Maggie McKay (Host): Welcome to the Kirby Connections Health Podcast, where we help you nourish your wellness journey with Kirby Medical Center. I'm Maggie McKay. On this episode, we're going to be talking about healthy bladder habits, pelvic pain, incontinence, and the role of physical therapy regarding the pelvic floor with physical therapist, Miriam Garrett. Thank you so much for joining us to talk about this important topic that affects a lot of people.

Miriam Garrett, MS, PT: Thank you, Maggie. I'm happy to share about it, because it's a real passion for me.

Host: That's great. Well, let's start with what are some essential healthy bladder habits that can help prevent incontinence?

Miriam Garrett, MS, PT: Beverages are a big part of that. So, there are many beverages that are irritating to the bladder lining, such as coffee and tea and alcohol, citrus and carbonation. Even artificial sweeteners can irritate the bladder. So if somebody loves their diet Coke with caffeine, they've kind of got three strikes against them with aggravating a problem they might be having.

Host: What about dairy, like milk?

Miriam Garrett, MS, PT: You know, it can be for some people, not for everyone. Those others are the bigger triggers for incontinence and bladder irritability. So, those are ones I usually just try to educate people that, if they're loading their day with a lot of those beverages, that they could expect more problems. And oftentimes it's just reminding them, you know, maybe you can cut back, increase your plain water intake so it kind of dilutes those in your bladder and that can be helpful.

And, you know, another healthy habit is just how many times a day are you going to the bathroom. We should be able to go two to four hours in between bathroom visits. And a lot of people say, "Oh, I have to go every 30 minutes or so." And that really reduces your productivity in a day. And then, at nighttime, at most once a night up to the bathroom is all we consider normal. Otherwise, it's interrupting your sleep habits too much.

Host: And how common is urinary incontinence in females? What's normal?

Miriam Garrett, MS, PT: Sadly, it's over 50% of a problem. And it's not a normal part of aging, which many people think. It's not a normal part of what we should expect after childbirths. But it is common so people think it's normal. And yet, there's things that we can do to help it. So, it's just getting that word out that there's things that we can help people with.

Host: What about pelvic pain? Is that normal or at least treatable?

Miriam Garrett, MS, PT: Definitely it's not normal and it's definitely treatable. So, your pelvic pain, you know, it could be part of the pelvis, maybe it is the pelvic floor. Maybe there's been some injury there in the past, maybe with childbirth. It could be muscular, it could be nerve pain, it could be scar tissue. And it can also though be referred pain coming from a low back or a hip problem. So, there's just many sources for that. So, we, in PT, try to localize that source and then address what seems to be causing that pain, because we want people to be able to function without that pain, if at all possible.

Host: And how important is early intervention in the treatment of pelvic floor disorders?

Miriam Garrett, MS, PT: Very important. So, just like most other things, the sooner we can start to address it, the usually more quickly we can help that patient. And I think, you know, a prime example is our postpartum women. And if we could just get them here on a routine basis after they've delivered their baby within six weeks, 10 weeks, there's so many things just even one visit can address on just making sure they can use their pelvic floor, because sometimes their pelvic floor kind of forgets what to do and they don't have that neuromuscular coordination after the pregnancy and delivery. And the abdominals kind of need a little help oftentimes, especially after a cesarean delivery. So, that's a prime example of if we could get these women in here, even one visit could really help them for the future.

Host: So, what is the role of pelvic floor or physical therapy in managing incontinence?

