals differently than those without the condition.

Medication, Pearls, Back Problems, and Cysts

Now that we have talked about a potential explanation for persistent genital arousal as it relates to the brain, let’s talk about some of the physiologic contributors. The first factor found to be correlated with PGAD has to do with what we put in our mouths. There had been some evidence to support that increased soy intake may affect the development of PGAD. Also, certain medications and withdrawal from them may also contribute to PGAD. Trazadone has been found to contribute to priapism (persistent and painful erection of the penis) in individuals with male anatomy and may also contribute to PGAD in individuals with female anatomy. There also has been a correlation with sudden withdrawal from selective serotonin reuptake inhibitors, (SSRI’s), a form of antidepressant, and the development of PGAD. We always have to remember the old adage that is familiar to anyone who has been taught to consume scientific literature that, “Correlation does not equal causation”. It’s really important to remember that phrase with PGAD, because there are many correctable physiological conditions that also contribute to PGAD.

Keratin pearls, sounds lovely, right? Not so much, and these bad boys are a big factor in the development of PGAD and other pelvic pain syndromes. Keratin pearls develop when the normal products of the vulvar tissue collect and harden under the clitoral hood. As you can imagine, having a keratin pearl is super irritating to this extremely sensitive tissue, not unlike having a piece of sand caught in your eye. This constant stimulation can certainly contribute to PGAD symptoms. Keratin pearls can be removed by an experienced doctor and bring relief for PGAD.

In pelvic floor physical therapy land we think a lot about the pudendal nerve. The pudendal nerve transmits sensory information from our genitals to our brain and gives our pelvic floor muscles instruction from the brain. The pudendal nerve comes off the sacral nerve roots, S2, S3, and S4, (remember this for later). This nerve can become compressed from tight muscles and fascia and can cause PGAD symptoms.

Physical therapists and other clinicians also think about the various “dynias”. Dynia is the Greek word for pain. In relation to PGAD we often think of clitorodynia, vulvodyina, and vestibulodynia referring to pain in the clitoris, vulva, and vestibule respectively. These “dynias” can be caused by irritated nerves, hormonal conditions and overactive pelvic floor muscles and should be addressed in order to help treat PGAD. Additionally, other pelvic syndromes like pelvic congestion can contribute to PGAD.

Do you remember the nerve roots for the pudendal nerve? It’s okay if you don’t. They are the sacral nerve roots S2, S3, S4. Your sacrum is part of your spine and problems in your back like a slipped disc, irritable facet joint, stenosis can all be culprits in irritating these very important nerve roots.

There are these things called Tarlov’s Cysts which recently have been found to be huge in the development of PGAD. Tarlov’s cysts are little sacs filled with cerebrospinal fluid and they can irritate those important nerve roots, S2, S3, and S4. In 2012, it was found that the rate of Tarlov’s cysts is exceptionally high in individuals with PGAD. Management of these cysts can help with this disorder.

Treatment Options and Finding the Correct Practitioner to Connect you to Those Options

So there is a lot of stuff to sort through when trying to figure out where your PGAD is coming from. It requires a skilled clinician to separate the signal from the noise. At Beyond Basics Physical Therapy, we are especially poised to help you get started on the correct treatment path.

Unlike many other clinicians, we are comfortable assessing things like the mobility of the clitoral hood, the mobility of the structures surrounding the pudendal nerve and other pelvic nerves, as well as being able to treat issues involving the back and tailbone. We also have strong and robust connections to physicians who are pioneers in the treatment of PGAD and can help facilitate access to complementary medical treatment.

The most important part of treating PGAD is finding the cause or the driver. Once the driver or drivers are found, you can begin the process of treating them and reducing PGAD symptoms. Dynias, clitoral adhesions, pelvic floor congestion, back issues and irritation to a pelvic nerve can be treated by physical therapy or a combination of physical therapy and medical intervention. Tarlov’s cysts may require surgery to correct. Additionally, medication to reduce the symptoms, mental health therapy and relaxation techniques can be helpful.

PGAD used to be such a mystery and in some respects, it still is; however, we are in a very exciting time, where knowledge about PGAD is growing as well as our ability to diagnose and treat this disorder. The internet is a very scary place to research PGAD and it can be hard to find almost anything hopeful or positive, but there is hope. Give the Pelvic Messenger Podcast a listen and make an appointment to see us here at BBPT today.

Charitable Giving Options to Support Research and Treatment

Like many pelvic pain conditions, PGAD is under-researched. Research is an essential weapon to help us fight PGAD and improve individual’s lives. Please consider donating to the following organizations to fund the development of diagnosis and treatment protocols for PGAD and other pelvic conditions. Also, consider having your company or a friend’s company match your donation.

