Are you peeing your pants when you sneeze?

If you said yes, it’s important to know that any urinary leakage is not normal! 

There is a lot of talk about “Kegal exercises” and the pelvic floor muscles… in 1948 Arnold Kegal, a gynecologist practicing in California, was the first to report that pelvic floor muscle training (PFMT) was effective in treating urinary incontinence (UI), and it's still the first choice of treatment today! (1,2,3)

A recent article reported, “The prevalence of UI was high in a national sample of the US adult population, with almost 1/2 of  women and 1/6 of men reporting urinary leakage.”

Delivering a baby is stressful for the pelvic floor. If we consider all the anatomical structures involved during a vaginal delivery, then we can start to look at other reasons for incontinence. (4)

The potential suspects are the:

• vascular system, especially “the venous plexus around the urethra,” JP Barral, P.T., D.O (5) 

• pelvic nerves going to the pelvic muscles and organs

• bladder and urethra can be injured during delivery

• pelvic fascia and ligaments of the organs

• pelvic floor muscles

During labor and delivery these structures can become overstretched, compressed and torn, resulting in pelvic floor dysfunction.

Incontinence has been linked to forceps use, duration of labor and the number of previous deliveries. There also appears to be a relationship between epidurals during labor and the severity of pelvic floor injuries. (6,7)

What should you do if you have leakage?

• Visit a pelvic floor therapist, incontinence is a symptom and can be treated

• Kegals are helpful! Contract the pelvic floor muscles before coughing, sneezing or laughing. This is called the “knack”

• Yoga and Pilates are good for core strengthening, make sure you are using the “TA” muscles

• Hydrate, women reduce their water intake to avoid leaking!

• Wearing pads are only a short term solution

References

1. Kegal A. H. 1948. Progressive resistance exercise in the functional restoration of the perineal muscles. American Journal of Obstetrics and Gynecology 56:238-249

2. Hay-Smith E, Bo K., Berghmans et al 2001. Pelvic floor muscle training for urinary incontinence in women (Cochrane review). The Cochrane Library, Oxford.

3. Wilson P D, Bo K, Nygaard I, et al 2002 Conservative treatment in women. In: Abrams P, Cardozo L, Khoury S et al (eds) Incontinence. Plymbridge distributors, Plymouth, UK, p 571-624

4. Koelbl H, Mostwin J, Boiteux J P et al 2001 Pathophysiology. In: Abrams P, Cardozo L, Khoury S et al (eds) Incontinence. Plymbridge distributors, Plymouth, UK, p 203-242

5. Jean Pierre Barral, New Advanced Urogenital Manipulation, Copenhagen, October 2017

6. Cutner A, Cardozo L D, 1992 The lower urinary tract in pregnancy and the puerperium. International Urogynecology Journal and Pelvic Floor Dysfunction 3:312-323

7. Francis W J A 1960 The onset of stress incontinence. The journal of Obstetrics and Synecology of the British Empire 67:899-903

A few secrets to keep your bladder at bay!

The urinary bladder is a storage sac for urine, it has the ability to change shape from triangular to ovoid as it bulges upwards into the abdomen. It empties through a tube called the urethra and other parts of this drainage system include the kidneys and ureters connecting into the back of the bladder.

Did you know that 50-60% of women report having a UTI, or urinary tract infection at some point in their life? UTI’s are so common that we neglect to think that recurrent infections are harmful for the entire urinary system. 

Recurrent UTI’s are mainly caused by reinfection of the same pathogen. They are the most common medical complication during pregnancy and E. coli is responsible for > 80% of all UTI’s. 

It’s important that all pregnant woman are screened for UTI’s at their first prenatal visit and during the third trimester.

Here are a few secrets…

1. Hydrate with water and make sure you are keeping it inside your body! Diuretics such as caffeine, alcohol, chocolate and fizzy drinks make you urinate frequently and dehydrate you.

2. The obvious things: wipe from front to back and empty after sex.

3. Keeping vaginal pH to a norm by wearing cotton underwear and staying away from irritating feminine products. Do not douche!

4. D-mannose has also been found to help prevent UTI’s.

If you start to show any signs of a UTI like: 

• Pain or burning with urination

• Fever, tired or shaky

• Bladder urgency and frequency (a strong urge to go, even though only a little comes out)

• Lower back or abdominal pain

• Urine that smells bad, looks cloudy or has blood in it

Try this “Home Remedy”

Measure 1/2 teaspoon of baking soda to 4 oz filtered water

Ingest 2-3 times per day until symptoms subside…if symptoms get worse within 24-48 hours then you need to see a doctor for urine analysis and you may need to take antibiotics. 

If you can, try to avoid taking antibiotics, they can destroy the body’s natural defenses. Be smart, situations are sometimes unavoidable. Listen to your own body!

