pelvic health

Bladder Chat

Bladder, bladder...what's the matter?  

I once did a community talk with that title (Bladder, Bladder What's the Matter?) and I loved it!  Huge turnout which was eye opening to so many women that they were experiencing similar bladder symptoms to the women sitting next to them-no matter their age!

Urinary incontinence, leaking urine with exertion (coughing, sneezing, laughing, lifting, exercise etc), happens to 1 in 3 women.  If you are in a public place today, look around.  That is quite a few women dealing with some sort of leaking.  Some of those women have been dealing with it since childbirth because maybe they were told it was normal at the age.  Some developed it closer to menopause when tissues and hormones started to change.  And some, well, they have been peeing a little bit with exercise since they were teenagers.  OR, maybe some of you don't leak (yet), but are experiencing the "gotta go pee" feeling BEFORE you leave for exercise class, when you get to the gym, during the class (fear of leaking) and then after the session.  Your bladder is owning you.  You fear of leaking is taking over your day and maybe that's why you are only wearing black workout pants anymore. 

No matter when your leaking or frequent urgency began, know this, it is a COMMON thing that happens BUT it is NOT NORMAL.  

You mean I can be fixed?  Sure thing. 

First, if you are having the urgency and frequency, it is possible your pelvic floor muscles are contracting (tightening) and you will want to see a pelvic floor physical therapist to learn how to control and calm them down to decrease your symptoms and take back your control of your bladder.  Think about all the time your will save from running back and forth to the bathroom.  It's worth it!! 

Same goes for leaking urine.  Not all women with urinary incontinence are dealing with just weakened muscles.  A lot of the time, other things are going on, like an imbalance within the muscle tissues.  I see this a lot in postpartum and menopausal women.  The muscles are not communicating to each other correctly and some develop tightness and some are working how they are suppose to.  With seeing a pelvic floor physical therapist, you are able to bring your awareness to those muscles and learn how to control and coordinate them again.  

So...this holiday season while spending time with people you love, why not ask a group of gals (maybe over some wine :) ) who has bladder issues going on and what they have done to improve them.  Maybe even suggest, you know what, this year, let's take back our health and improve these bothersome symptoms by seeing a pelvic floor PT :).

 

What You Need To Know About Pelvic Health

As women, we live in this one body, yet, we still have a difficult time bringing awareness to the pelvic floor muscles and learning how to contract and relax these muscles. This is a topic that surprisingly, not a lot of women are well educated on. I love addressing the pelvic floor muscles, their roles in our health and how they can change with pregnancy and birth.  

The pelvic floor muscles offer many functions to our bodies: they are supportive to our organs, they help pump/ circulate fluid in as we breathe in and out, they aide in sexual function, they control opening and closing of our openings and stabilize our SI joint, pelvis, hip joints and lumbosacral joints. The muscles run from the front of the pelvis at the pubic bone, to the sits bones and attach to the SI/ tailbone area.  When functioning properly, the pelvic floor muscles should fire prior to movement of lifting children, laundry, jogging, grabbing a glass of water etc. So it is important to continue to focus on your pelvic floor muscles through all phases of life.

Your "core" is made up of your diaphragm, pelvic floor muscles, transversus abdominus and your mulitidus muscles in your low back.  So, as you can see, doing abdominal exercises for your "6-pack" muscles, will not target the true core. 

With life, we generally create habits.  Even within our bodies, we tend to do things the same way most of the time.  For example, we tend to carry our children or purse on the same side of our body.  This can create compensations to certain tissues and joints, especially during pregnancy and postpartum.  For instance, during pregnancy we may stand with our bum tucked under, our abdominals stretched and tightness in our backs to hold us up with our growing belly/ uterus.  After birth, our bodies stay in a similar posture, with weakened tissue and we start moving throughout the day making new compensations with carrying an infant or a toddler.   Seeing a pelvic floor physical therapist can help you fire and re-train your core the proper way to improve your core support during pregnancy and postpartum. 

One day, I hope it becomes a natural thing for a women to be seen at least once during her pregnancy and then get an automatic referral to a pelvic floor physical therapist postpartum to check on how the pelvic floor is functioning prior to beginning an exercise routine.  I believe many women would benefit on a prenatal visit with a pelvic floor physical therapist, to figure out how to make their pelvic floor muscles function properly and then what posture and body mechanics would be beneficial to avoid to promote a healthy pelvic floor.  Then postpartum, addressing women's pelvic floor strength, endurance, coordination and any areas related to pelvic floor dysfunction, diastasis recti or scarring from cesarean birth or perineal tearing.  I think so many women are doing too much too soon instead of giving their bodies enough time to heal postpartum prior to jumping back on the exercise train.  Remember, it took your body 9 months to grow that baby (ies), so give it grace with healing.  You will be glad your took your time and were smart with your healing and exercise, instead of rushing back into things.  

