Urgency Part 2: Your Bladder is a Big Fat Liar

In Urgency Part 1 we talked about what Urgency is, and what might contribute to it. Again, an urge is a sudden strong sensation to empty your bladder that is hard to postpone.

What’s so abnormal about this sensation, you might ask? Let me break it down.

Our bladder’s job is to fill, hold, then empty. That’s it. All day long, it moves through that cycle. The walls of the bladder are a muscle. That muscle relaxes to fill and hold, then contracts to empty. It’s a smooth muscle though, meaning you can’t control it—it’s like the muscle of your heart (thank goodness we don’t have to think about contracting that one, right?!).

A normal “full bladder” sensation is a STRETCH, meaning the walls of the bladder stretched or lengthened enough to tell you it’s about full. You can easily ignore this, though, and move on with your day. You’ve had this feeling, right? Right. 

An urge, however, is a CONTRACTION, or shortening, of the bladder walls. Which means it is literally trying to empty, right then and there. No wonder it sends you running to the toilet! What’s the worst thing you can do if your bladder is literally trying to empty? Step your legs apart, right? Walk. Run. Yep, that’s definitely not going to do the job.

This is basically an incorrect signal, and often a false alarm. The strength of an urge is NOT correlated with how full your bladder is. Your bladder is a big fat liar. And the more you follow its command (ie. head to the loo), the more it thinks it’s normal. The bladder is, for better or worse, highly trainable. It squeezes, you run, and it gets reinforced that this is ok. Super annoying.

If it’s trainable, can you train it back, you ask? Absolutely.

How?

The short answer is: stop obeying it! Try to ride out the urge with legs crossed and by squeezing your pelvic floor. If you can wait till the urge subsides, then head to the toilet: you’ve won. Keep doing that and it should start to get easier to control, and sometimes go away completely. 

The long answer: Head to Urgency Part 3 for the full scoop on Bladder Training.

Urgency Part 1: When You Gotta Go

When you gotta go, do you GOTTA GO? Do you feel like your bladder is going to explode every time you put your key in the front door? Does running water send you running to the bathroom?

Urinary Urgency is defined as a “sudden, compelling urge to urinate.” Sure it happens after you hold it for a while, like on a plane or at a movie, which is totally normal. But if it happens ALL THE TIME, and starts to limit your life? That’s a problem. It’s one of those things that a lot of people don’t realize is a problem until they hear that it’s not actually normal.

What causes urgency? There are a few different contributors. The most common is bladder irritants, which are foods and drinks that the bladder just doesn’t like. The big ones are coffee, tea, alcohol, carbonation and artificial sweeteners. (Most of us can relate to hitting the road with a cup of coffee only to stop at the first rest area we come across, amiright?) Others are acidic foods like tomatoes, spicy food, and citrus.

Another big cause of urgency is not drinking enough water. Say what? A lot of people with bladder issues cut down their fluids to AVOID having to pee, but this actually contributes to the problem. If your body doesn’t have enough fluid, the bladder is really unhappy. Why would it want to hold on to super concentrated urine? One easy way to tell if you’re hydrated is to check your output: if it’s smelly, dark urine, you’re probably dehydrated. You want it to be “clear and copious,” as my high school track coach always said (oh the things we remember).

My advice: work toward drinking half your body weight in fluid ounces, mostly water. Don’t like water? Add cucumber or a slice of lemon.

There is usually lot more going on with Urgency, but I don’t have room for it here. I typically spend two whole sessions on educating my patients about how the bladder works and how to retrain it!

If you raised your hand with those first questions, start with looking at what you put into your body (and therefore your bladder). I’ll share more in Part 2, so keep an eye out!

What makes you gotta go? Share in the comments!

On "Doing Yoga"

One of the most frequent things I hear from patients is that they just don’t have time for exercise, or yoga, or their home exercise program. Particularly when it comes to yoga, I think there is a perception that to Do Yoga means to carve out 75 minutes to go to a studio in your Lululemon pants and feel amazing afterward. I don’t know about you, but that’s just not the reality of my life most days. I was stuck in this perception for a long time, too. Even when I started my own home practice, I still felt like I didn’t Do Yoga if I didn’t spend at least an hour and go from “start in a comfortable position” and “end in savasana.”

You know what though? I’m over that. Yoga is yoga is yoga. Yoga is 5 minutes of meditation on the bus or on a meditation cushion. Yoga is standing on my back deck moving through a few postures (asana) before bed, or when I wake up in the morning. Sometimes I get to a class, but now that I’m teaching it’s more common that I’m in front of a class. I make space for it when I can. And you can too.

I try to start my mornings consistently: wake up early, meditate for a few minutes, then move through this seated asana. It moves my spine through all the planes of motion: flexion/extension, sidebending, and rotation. It feels SO good. And only takes a minute.

I posted a video on Instagram and IGTV of my morning routine. Click on the link to follow along—no matter what you’re wearing and where you are. Take a minute to move with me!