Donate to support pelvic pain research here:

International Pelvic Pain Society: IPPS https://wjweis.association-service.org/securesite/ipps/donations.aspx

International Society for the Study of Women’s Sexual Health ISSWSH; http://www.isswsh.org/about/endowment-fund

Sources

Aswath M. Pandit L, Kashyap K. et al. Persistent Genital Arousal Disorder. Indian J Pyschol Med. 2016; 38(4)

Jewell T, Legg T. What is persistent genital arousal disorder (PGAD?). Healthline. 2017 [Accessed: November 13, 2017]

Komisaruk B, Lee H. Prevalence of Sacral Spinal (Tarlov) Cysts in Persistent Genital Arousal Disorder. J Sex Med. 2012 Aug;9(8):2047-56.

Stamas, Stephanie. “ Dr. Irwin Goldstein: Treating Persistent Genital Arousal Disorder (PGAD).” Audio Blog Post. Pelvic Messenger Podcast. Blog Talk Radio. March 2017

Waldinger M, Schweitzer D. Persistent Genital Arousal Disorder in 18 Dutch Women: Part II- A Syndrome Clustered with Restless Legs and Overactive Bladder. J Sex Med. 2008

Hope with Pelvic Pain: A Patient’s Story

The writer of this blog and patient and wishes to remain anonymous.

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I am a 65-year-old married professional male who resides in NYC. About a year ago, I woke up with pelvic pain and I assumed it was a urinary infection. Immediately I went to my urologist, who gave me a urine test which showed a slightly elevated white blood cell count and was given antibiotics for two weeks. Despite this treatment, the pain continued and I went for another test, which was negative.  I was told I had an inflamed prostate and to avoid spices and caffeine. This pain was so severe and constant that it affected all my daily life activities. Even painkillers, which I took for a short duration, could not relieve the pain.
Having performed my own internet research, for the better or worse, I came across several blogs on how pain sufferers had these similar symptoms that remained unresolved for years. The majority of these blogs focused on the perineal nerve, which I thought could be my issue. Therefore, I then went to a neurologist who claimed this was not the problem and then had other nerve blocks without any relief. Neither the urologist, neurologist, or general practitioners could offer any explanation.
Then, going back to the internet I found the keyword “pelvic pain”, which unlocked this pain mystery with services offered by only a handful of providers. The explanation was that rather than having headaches or backaches from stress, I was tightening my pelvic floor muscles thus creating pain.
After reviewing the few physical therapy sites I decided to try Beyond Basics for a discussion, evaluation, and treatment. I was able to schedule an appointment right away without needing a prescription from a physician. At my first session, I explained that I lacked the hope that this problem would ever be resolved, but that I would be committed to their program.
Now after almost two months of weekly sessions, my Physical Therapist has led me on a road to holistic recovery guided by exercises, massage, education, and emotional support.  I understand that the scale of pain relief will be a roller coaster, but now for the first time, I can relax when there are dips in pain.
I want to conclude my first blog by saying that my Beyond Basics PT has given me “hope” by defining the problem and offering a solution with life lessons on how to deal with this issue that is unknown to so many people.
It has been a few weeks in which I have no pain, feel fully recovered and I am back to appreciating life.

Anonymous

 

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)

 

 

Yeast the Inflammation Beast

 

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Fiona McMahon DPT, PT

You are what you eat. Trash in equals trash out. You can’t exercise yourself away from an unhealthy diet. These adages are often on my mind as I make my food choices because of the myriad health professionals who have taken time to come to our practice to tell us how we can improve our own and our patients’ health by taking more time to look at what we are consuming in our diet. Lately, many of these clinicians have been focusing on candida overgrowth and diet, which can contribute to pain and inflammation conditions.

What we eat can directly affect the bacterial and fungal makeup of the gut, AKA the gut microbiome. The gut requires a certain level of good bacteria to help us digest what we eat. Over time a poor gut microbiome can affect how efficiently the gut works. The function of the gut goes beyond just digesting food but also is vitally important for the production of neurotransmitters, which help to spread messages within the brain and throughout the whole body.  The microbiome also plays an important role in our hormones and immune system. When the microbiome of the gut is not balanced, it is called dysbiosis.

One of the most common culprits in gut microbiota dysbiosis is candida, (Yeast!). Candida is a naturally occurring inhabitant of the body and when it’s at appropriate levels, it doesn’t tend to be noticed, but anyone who has experienced a yeast infection knows that if this little guy is allowed to go unchecked, it can do a lot to make you miserable. Besides plaguing women with itching, burning vulvas, a yeast overgrowth may cause many other ailments.

