Diet and Endometriosis

Fiona McMahon, DPT

Yellow ribbon
Yellow ribbon, Bone cancer / Osteosarcoma. Endometriosis awareness.

March is Endometriosis Awareness Month. Endometriosis is a condition that is near and dear to our hearts at Beyond Basics Physical therapy. Endometriosis is a gynecological disease that occurs when a tissue similar to the lining of the uterus implants itself outside of the uterus in the abdominal and pelvic cavity. It is an inflammatory condition, whose symptoms can vary from mild to severe. Most commonly endo is seen as causing painful periods, but it can also cause bowel and bladder symptoms, issues with fertility, pain with sexual activities and general pain. For the past two years we have done a post about endometriosis during endometriosis awareness month on how musculoskeletal pain can be a contributor or the primary cause of abdomino-pelvic pain condition. To learn more about how the disease affects the body and its symptoms as well as how we treat the condition at BBPT click here:

For this year’s Endometriosis Awareness Day I decided to review an article on how diet may or may not affect endometriosis. The full version is here for free:

http://www.rbmojournal.com/article/S1472-6483(13)00007-2/abstract

About this Article

The article by Fabio Parazzini and his colleagues is a literature review. The point of a literature review is to aggregate many studies on one topic and determine a general trend in the data in one place. A literature review is not as powerful as its cousin a meta-analysis, in which more powerful statistical tools can be applied to interpret the data. Nonetheless, literature reviews can provide us with a general sense of what is going on in a certain field of research.

First things first, let’s talk about the limitations of this review. Designing a single study on endo and diet can be rather difficult. First of all, not all endo is the same. Women with endo can experience vastly different symptoms that don’t always correspond to the amount of endometrial deposits seen on laparoscopy. It can be really difficult for researchers to ensure they have a homogeneous (or similar) study population. Secondly, studying something like diet it usually correlational and not causal. Diet can reflect a lot of other components besides the nutrients going into one’s body. Diet may reflect factors such as culture, wealth, education, geographic region, which all may play independent roles in the diagnosis and progression of endo. Most of the studies examined were based on self-report, which also may not be entirely accurate.

Now that we have the caveats out in the open, let’s talk about why a study like this is useful. Like I said before, this article is an aggregation of multiple other publications. When we see similar results produced by different authors in different groups of people, it lends a little more weight to the individual study’s findings. Most importantly Parazzini is also careful to include information on why a particular food group may be more beneficial or even harmful in the progression of endometriosis.

What the Article Found

Green Vegetables and Fruit

The authors found two studies that show that a higher intake of green fruits and vegetables reduce the risk of endometriosis. They found that the higher the intake of green fruits, specifically (think okra, etc) caused the decreased risk of endometriosis and did not find the same relationship with green vegetables (think kale, spinach, and lettuce). Parazzini notes that green vegetables and particularly fruit are high in a compound called organochlorine, which has been shown in other studies to reduce the risk of endometriosis. Organochlorines are a particularly broad class of molecules and can be found in healthy things but also make up compounds used in industrial purposes. This study is referring to those occurring naturally in vegetables and fruits.

Vitamin A

Vitamin A is found in animal products like fatty fish, dairy, and animal kidneys and livers. Its building blocks are found in green and orange vegetables and fruits and can be manufactured into vitamin A in the body. Parazzini and colleagues found mixed results some with no benefit for development of endo and some that did show benefit. No studies showed harm.

Vitamin C and E

These vitamins were not consistently found to be helpful in reducing endometriosis risk. Some studies reported that increased amounts of vitamin C and E intake reduced risk of endometriosis, while other studies failed to yield significant findings. Parazzinni did provide evidence from other studies which demonstrates the antioxidant properties of vitamins C and E. Parazinni purposes that because there may be a link between oxidative stress and disease, vitamin C and E may be helpful in reducing the inflammation associated with endometriosis.

Red Meat and Saturated Fat

Again, results were mixed. Saturated fat mainly occurs in animal products. Some studies found a correlation between red meat and endo risk, but no association with butter. In other the results were flipped.

Other items investigated

  • Soy
  • Olive Oil
  • Fish and Omega 3
  • Minimal to no evidence supporting associations between endo and dietary intake for any of these products were found.