Thanks for moving with me today. Thanks for Doing Yoga. Namaste.

What do you find to be the biggest barriers to doing yoga or whatever your movement practice is? How do you make time for it? Share below!

Workshop Alert

I spent all day a couple Sundays ago at the Fear Her Fight Womxn’s Strength Summit and I was basking in all the power in the room. Not the power of the lifting—yes they lifted a lot of heavy things—but the power of voices joined together cheering and encouraging and celebrating. It was pretty epic.

All the while I got to sit at my table in the back and talk about my favorite things over and over again: the pelvic floor. Whether it was an individual or a group, I got to show women the anatomy of the pelvic floor and the vulva, talk about the muscle types and how they work and why they sometimes don’t work the way we want them to. I got to teach how to engage them correctly and how to train them to be coordinated during squats and jumps and deadlifts. We talked about the state of postpartum care and incontinence in sports and all the stuff that gets us all fired up. I was in my element. I love this stuff. I could talk about it all day.

And that’s why I’m on a Workshop spree. First up? My home gym, Ascent Fitness. On Wednesday, June 26 I’ll be presenting my first ever SOLD OUT workshop. The first hour will include education about the anatomy of the female pelvis and pelvic floor, how it relates to the rest of the core, and various ways to engage the muscles properly. Then we’ll warmup and move into a 50-minute workout focusing on integrating the pelvic floor and core with each exercise. The workout will be mostly body weight exercises like squats, lunges, and jumping, and I’ll walk you through each move, so no worries if you feel like you’re not not “in shape”. No Turkish Getups involved!

Since this one filled up so fast, we’re busy finding a date for the next one. If you don’t want to wait till you see one posted, give Ascent Fitness a try! You can audit a class for FREE! Find me coaching there Tuesdays bright and early (5:40 am) and Wednesday evenings at 5:15 & 6:30. Trust me, it’s the best gym I’ve ever been a part of. I’m a big gym snob, and this place won me over.

Keep an eye out for more workshops if you missed this one!

Want to host a workshop? Let’s collaborate! Send me a message and let’s start dreaming!

Namaste

Namaste

If you’ve been to a yoga class or two, you’ve likely heard the word “Namaste” spoken at the end of class. When I first started practicing yoga in college, I didn’t know what it meant, and honestly, it kind of freaked me out. Was it an incantation for some foreign deity? Was I invoking a spirit? Nope. It’s neither. It is a Sanskrit word that translates roughly to “The divine in me honors the divine in you.” Some use the word “light” or “teacher” in place of divine, and I think they all make sense. The phrase is simply an acknowledgement that there is a piece of divinity (call it God, Spirit, or what you will) in each and every one of us.

When I became a PT I thought I would go out and change people’s lives. I like to believe I do that, but I didn’t expect my patients to change me the way they have. I have learned SO MUCH from all the individuals I have touched and taught over the past decade. They have helped mold my view of the healthcare system, the human body, “evidence-based medicine” and alternative (or “woo”) approaches to healing. They have given me tips on marriage, on family, transformed my view on what it means to be a mother and a woman, and given me confidence in my vocation.

Considering all that, I’m not quite sure why I was surprised to find the same thing when I started teaching yoga. Teaching a room full of students has in turn taught me how to be a better teacher. Perhaps it is each individual over the years that has taught me so much, or perhaps it is that spark of light, of divinity, that common thread that is in each of us, that is teaching us all the time. We just have to look for it. It’s there. And it’s quite easy to find if you are aware.

I now end my classes as I’ll end this post: “The teacher in me honors and sees the teacher in each of you. Namaste.” 

Yoga for Menstrual Cramps

I don’t know about you, but my periods have never been fun. I remember as a teenager being late to school because I was throwing up, my cramps were so bad. Once I was at camp and didn’t bring ibuprofen; the camp nurse would only give me one Tylenol every 6 hours. Needless to say, that did not cut it. I remember spending 3 miserable days with my head on the table in the Craft Shack, just wishing time would move faster.

It’s become more manageable over time, with the help of naturopaths and acupuncture and becoming more embodied. At times I have practiced gratitude for my bleeding, for the incredible way my body cleans itself out each month, and it actually made it pleasant (thanks to Tami Lynn Kent’s Wild Feminine for that inspiration). Then as I entered the world of TTC (trying to conceive) and subfertility, that became a little harder to do. It’s like insult to injury to be bleeding AND have cramps, when I am working so hard to just be pregnant.

But I digress! This post is NOT just a complaint against Aunt Flow. I do think she’s lovely, even when she feels like an unwanted guest. I want to share something that has helped me over the years to manage the discomfort during my moon-time: malasana.

I can’t tell you the exact mechanism of relief, but I can tell you it’s an excellent posture for relaxation of the pelvic floor, especially if you focus on releasing tension. Imagine your sitbones moving apart. Or your tailbone moving backward, even “wagging.” This is the first thing I recommend for my patients with pelvic or tailbone pain, too. And of course, it’s an excellent position for laboring (though not so hot for actual delivery since it’s correlated with an increased risk of tearing!).