"I had a csection, so why do I need to heal my pelvic floor?"

This is a question I seem to get quite often. "I had a csection, so why do I need to heal my pelvic floor?"

During pregnancy, your pelvic floor muscles are compromised and stretched with weight of growing baby and uterus.  This can cause the pelvic floor muscles to be more lax than normal.  Changes in posture during pregnancy, also cause changes to pelvic floor muscles.  For example, standing with your butt tucked under to accommodate growing belly, can cause tightness and change in tone in your pelvic floor muscles.  This can lead to pelvic floor dysfunction (urgency, frequency, leaking of urine, pelvic pain). 

Pelvic floor muscles are also involved if you pushed prior to cesarean birth.  Also, cesarean scars can cause issues with nerve function to the pelvic floor, where you might develop pelvic pain with sex, urethral burning, or feeling of needing to pee all the time.  It is important to get the pelvic floor muscles to function properly with your “core” after birth.  See a pelvic floor physical therapist to re-train your pelvic floor muscles and core to function properly again as you care for your family at home or during an exercise routine.  

Seeing a pelvic floor physical therapist postpartum is ideal.  If you are looking for someone in your area and would like a recommendation, just let me know!!  

Should We See A Pelvic Floor Physical Therapist Postpartum?

Just a little food for thought.  Delivering a baby, vaginally or cesarean, is a difficult job for our body.  I hate to say it, but birth is traumatic to our tissues.  The muscles are stretched during childbirth, some are torn or even cut through, in order to do what is best to get baby out safely.  As a pelvic floor physical therapist, I have often wondered, why are these women missing out on opportunities to improve the function of their pelvic floor and abdominal muscles after delivering a child?  In all other areas of muscle injury (strain) or rupture/ tearing, patients are usually advised to seek the help of a physical therapist for regaining muscle control, range of motion, strength, flexibility, stability and overall function.  For instance, someone might have a whiplash injury (similar to a childbirth with minimal or no tearing), they would see a physical therapist to stretch tight muscles and strengthen weak muscles.  If someone tore their Rotator Cuff, they may have surgery to fix the muscles (similar to repairing pelvic floor muscles or abdominal muscles after delivering a baby(ies)), then they would seek the help of a physical therapist to stretch the tight muscles, regain coordination of the muscles, teach the brain how to connect with the muscles again, and go through a program of improving range of motion and strength/ endurance of the muscles.  

I think we are missing this with our new moms.  Think about it.  Women are pregnant for approximately 9 months (posture changes, back muscles tighten, abdominal muscles weaken etc) and then they go thru delivery (with tearing or not) and their body's are expected to bounce right back while taking care of a rapidly growing new born.

What I see with my patients are poor postural stances of weakened and stretched abdominal muscles, tight and short low back muscles, sometimes tucked bums or ribs thrusts with carrying and lifting baby/ children/ car seat etc.  I think it would benefit so many new moms to be referred to a pelvic floor physical therapist postpartum.  Every new mom could come in for a screen to see if they are having any issues and if there are any things a new mom should be working on in the first couple of months.  I personally think, it would be beneficial to see a pelvic floor physical therapist for a screen PRIOR to getting back into an exercise program.  A pelvic floor physical therapist can evaluate women for diastasis recti, pelvic pain, pelvic organ prolapse, urinary incontinence and proper postural and body mechanics.  Hopefully with seeing  pelvic floor physical therapist, this would prevent more pelvic floor risks and issues in the future. 

So...see a pelvic floor physical therapist today, even for a screen, to see if you would benefit from starting a pelvic floor home exercise program.  Why not support your tissues for a stronger future?  

The Scoop on Poop

Everyone poops.  This is a discussion I had with my 4 year old recently.  He was avoiding going "number 2", until we were getting home at the end of the day. 

We discussed how everyone poops.  Mommy poops.  Daddy poops.  Grandmas and Grandpas poop. His teachers at school poop.  His daycare lady poops.  All the kids he is around all day poop etc.  We talked about the different places people go too.  He seemed shocked that people would poop outside of their house.  I tried to explain, when your body is telling you it needs to get something out, aka for him a belly ache, then you need to listen and go to the bathroom instead of waiting all day and being miserable.  (As this can cause some pelvic problems down the road)

This is often a similar discussion with my patients.  Bowel movements are often a topic with pelvic patients, as the organs are supported by the pelvic floor muscles.  Constipation and frequent bowel movements can both cause pelvic floor issues so it is best to address them when treating pelvic floor symptoms.

Poop kind of has a bad reputation, which is sad, because it can tell you a lot about your health.  So before you flush after your next BM (bowel movement), be sure to take a glance inside the toilet and just see what your poop is telling.  Yes, I said check out your poop!  