Miriam Garrett, MS, PT: With incontinence, oftentimes it is pelvic floor muscle weakness. I brought my pelvic model just to give a little example. But this is a female pelvic model, so the two sides of the pelvis are mirror images of each other. They meet in the front at the pubic bone, which is below the navel. And then on the backside, your lumbar spine, this is the last vertebrae there. Then, your sacrum and then your tailbone. So, the pelvic floor muscle group is a three-layer muscle group where this is the most superficial. Then, there's a middle layer, and then the innermost layer is that light pink. So, those three layers work together so that there can be coordination of-- there's a small circle there, I don't know how well you can see it, but that represents the urethral opening where the bladder empties, then the vaginal opening, and then the anal opening. So, sphincter control is a big part of what these muscles do support. The deepest layer is a big part of our pelvic floor, not only the pelvic floor support for the bladder. So, the bladder's going to sit here, and then the uterus would be behind it. And then, some of the intestines will sit down into this pelvic bowl a little bit.

But the pelvic floor group itself is part of our deepest core support muscularly. And then, the lower abdominals, the gluteals, and the low back muscles fill in a more external layer of that core support. So if the pelvic floor muscles are weak, they're not supporting the bladder as well, and that can be a reason for leakage. Trauma during delivery, where we maybe lose some of that structural support of the ligaments, can cause some weakening and change of position. People talk about prolapse and that can contribute-- especially of a bladder-- to some leakage. And then, sometimes people's pelvic floor muscles are really tight. If you think about athletes who are really hardcore athletes and they do a lot of core work, but they don't oftentimes do a lot of flexibility to counteract all that strength training, that can weaken the muscles, just because they don't have that flexibility for their strength.

So, it's a lot about, one, do they know how to activate their pelvic floor? Because when you ask somebody to do their Kegel exercises, oftentimes they're just squeezing their buttock muscles or their glutes and don't even know they're not strengthening their pelvic floor. So, that's probably the biggest thing I start out with on my patients, is just getting them to learn how they can coordinate the pelvic floor muscles over the glutes so we can actually do some strengthening when they're weak. And we're always doing abdominal strengthening and coordination. And then, definitely, flexibility if that's needed. And usually, hip strength is a big piece of just that instability and weakness in the whole pelvic region. So, a lot of education. And I find just helping people understand how that part of their body, the anatomy, and then how it functions goes a long way, and just helping them understand how things can work better.

Host: Well, it's great to see the model that you showed us, because I actually never have seen one. And when you hear about the pelvic floor, it's like, "Well, where is it exactly?" So, that's very helpful to see and to have explained. Very helpful. Miriam, how effective are lifestyle changes like diet and exercise when managing symptoms of pelvic pain and trying to improve bladder health?

Miriam Garrett, MS, PT: That's very important, like most issues, that being willing to take the education that can make a difference in dietary beverages, just overall health. And so many of us, you know, we don't think about our pelvic region when it functions naturally. And then, when things are not working well, we don't quite know how to handle it. So, just taking those tools. And I try never to tell people, you know, "You can't drink those beverages that are a big part of your problem. But just understand when you do drink them, your problems are probably going to be worse." So, just putting that control and that decision back in their lap is usually very empowering. I just suggest-- well, try to drink a little more water so you dilute things and see if you can dial back, so that in general you're happier and you're making better choices.

Host: Did you mention alcohol in that list of drinks to maybe cut down on?

Miriam Garrett, MS, PT: Yes.

Host: Okay. I thought so. In closing, anything else you'd like to add?

Miriam Garrett, MS, PT: I guess I just want to encourage women, I know it's such a sensitive subject and private subject most of the time. And we don't even like to talk to our doctors about it. But sadly, the idea that physical therapy can be helpful is not well known. So, having the courage to mention it to your doctor and even getting one assessment. Because even just learning a few things about your own body could really make a big change. And I would say the vast majority of the people I get to work with see their results that they're wanting. So, it's just really encouraging, and I really enjoy this patient population.

Host: That's awesome. Well, thank you so much for sharing your expertise. We really appreciate it, and it was very informative.

Miriam Garrett, MS, PT: Oh, well, thank you. I appreciate the opportunity.

Host: Again, that's Miriam Garrett. And if you'd like to find out more, please visit kirbyhealth.org/services. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening to Kirby Connections Health Podcast from Kirby Medical Center.