 

What’s it All Mean?

One of my patients once told me she was instructed to finish every study, with the phrase, “more research is needed.” This is certainly the case in the field of endometriosis treatment. There’s a lot about endometriosis that we don’t understand We need well constructed studies that will allow researchers to do more powerful meta-analysis to help guide our treatment. This review was only able to include 11 studies for review out of the 256 initially found.

With all that said, I do think there are some key takeaways from this study. There was a general trend in healthier foods and more promising results. Parazinni was also diligent to include mechanisms by which these healthy foods could be helpful. Secondly, there was no harm found by eating what is considered a healthy diet, (high in greens and vitamins). These findings, although small, in combination with the general benefits of a healthy diet, should encourage patients with endo to explore in more depth how eating certain foods affects their symptoms.

At Beyond Basics we take pride in treating our patients from a holistic perspective and we appreciate that we can collaborate with other healthcare providers in our community, including expert nutritionists, naturopaths, functional medicine doctors and mental health therapists. We find that the combination of diet, specific physical therapy techniques, mental health and self-care, can significantly reduce pain and other symptoms and improve function in many patients. Our clinicians specifically are experts in manual therapy techniques such as visceral and connective tissue mobilization techniques, myofascial release and other soft tissue mobilization techniques discussed in the previously mentioned endometriosis blogs. If you are suffering from endometriosis, come visit us today.

Learn more about what we do at BBPT with our upcoming PH101 classes, which are free to the public. Here are some you may find interesting:

April 6th: Does my diet really matter?

April 13th: Pain & Sexuality: Is it all in my head? No, it is not!

April 20th: Ladies Only Session

April 27th: Optimize reproductive health

May 4th: Improve your birthing experience.

All events are at 7pm with light snacks.

Register at: pelvichealth-101.eventbrite.com because space is limited!!

See full list of classes below

pelvic-health-101-spring-2017

The use of Breath in the Pilates Method

Denise Small PT, DPT

The following series of Pilates blog posts will focus on the principles that define the Pilates method.  Joseph Pilates developed his methodology using eight basic movement principles: whole body movement, breathing, balanced muscle development, concentration, control, centering, precision, and rhythm.  Today’s blog will focus on the principle of Breathing.

pilatesBreathing is a natural phenomenon that is performed thousands of times a day. Our daily intake of oxygen and expulsion of carbon dioxide is needed to cleanse our blood, and maintain the functioning of our body systems.  That being said, there are different ways to manipulate one’s breath to help facilitate certain physiological functions. For example, there have been many BBPT blog posts about diaphragmatic breathing, where one breathes into their abdomen to get a stretch of both the diaphragm and the pelvic floor muscles. Well, Pilates had his own approach to breathing, which was a variation on Diaphragmatic breathing.  Pilates approach to breathing was aimed at getting maximal air intake and release to give the body, what he called, “an internal shower” to rid the body of “toxins”. Pilates focused specifically on lateral expansion of the diaphragm, whereas traditional diaphragmatic breathing focuses on the vertical expansion of the diaphragm. In order to achieve this, Pilates encouraged maintaining the engaged tone of the abdomen, while breathing into the front, sides, and back of the ribcage. See the image below for further explanation.

 

Pilates- Ribcage/ Chest breathing versus Belly/Diaphragmatic breathing

This is an overly simplified view of the actual mechanics. However, both versions are very important. With the ability to differentiate between ribcage and diaphragmatic breathing you can offer your diaphragm a 3-dimensional stretch and the ability to work on abdominal contraction as well as endurance. If you have any questions you can ask them in the comments section. Or come visit me at Beyond Basics for a Pilates Private session!

Yeast the Inflammation Beast

 

candida-albicans

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 of 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 make up 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, 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 were 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 was 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.

 

 

PillsThe 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

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Increase your consumption of good fats (omega 3’s) to help reduce inflammation.

Food high in omega 3’s include 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

doctorFind 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.

 

 

Sources:

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

BBPT Health Tip: Adding Pelvic Floor Relaxation to Deep Breathing

Amy Stein DPT, PT and Fiona McMahon DPT, PT

 

bookhppThis blog contains information adapted from Heal Pelvic Pain by Amy Stein. If you are interested in learning more about pelvic floor exercises you can do on your own, please visit http://www.healpelvicpain.com/ , http://amzn.to/2ioSz2J, or visit us at Beyond Basics Physical Therapy in New York City to get your copy today.