As a women’s health physical therapist…

UTI’s are a concern, infection creates scar tissue, and this scar tissue organizes itself in such a way that shortens the urethra, preventing urethral lengthening and compromising it’s function. A recent pilot study by Brown and Ross, showed a correlation between a shortened urethra and urinary leakage in women aged 32-47 years old. Incontinence will be a  great topic for next time!

How to take care of your gut bacteria: An expert's guide!

Dr. Bruno Donatini, M.D., Ph.D., D.O., an expert in evaluating and treating imbalances of intestinal bacteria, gave an insightful presentation at the Fascial Crossroads Conference in Rome this past October. He stated that, “gastroduodenal emptying disturbance is probably the first step leading to 90% of metabolic disease.”

Many people can no longer eat foods freely, they experience symptoms such as bloating, abdominal pain, heaviness, drowsiness, flatulence and belching.

Where does one begin? There is access to so much information and it is confusing!

An easy and effective way to assess the state of someone’s intestinal flora is using a Hydrogen Breath Test. Any physician can do this test but it’s most commonly used by gastroenterologists and naturopaths.

Dr. Donatini shared a few natural and easy tips for keeping the good intestinal bacteria.

These are some of his guidelines:

1. You must clean your mouth! 

• The best way to do this is with hydrogen peroxide

• Dilute 1/8 cup of hydrogen peroxide (3%) : 1/8 cup of water

• Once mixed, use immediately

• Swish around your mouth for 2 minutes daily before bed

2. Use essential oils: Thyme and Oregano (Only use high quality and organic pure essential oils)

• Essential oils can be absorbed through the skin using a carrier oil 

• Good carrier oils include: Organic Jojoba and Sweet Almond

• The ratio is 20 drops carrier oil : 1 drop essential oil 

• If you are sensitive to essential oils, use 30 drops carrier oil : 1 drop essential oil

• Gently massage your entire abdomen before going to sleep

OR

• Ingest Thyme and Oregano essential oils

• 20 teaspoons of Organic Ground Flaxseeds : 1 drop Oregano or 1 drop Thyme 

• Shake and store in an airtight mason jar

• You can use the two oils together, and will need to add another 20 teaspoons of ground flaxseeds

• Take 1/2 a teaspoon twice per day or mix in something like a smoothie 

Use the essential oils for up to 6 months, 2 months minimum. He also recommends the FODMOP diet to detox.

3. Eat mushrooms

Dr. Donatini became interested in medicinal mushrooms in 1994, he published the first scientific  study on their therapeutic benefit treating oral humanpapilloma virus (HPV). 

What about probiotics?

Dr. Donatini does not consider probiotics a long term solution and it may not be a good idea to add bacteria to the gut, especially in cases of bloating and poor gastric emptying.

It’s most important to slow down the proliferation of bacteria that “cut and damage” the tissue. Any inflammation or bleeding of your gums is a sign of poor gut flora. 

If you are concerned about fertility…

Start cleaning your mouth, bacterial imbalances can lead to infertility. 

This also applies if you are pregnant, you should have a daily mouth cleaning routine, it will help your baby’s immunity and potentially prevent autoimmune diseases.

Last tip: Significantly reduce or eliminate your sugar intake!

Next month I will share a home remedy from Dr. Donatini to treat UTI’s.

Happy mouth cleaning!

Good advice for better breast health

October is breast cancer awareness month, and it's estimated that 1/8 women will develop breast cancer in their life time. There are some situations that we have little control over, women can be genetically predisposed, and we are unable to hide from all the environmental toxins out there.

What we can do to help prevent breast cancer, is regular breast massage, whether it's self massage, or with a partner, the more positive and loving attention your boobs get, the better it is for their health! 

Researchers in California found that malignant breast cells that were compressed and squeezed, stopped growing. The untouched cells continued to grow uncontrollably in a way that leads to cancer.

Breasts are glandular organs made of fatty tissue, and a network of lymphatic vessels that connect to lymph nodes in the arm pit and lower neck. They can become sensitive and painful at different stages of the mensural cycle, typically at ovulation, pre-period and during your period. When they become heavy and larger in size, it’s a sign of fluid congestion.

Breast massage will help move lymph fluid and encourage the elimination of toxins, while improving oxygenated blood flow. It also has the added bonus of firming up your boobs, making you just a little more perky!

Try this daily or weekly routine... 

It can be practiced lying on your back or in an upright position, after a shower is a great time!

1. Start with rubbing a small amount of coconut oil onto the palm of your hands.

2. Use your hands to cup the bottom of each breast, gently lifting them upwards, and moving your hands around the entire breast in an outward circular motion, repeat for 10 circles. 

