Category: Bladder/Urologic

Everyone knows from Phys Ed 101 that it’s important to drink water while exercising to offset the fluid loss that occurs while sweating.  But, how much water is the appropriate amount?  Is there such a thing as hydrating TOO MUCH?

Traditionally, most athletes and personal trainers promote the concept of more is better.  Drink before, during, and after workouts, regardless of what thirst dictates.  However, in a recent article in The Washington Post, author Ariana Eunjung Cha (July 1, 2015, refer to link) encourages readers to challenge their previous assumptions in light of important recent research.

Exercise-associated hyponatremia is a dangerous condition that may develop up to 24 hours after a heavy workout.  It is characterized by decreased sodium ion concentration in the blood due to hyperhydration.  Sodium is an electrolyte which helps maintain the proper amount of water in the blood and cells.  Excessive water intake can shift the delicate fluid balance and create an environment where, relatively speaking, there are fewer (“hypo-“) sodium ions (“natremia”).  If the kidneys are unable to restore homeostasis through healthy mechanisms (such as urinating or sweating) the excess water can result in swelling throughout the body, including the brain (which in turn can result in seizures, coma, or death).

Too much of ANYTHING is not good- In fact, studies have shown that hyponatremia can occur even if one’s beverage of choice is a sports drink (as opposed to water)[i].  Drinking any fluid simply for the sake of “playing it safe” puts an individual at risk of developing exercise associated hyponatremia (EAH).  In a 2013 study that analyzed ultramarathoners in Northern California, researchers discovered that 15.1% of participants demonstrated EAH and 18.5% of marathon finishers were dehydrated at the finish line compared to 34.9% who were overhydrated[ii].

For those of you who recall from chemistry class that the formula for salt is NaCl (sodium chloride), you may be thinking that an appropriate solution to combat hyponatremia would be to ingest large amounts of salty food prior to a marathon.  While I applaud your creativity and knowledge, research has shown that this, unfortunately, is not an appropriate preventative measure against EAH.  However, “early recognition and field management with oral hypertonic saline (salt water) in combination with fluid restriction can be effective treatment for mild EAH[iii].”  Therefore, the best advice I could offer you, dear reader, is advice that I find myself telling patients regularly.  TRUST YOUR BODY.  Follow your internal regulatory drives.  When your hypothalamus is telling you that you are thirsty, THAT is the appropriate time to drink.  By respecting your innate needs and listening to the messages that your body is sending you, you can help maintain fluid balance which will enable you to exercise in health.

 

[i] Almond CS, Shin AY, Fortescue EB et al. (April 2005). Hyponatremia among runners in the Boston Marathon. N. Engl. J. Med. 352 (15): 1550–6.

[ii] Hoffman MD, Hew-Butler T, Stuempfle KJ. Exercise-associated hyponatremia and hydration status in 161-km ultramarathoners. Med Sci Sports Exerc. 45 (4): 784-91.

[iii] Hoffman MD, Myers TM. Symptomatic exercise-associated hyponatremia in an endurance runner despite sodium supplementation. Int J Sports Nutr Exerc Metab. June 9, 2015.

 

 

Outdoor sport weather is here!  As any fellow George Washington Bridge runner would know, cyclists are out in full force.  Obvious health requirements for all cyclists include wearing a helmet, maintaining adequate hydration, maintaining properly functioning breaks, and using bells and lights to alert surrounding pedestrians.  Today, I have decided to discuss the less known health considerations that all cyclists should know, and with that I bring to you a blog about the effect of cycling on the pelvic floor.

Cycling stresses the pelvic floor muscles and structures unlike any other sport.  Narrow, non-padded seats and crossbars are two big culprits responsible for pelvic floor dysfunction.  Our body was designed for sitting to occur on our ischial tuberosities (aka the “sit bone”), however majority of bicycle seats force its users to sit on the perineum, particularly on the ischiopubic ramus (the segment that connects the pubic bone to the ischial bone of the pelvis.  The increased pressure against the seat of the bicycle in this sensitive area can result in elevated muscle tension, urogenital dysfunction, and compression of nerves and/or blood vessels which supply the penis and testicles (males) and the labia and clitoris (females).  Nerve compression can result in numbness, pain, or a burning sensation.  Blood vessel compression can interfere with circulation, which may manifest as erectile dysfunction in males.  To give you a sense of the amount of pressure placed on the pelvic floor during cycling, consider the following: during blood pressure readings, the cuff is inflated to approximately 120 mm Hg (= 2.32 lb/square inch) to restrict arterial blood flow momentarily.  During cycling, a typical nosed bicycle seat produces 2.90 lb/square inch and may rise to a whopping 5.37 lb/square inch during vigorous activity, more than double the amount required to restrict blood flow during sphygmomanometer usage!  This comparison helps us clearly understand how intense cycling can result in pelvic floor dysfunction.

So what can be done to protect one’s pelvic floor?  For starters, the noseless bicycle seat, also known as an ergonomic cycle seat, helps alleviate perineal pressure.  Many different brands and types are available, and I would recommend sampling from several options in person at a professional bike shop prior to purchasing your most comfortable seat.  Furthermore, a research study published in The Journal of Sexual Medicine (May 2012, link to article) analyzed the effect of handlebar height on perineal and total saddle pressure (measured in kilopascals/kPA).  Forty eight female cyclists who rode a minimum of ten miles/week were included in the study.  Handlebar placement positioned below the saddle was associated with a 3.47-kPA average increase in perineal saddle pressure.  Therefore, raising the handlebars can help decrease perineal pressure and promote improved sitting posture.

In addition, pelvic floor physical therapy, such as the type delivered at Revitalize Physical Therapy, helps to restore normalized muscle tone, eliminate tension, alleviate nerve compression, and improve blood flow.  It would be an honor to help with any of these conditions.  You now have the facts, and knowledge is power!  Take this information and run with it…or cycle with it!  May you have a happy, healthy, energized, and athletic summer!