The basic movement is simply a squat: heels down, butt down. I use my elbows with hands in prayer to push my knees apart and give more stability. Other options include having a block or bolster under your bum, having something under your heels if you have short calves, leaning against a wall, or leaning back while holding on to something stable like a doorway or sturdy table leg. Then just hang out. The more supported you are, the more you can relax your pelvic floor. Then, ahhh.

What tricks have you found to manage menstrual cramps? I’m always looking for more tips!

Pelvic Organ Prolapse (Part 1)

Let’s talk about pelvic organ prolapse. You might call it a heavy feeling, or a bulge, or say it feels like there’s a “golf ball in your vagina.” You might feel something when you wipe, or you might think stuff is going to fall out. I’ve had more than one woman tell me her vagina is falling out. Oofda.

 Well what’s going on? First of all, don’t worry: your organs ARE NOT falling out. I always say I can fix a prolapse 50% in one visit by just telling my patients that fact. Did I change where their organs are sitting in their body? Nope. But I affected their perception, gave some peace of mind.

Prolapse occurs when one or more of the pelvic organs (bladder, rectum, or uterus) drop lower in the pelvic cavity due to a decrease in support. All of these organs are “suspended” inside the pelvic cavity by ligaments around the uterus. From below, they are supported by the pelvic floor, like a hammock. During pregnancy, these ligaments obviously stretch A LOT. In the most perfect vaginal delivery, the pelvic floor also stretches A LOT. Even with a cesarean birth, the ligaments still stretch, so it doesn’t necessarily prevent prolapse.

As I said before, it often feels like a heaviness or bulge in the vagina. Many women feel this immediately postpartum, then it gets better over the first several weeks. Some women notice it all the time, while others don’t notice it at all. Some feel it more after a workout or a long walk. Sometimes it goes away completely when they lie down. Sometimes it interferes with sex, causes urinary leakage, or causes constipation.

The good thing about prolapse? It’s not going to harm you. As professionals in this area, we care more about how much it BOTHERS you than how severe the prolapse looks objectively. Which is why I can fix one 50% in one visit ;). It’s all about perception. No good doctor should recommend surgery if you aren’t complaining about how it feels.

How is it treated? Start with physical therapy. We can’t necessarily tighten ligaments from above, but we can sure work on strengthening the pelvic floor to improve support, provide manual techniques to optimize organ position, and teach you strategies to minimize discomfort. And we can keep reminding you that nothing’s going to fall out. ;)

About Insurance

Let’s talk about insurance.

I am an out of network provider. I do not contract with any insurance companies, and patients pay me directly at the time of service. In turn I provide them with a “superbill” which they can submit to their insurance to be reimbursed directly.

Here is why I chose this route:

I have never liked people telling me what to do without good reason. Ask my parents, teachers, and past bosses and they’ll tell you this is true. Some might call it stubborn, but I consider it self-advocacy.

When I started my practice, I had to decide if I wanted to take insurance or not. The first question a prospective patient asks is “Do you take my insurance?” If I answer yes, I have removed one barrier. However, taking insurance often creates more barriers:

-Many insurances require a referral for PT, which means one more appointment to make and get to, adding an unnecessary barrier. Most of my patients are busy moms—it’s enough to ask them to make an appointment with ME, where they’ll actually get some help! Having a visit simply to get a referral does nothing to actually help an individual, and the runaround often is enough to make a gal give up seeking the help she needs.

-Some limit the number of visits they’ll cover based on algorithms instead of your unique person and situation. It’s fairly common to see insurance approve “6 visits in 3 weeks.” This is fine for an ankle sprain, but for someone dealing with incontinence or painful sex for a decade, it really just doesn’t cut it.

-Some won’t pay until you hit your deductible, which can be upwards of $5,000. I’ve had patients complete several visits before getting a bill in the mail, only to realize none of it was being covered because they hadn’t met their deductible.

-They all require an absurd amount of administrative time for the provider. As a one-woman show, I believe my time is time better spent on providing excellent patient care. It’s what I’m good at. And really, that’s what you are paying for. 

Like I said, I don’t like other people telling me what to do, and I don’t want anyone telling me how to treat my patients. Ultimately, I believe this relationship is between you and me, and a third party shouldn’t be telling me how much I can treat you or how much your care is worth. I work for you, not your insurance. I want you to know the value of what you are paying for, no surprises.

Our healthcare system is broken—I don’t have to tell you that. It is too broken for one person to come along and fix it. I believe we all need to be our own self-advocates. The first step to doing that is to understand the coverage that you have individually. Often, it’s not as comfortable as we thought it was.

I encourage all of you to know your coverage. Don’t know where to start? Here is a list of questions to ask your insurance company. Keep asking questions until you REALLY understand your coverage. Keep advocating for yourself and your family.