3. Then open your armpit, lifting your arm about 60 degrees. With the opposite hand, gently sweep your over the entire breast, moving fluid out and into the armpit, repeat 5 times on each side.

4. Place your finger pads into your armpit, use your thumb to make circular clockwise movements, kneading the pectoralis muscle, this may feel tight and ropey from spending hours in front of a computer. Massage for 30 seconds on each side.

5. If you have time, finish with a gentle chest opener on the lying on the floor, using a yoga block in-between your shoulder blades, and arms stretched into a “T ” shape. Breath into the opened chest space for 5-10 breaths.

6. Finish with drinking a glass of filtered water to flush the toxins.

7. Wear a properly fitted bra, wireless is best! When you get home, take it off and let the girls out.

8. Be mindful of what you put on your skin, no deodorants with aluminum on the label.

9. Don't forget, always be kind to yourself, especially during your boob rub! :)

How healthy are your reproductive organs...

This may be a thought that crosses your mind when you are reaching your mid 30’s or when you seriously want a baby. 

As a culture, women are having babies later in life. The average age for first time mums in the US is 28, it was 26.3 in 2014. The 2016 CDC report found a first time rise in the number of births for women ages 30-34. 

So if women are starting to have babies in their 30’s, and pregnant women at 35 are labeled as having “advanced maternal” or anxiety provoking, “geriatric” pregnancies…

What can we do to preserve our fertility, other than freezing eggs? 

Challenges with conception and carrying to full term affects 12.1% of american women , 7.3 million have tried invasive and expensive fertility treatments.

Our reproductive system is beautifully complex, functioning on precise timing with a delicate balance of hormonal activity, controlled by the nervous system, and traveling through the blood. Any disruption within this system can throw the synchronicity off! 

Manual therapy can be extremely helpful in promoting the health of your reproductive organs, as well our body as a whole. A healthy functioning organ, like an ovary and uterus, moves within a certain range of movement, and it has motility (an intrinsic movement within the organ itself). 

All of these movements or lack of movement can be assessed, and treated by a skilled manual therapist practicing visceral (organ) manipulation.

When an organ has abnormal movement, it does not do its job well! 

The function of the ovaries are to release 1-2 eggs per month, as well as releasing estrogen and progesterone, two important reproductive hormones. Ovarian restrictions can impact ovulation and create hormonal imbalances. (Harvey, 2010)

Fallopian tubes allow released eggs to meet potential sperm and implant into the uterus. Blocked tubes will prevent conception, restrictions on the outside will limit their movement, and an egg may miss it’s opportunity to connect with a fallopian tube.

The uterus, when restricted in any direction can compress nerves and arteries. This compromises blood flow essential for supporting and nurturing a developing baby. During orgasm the uterus rhythmically contracts lifting upwards while opening the cervix, lack of movement or loss of cervical opening will adversly affect fertility. (Barral,1993)

What prevents these organs from moving?

Scar tissue or adhesions caused by:

• Poly Cystic Ovarian Syndrome (PCOS)

• Endometriosis

• Pelvic infection- STI’s, BV, yeast or pelvic inflammatory disease

• Any abdominal and pelvic surgeries

• Cervical cone biopsies or LEEP procedures

• Trauma- falls onto the pelvis/tailbone, seat belt injury, sexual abuse or an emotional trauma

• Abortion, D&C or Miscarriage

• Child birth and C-section

• Intrauterine Devices (IUD)

The good news is…

In 2015, a ten-year retrospective study of 1392 female patients diagnosed with infertility were treated using a whole body manual therapy approach. 

The results are truly promising, 40-60% of the women were successfully pregnant, 43% with endometriosis and 53% with PCOS were able to get pregnant after treatment. 

We need to be proactive about our reproductive health! 

Having enjoyable sex, eating nutritious foods, regular exercise, lowering stress levels, taking supplements/herbs and acupuncture all support reproductive function. 

However, if there is a mechanical reason why women or men are struggling with fertility, it can be treated by mobilizing the specific structures involved. It could potentially reduce a lot of anxiety, and expense if manual therapy is tried first! 

In cases where medical assistance is still needed, having a uterus that is fully mobile and receiving good blood flow will provide the most optimal environment for pregnancy and delivery.

References: 

1. https://www.cdc.gov/nchs/data/vsrr/report002.pdf

2. https://www.cdc.gov/nchs/fastats/infertility.htm

3. Harvey, A. A Pathway To Health. How Visceral Manipulation Can Help You. North Atlantic Books, Berkley, California,  2010

4. Barral, J.P. Urogenial Manipulation. Eastland Press, Inc 1993, 2006

5. http://alternative-therapies.com/openaccess/ATHM_23_3_Rice.pdf