Bladder/Urologic Archives - Page 14 of 14 - Revitalize Physical Therapy

June 15, 2015

Important SPINformation

How Does Cycling Affect Your Pelvic Floor?

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!

April 28, 2015

Is It Normal If…?

Anatomy — 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!