Science has pointed to the role candida can play in contributing to chronic and inflammatory conditions. In one study by Kumamoto in 2011, candida overgrowth was associated with delayed healing of inflammatory lesions and was associated with pro-inflammatory cytokines (chemicals) and increased incidence of inflammatory bowel disease like ulcerative colitis and Crohn’s disease.

Yeast overgrowth can also affect the bladder along with over colonization of Saccharomyces (another form of fungus). In fact, yeast and Saccharomyces were found to be higher in women during a flare of interstitial cystitis than when their symptoms were low.

Yeast is not the only organism that can get out of balance and affect our bodies in harmful ways. There are many other players that can get out of balance. Some signs of an altered gut microbiome is a history of allergies, eczema, or repeated fungal infection.

 

What to do?

It all seems pretty dire, right. How do you control who is colonizing your gut, when you barely have enough time to make it to the gym after work? There are a few simple steps you can start with.

Avoid antibiotics, unless your doctor thinks you need them.

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The medical community has become a lot more aware of the dangers of over-prescribing antibiotics from their perspective, but it is important to keep in mind that a powerful antibiotic can wipe out good bacteria and bad bacteria in one fell swoop. If the good guys in your gut are reduced, the bad bacteria have a better chance of taking over. Take antibiotics only when recommended. Keep in mind antibiotics will not help treat viruses like the flu, they can only treat bacterial infections.

Modify your diet

close-up-cooking-cuisine-629093.jpgIncrease your consumption of good fats (omega 3’s) to help reduce inflammation.

Food high in omega 3’s includes flax and hemp seed/oils, fish (the fishier the fish, usually means more omega 3’s, for example, herring is higher in omega 3 than a milder fish like snapper). Also, reduce your consumption of processed foods which can increase inflammation levels and eliminate simple sugars and fried foods. If this is only minimally successful, try a gluten and dairy free diet.  

If simple changes are not helping consider seeing a professional

Find a naturopath, functional or integrated MD, or nutritionist who can investigate more fully whether or not you have SIBO (Small intestinal bacterial overgrowth), candida overgrowth, or other gut microbiome disorder. Or perhaps you are lacking certain ingredients, vitamins or mineral.  These professionals can tailor a diet and medication regimen to help return your gut microbiome to tip-top shape.

fiona2018

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)

 

 

Sources:

Kamamoto C. Inflammation and gastrointestinal candida colonization. Cur Opin Microbiol. 2011;14(40): 386-391

Bringing Things into Balance: The Relationship Between Low Back Pain and the Pelvic Floor

By: Katie Parrotte, PT, DPT, OCS, CFMT

Back Pain or Fitness (2)The Occurrence of Low Back Pain

Low back pain is the most common cause of disability and lost work time among working-age adults in industrialized countries (1). In fact, the worldwide prevalence of chronic low back pain has been estimated to be 11.9% of the population on a given day, and 23.2% of the population in a one-month period (2). That is a significant number of people! Determining effective treatments for low back pain can be challenging for various reasons: 1. there are no clearly defined risk factors that predict the development or outcome of low back pain; 2. most patients do not present with any significant findings physiologically or anatomically; 3. and pain can generate and spread at numerous locations within the nervous system, and can constantly change (1).

Treatment of Low Back Pain

There are many challenges associated with low back pain diagnosis and outcomes. Because of this, and the fact that so many people across the globe are impacted by it, there are many options out there for treating this condition. Some methods that have been proven to be effective are spinal manipulation (a high-velocity thrust applied directly on the vertebrae, or backbones, to improve movement and decrease pain), trunk coordination, strengthening, and endurance exercises (to target deep abdominal and back muscles that help to stabilize the spine), general fitness exercise, and patient education (1). These types of interventions are certainly helpful and have allowed many individuals experiencing low back pain to return to their daily lives. However, perhaps the areas that are being addressed with these interventions are not getting to the whole story… There is another area of the body that plays a significant role in the stability of the back but does not regularly get addressed with standard treatment to low back pain: the pelvic floor.