Your poop has gone on quite a trip to end up in the toilet.  Remember, at one point, that poop was food.  The salad you ate last night went into your mouth and started the digestion process with chewing (side note: try chewing 20-30 times with each bite to help with digestion).  When you swallowed, it ended up in your stomach where it continued to break down with acids and other organs helped with this process.  The nutrients of your dinner are absorbed in the small intestine. Then your salad became waste product as it reached the colon to begin it's journey of leaving the body.  When stool reaches your rectum, you get a signal from your brain that something is about to exit and make an appearance.  It is best not to hold back your poop, but to take the time to sit down on the toilet, with your knees slightly above your hips (squatty pottys), to have a nice relaxing bowel movement (breathing and "shhhhh-ing" are great tips to help with the relaxation).

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So what does healthy poop look like?  I get this question a lot and most people are surprised there are many types of poop, 7 according to the Bristol Stool Scale :). You want to strive for a Type 3 or 4. If you are more type 1 or 2 it is a sign of constipation, and adding water and/ or fiber can improve this.  If you are a type 5, 6 or 7 regularly, you may have an issue with absorption or have an infection. 

Color of poop is another thing to pay attention to as it can tell you what is going on with your organs.  Poop also gets it's color from your food so don't be too alarmed it if changes red when you eat too many beets or cranberries! Poop should be a nice milk chocolate type of color.  If it is a black, tar like color it can be a sign of bleeding so consulting a physician to rule things out is a good idea.  Stools green/ yellow in color can mean you are eating a good amount of green things or a sign of gallbladder issues.  If you are starting a diet, don't be shocked to have a variety of colors when you glance in the toilet. 

Last one, should your poop float or sink like the Titanic?  Floating poop can be a sign you have too much fat (bad fat) in your diet or issues with your liver or gallbladder.  Cutting back on pizza and fast food may give you a successful poop sink in the toilet.  

What You Eat MAY Affect Your Hormones

The talk of how crazy women can be has been going on for centuries.  Did you know a hysterectomy was thought to cure women of "hysteria"? Crazy right?!  The thought was women were going crazy (mood swings) because their uterus was searching for children.  So they must be cured if you remove it. 

I am thankful to be living in times of modern medicine.  We know so much more now days about what can affect our hormones.  There are lots of options out there, but I will be focusing this blog on more food related items. 

So how can our hormones get "imbalanced"?  The most common causes are: 

  • excess stress
  • lifestyle choices
  • aging
  • genetics
  • lack of nutrients
  • pregnancy, miscarriages and abortions 
  • environmental exposure to toxins

We have quite a bit of control over the above, especially our genetics.  New studies have shown that we can turn on and off genes in our DNA with external factors (such as diet, sleep and stress). How cool is that?!  The DNA is still passed down to your children and grandchildren, but the choices you make today, can affect your great grandchildren.  Pretty amazing.  

So what choices can we make to make a positive change?

  • Start adding dark, leafy greens: most nutrient dense food, yet lacking in a lot of people's diets
    • dark greens clean you blood, improve circulation and improve your immune system by restoring strength and reducing inflammation
    • Start by adding in a 1/2 cup of cooked (lightly sauteed or steamed is best) greens to your day.  Slowly work your way to 3-4 cups of raw and cooked greens
  • Add more healthy fats (Fats! Handout)
    • Women's bodies are made up of about 60% fat.  That's almost 50% more than males and it is important for our fertility (that's hormones ladies!). 
    • When we eat a low fat diet, our bodies have a harder time digesting fat-soluble vitamins (Vitamins A, D, E and K) which play an important role in hormone regulation. 
    • Add more Omega 3s to support brain function (deficiencies have been linked to ADD, ADHD etc) 
    • Examples of my faves: coconut butter and avocados
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How much fat do I need?  It depends.  Start by keeping a journal and see how you feel after eating good fats. I feel better when eating meals with more healthy fats and I find I am eating more fats now than ever before, somewhere between 30-50% of my daily food, especially while pregnant. Eating more healthy fats has been shown to help some women regulate their hormones to getting their periods/ cycles back on track (while reducing their carbs, not eliminating them).

  • Chewing starts your digestion and most of us aren't chewing our food enough.
    • Chewing less makes it harder for food digestion to occur and can cause bloating, gas, abdominal pains, constipation/ diarrhea etc 
    • TRY chewing your bites 20-30 times and see if you notice a difference in how you feel!

So again...

  • Take longer to chew your bites (20- 30 times)
  • Add 1/2 cup of leafy greens to 1 meal a day, working up to each meal 
  • Add good fats to one meal.  It might be avocado slices to your eggs in the morning or to a salad at lunch.