 

In an earlier post we discussed the positive benefits of adding diaphragmatic breathing to your routine to reduce stress. If you missed it, check it out here .

But why not go a step further. Did you know that you can add pelvic floor drops to your breathing routine to help relax a tight and painful pelvic floor.

 

What is a pelvic floor drop?

A pelvic floor drop is the relaxation of the muscles of the pelvic floor. It is like that feeling you have when you can finally relax the muscle in between your legs after holding urine in for a long time. It’s a great feeling of relaxation and here’s how you can mimic it when you don’t have to go.

 

But How do I do it?

 

  • Step 1: Get comfortable. Sit, stand, lay down, whatever suits you, relax your body and close your eyes
  • Step 2: Breathe deep. Inhale between 3 and 5 seconds
  • Step 3: Exhale. Exhale slowly, 5-6 seconds. As you exhale imagine your breath gently placing pressure on your pelvic floor into relaxation. Don’t push or strain.

Like diaphragmatic breathing, you can use this technique throughout the day to help reduce stress and pain in the pelvic floor. Happy breathing!

BBPT Health Tip: Seated Hamstring Stretch

Fiona McMahon DPT, PT

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Fenitra, of BBPT shows the correct way to perform this stretch. Notice how she doesn’t curve her back forward in order to perform the stretch

Seated Hamstrings Stretch

Hello folks! Beyond Basics Physical Therapy’s latest health tip is the seated hamstrings stretch!

Why seated you ask? In selecting this stretch over other hamstrings stretches, I wanted to pick something that most everyone can be able to do. This stretch is particularly beneficial for those of you who have difficulty getting on and off the floor. Although if you do have difficulty getting off of the floor, it is important to go to physical therapy and get the training to do so, as being able to independently get up off the floor is imperative for maintaining independent function as you age.  Another point: if you have any sciatic pain or sitting pain, please seek a physical therapist before attempting this stretch.  

Muscles involved: Hamstrings, gastroc soleus complex ( your calf) and to some extent your sciatic nerve

Stretch Type: Static: Best if performed after workouts on warm muscles. Exercise caution if stretching cold muscle, because unwarned muscle doesn’t stretch as well as warmed up muscles.  

Caution: It is possible to overdo it. Stop the stretch or ease up if you feel tingling in your legs or pain in your low back.

As always: No stretch should ever be painful. If a stretch is painful, stop and consult your physical therapist for modifications.  

 

Directions:  Sitting in a sturdy chair, ( don’t do this on a rolly stool or office chair, please!). Straighten knee of leg to be stretched and point toes up. Lean forward at the hips until you feel a gentle stretch in the back of your leg. Don’t round your back. Keep in mind, for those of us with tight hamstrings, you will feel the stretch without too much of a forward bend.  So take it slow!

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Fenitra demonstrates a straight knee and pointed toe while performing her stretch
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Fenitra demonstrates this stretch

World Aids Day

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Today, December 1st 2016, 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 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 do not know they have the virus. Testing is necessary to start treatment and reduce harm done to your immune system as well as risk of transmission to others.

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

  • You have had sex with someone who is HIV positive, or someone whose status you were unsure of since your last test
  • Had tuberculosis or hepatitis
  • Used shared needles
  • Been diagnosed with another type of sexually transmitted disease

HIV/ AIDS and Physical Therapy

Physical Therapists do not treat AIDS or HIV, rather, they treat 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

Sources:

AIDS.gov

Resources:

HIV/Screening:

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

How to Improve Bladder Health

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 honor of bladder health month, 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

bladder_ureteral_cancer-1

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:

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 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. For more information on prostate cancer click here (link to old content). Also keep your eyes peeled for a blog on non-bacterial prostatitis coming soon!

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.  

Conditions of the Bladder

Gotta_Pee_Toilet_signsIncontinence

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 (link to content)
  • 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”, “Women 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.

water-life-cropDiet 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. Check out John’s Hopkin’s bladder irritant list here { hyper link ( navigate to seperate window)], 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 ( link to BBPT here). 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