Treating the Pelvic Floor to Address Low Back Pain

Several studies have looked at incorporating pelvic floor-specific strengthening programs in the treatment of chronic low back pain. One study looked at women who were experiencing low back pain and urinary incontinence (the involuntary leakage of urine) (3), while two others looked at individuals experiencing chronic low back pain independently in men and women (4, 5). In all three studies, investigators compared “routine” physical therapy to routine physical therapy plus the addition of pelvic floor strengthening. Results revealed that incorporating pelvic floor strengthening decreased low back pain, decreased the incidence of urine leakage in the case of urinary incontinence, improved function based on specific questionnaires, and increased pelvic floor strength and endurance (3-5). This strengthening was completed by either performing isolated pelvic floor contractions (4, 5), or performing abdominal and pelvic floor muscle contractions while performing specific stabilizing exercises (3).

The Relationship Between the Pelvic Floor and the Low Back

Why did strengthening the pelvic floor make a difference in the above studies? This is likely because the pelvic floor is one of the muscle groups that contributes to overall spine stability; the others include the diaphragm, the transverse abdominis (a lower abdominal muscle), and deep muscles in the low back (3). Several studies out of Norway and Sweden have revealed that in women without pain, the pelvic floor activates just prior to arm or leg movement (6-8). This is important because it reveals that when the pelvic floor is working efficiently, it provides stability to the trunk and pelvis, allowing for functional postures and movements to occur.

Conclusion:

The pelvic floor is an important stabilizer of the spine and pelvis, and activates just prior to movement to allow for efficient function. When an individual is experiencing low back pain, not only do the abdominals and low back muscles require strengthening, focusing on the pelvic floor can help to eliminate pain and resume daily function.

If you or someone you know is struggling with unresolved low back pain, make an appointment with a pelvic floor physical therapist today for further assessment. Feel free to contact our midtown office at 212-354-2622 or our downtown office at 212-267-0240, or visit our website (www.beyondbasicsphysicaltherapy.com) for more information!

Thank you so much for reading our blog.

K5 (2)

Katie Parrotte, PT, DPT, OCS, CFMT practices at our midtown location.

If you have questions about orthopedic, pelvic, or sports physical therapy, including back pain, 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)

Sources

 

1. Beattie PF. 2016. Current concepts of orthopedic physical therapy – the lumbar spine: physical therapy patient management using current evidence, 4th edition. (p. 3) Orthopedic Section – APTA.

2. Hoy D, Bain C, Williams G, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012; 64 (6): 2028-2037. doi:10.1002/art.34347.

3. Ghaderi F, Mohammadi K, Sasan RA, et al. Effects of stabilization exercises focusing on pelvic floor muscles on low back pain and on urinary incontinence in women. Urology. 2016; 93: 50-54.

4. Mohseni-Bandpei MA, Rahmani N, Behtash H, et al. The effect of pelvic floor muscle exercise on women with chronic non-specific low back pain. Journal of Bodywork & Movement Therapies. 2011; 15: 75-81.

5. Bi X, Zhao J, Liu Z, et al Pelvic floor muscle exercise for chronic low back pain. Journal of International Medical Research. 2012; 41 (1): 146-152.

6. Sjodahl J, Gutke A, Ghaffari G, et al. Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the active straight leg raise in women with and without pelvic girdle pain: an experimental study. Clinical Biomechanics. 2016; 35: 49-55.

7. Stuge B, Saetre K, Hoff BI. The automatic pelvic floor muscle response to the active straight leg raise in cases with pelvic girdle pain and matched controls. Manual Therapy. 2013; 18: 327-332.

8. Sjodahl J, Kvist J, Gutke A, et al. The postural response of the pelvic floor muscles during limb movements: a methodological electromyography study in parous women without lumbopelvic pain. Clinical Biomechanics. 2009; 24: 183-189.

Be a Bladder Whiz! Healthy Bladder Tips for All!

Fiona McMahon PT, DPT and Amy Stein PT, DPT

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

So what are we working with?

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

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

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

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

So how do I help my bladder?

Posture

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

Stretch!

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

pelvic health book pics 001

Here’s how to do the stretch

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

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

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

Bladder Training

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

 

Diet

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

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

Manage Constipation

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

 

Physical Therapy Can Help Cure!

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

fiona2018amy2016

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)

World AIDS Day

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

What is AIDS/HIV?

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

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

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

HIV Testing

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

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

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

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

 

HIV/ AIDS and Physical Therapy

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

You can mark today by doing a number of things:

Wear a red ribbon to spread awareness

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

United Nations (UN AIDS)

https://donations.unaids.org/

UNICEF

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

 

Resources:

HIV/Screening:

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

Pelvic Floor Myth Busters! Does Holding in Your Pee Cause UTI’s?

Fiona McMahon PT, DPT (Pronouns: She, Her, Hers)

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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!

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Fiona McMahon is currently seeing patients at our Midtown Location

 

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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