Is It Normal If…?

Pelvic Floor Muscles (“Fist”) Surrounding Urethra (“Hose”)
Many of us don’t think twice about our bladders.  When our internal plumbing system functions as it should, we generally count our blessings and proceed onward.  However, it becomes a topic of interest and concern when it doesn’t behave properly.  Sometimes, individuals may experience what I like to call “tell-tale bladder” signs, and these signs may be indicative of pelvic floor dysfunction.  These signs may include urinary frequency (a constant feeling of having to urinate, even if one has just voided recently), urinary urgency (a strong and sudden urge to urinate, without ample warning time), urinary incontinence (involuntary loss of urine), urinary hesitancy (difficulty initiating urine flow while trying to void), and pain or a burning sensation while urinating.

None of these sensations are normal, and no one should have to live with any of the aforementioned symptoms!  It is important to keep in mind what is considered “normal,” and that includes voiding 6-8x/day, 0-1x/night, and a feeling of complete emptying of the bladder after urinating.  In addition, one should never feel straining or pain while urinating.

If you can relate to any of the symptoms described in the first paragraph, it may be indicative of pelvic floor muscle dysfunction.  The pelvic floor muscles play an important role in elimination of urine (and feces).  The pelvic floor muscles contract in order to “hold it in”, i.e. to maintain urinary continence, and they relax in order to allow for complete emptying of the bladder.  If the pelvic floor muscles become tight (ex. due to prolonged sitting, stress, or previous trauma, to name a few causes), the muscles may not be able to fully relax for complete emptying of the bladder.  The analogy I tell my patients is to imagine that the pelvic floor muscles are like a fist squeezing around a hose.  In my analogy, the hose represents the urethra, the opening through which urine exists the body.  If the fist remains stuck and is unable to open around the hose, it will be difficult for water to pass from one end of the hose to the other end.  So too with the pelvic floor muscles; if the pelvic floor muscle “fist” remains clenched tightly around the urethra, it will interfere with elimination of urine through the urethra.  This can result in many of the aforementioned symptoms.

You are probably wondering, “So great.  I now understand WHY I am experiencing these symptoms.  But how do I open up that fist up around the hose?  How do I fix the problem?”  PELVIC FLOOR PHYSICAL THERAPY is an excellent and effective intervention to help stretch the tight pelvic floor muscles and restore normal resting tone.  Pelvic floor PT also includes trigger point release of any “muscle knots” which may be present in the pelvic floor, and the skilled practitioner can also provide myofascial release and connective tissue mobilization of tight structures, including tendons, ligaments, and nerves.  In addition, appropriate home exercises are taught which will enable you to maintain the benefits gained between sessions, and they will allow you to progress your healing process.  If you think that YOU may benefit from pelvic floor physical therapy, please speak to you doctor about its appropriateness for you.  I would love to have the opportunity to help you!

Back to the Beginning: Placental Potential

The placenta is a fascinating and versatile organ which connects fetus to mother during the forty weeks of pregnancy.  It is a temporary organ which brings oxygen and nutrients to the fetus during pregnancy and allows for removal of waste and other toxic substances.  It is the “elastic clause” of organs, so to speak, due to the fact that it serves as many organs for the price of one!  The placenta acts as the kidneys, the liver, the lungs, the endocrine system, the gastrointestinal system, and the immune system.  The hormones produced by the placenta promote fetal development and maintenance of the pregnancy.  In addition, the placenta protects the fetus from the immune system of the mother (which perceives the fetus as a foreign object).  If we women thought that we were good at multitasking, be even more impressed with your placenta’s ability to do so!

Picture of placenta
A multi-tasking organ

The health of the placenta plays a large role in the health of the developing fetus.  Medical problems such as preeclampsia, gestational diabetes, stillbirth, and premature labor and deliver may occur when placental problems exist.  In addition, lifelong health of both mother and child are influenced by the placenta.  To date, not much is known regarding what actually constitutes a “normal placenta” and how it actually functions.  According to Dr. Diana Bianchi (Executive Director, Mother Infant Research Institute, Tufts Medical Center), the placenta is “the Rodney Dangerfield of organs.  It doesn’t get respect. It gets thrown out at the end of pregnancy.”  The only research that we have involves studying the placenta AFTER delivery, as opposed to during pregnancy itself.

Fortunately, the National Institute of Health (NIH) has initiated the Human Placenta Project, a $41.5 million project which has multiple goals.  Several of these goals include developing improved technology to analyze placental development during pregnancy and the creation of non-invasive methods to predict poor pregnancy outcomes.  Furthermore, the project is aimed at better understanding the connection between placental health with long term maternal and fetal health, and researchers seek to develop interventions in the case of poor predicted placental and fetal outcomes.   Hopefully, these research objectives will be achieved in order to improve maternal and fetal outcomes.

For more information on the Human Placenta Project, please watch the following short YouTube video from the NIH: