Go With The Flow: Bladder Health & The Pelvic Floor

Rachel Gelman: All right, welcome back to Not Enough Information podcast. I am Dr. Rachel Gelman, pelvic floor physical therapist, joined with my dear friend and colleague, Dr. Britt Van Hees, fellow pelvic floor specialist. And we are here to talk about things that we feel like people don't have enough information about and need more information about.

Britt (she/her): Yes, that's true.

Rachel Gelman: Yeah, and so today, I think we want to talk about things people should know about bladder. health.

Britt (she/her): Yep, bladder health is very important.

Rachel Gelman: It is, and I think something

Britt (she/her): It is.

Rachel Gelman: we hear a lot from people that is a very common myth is people coming in thinking they have a small bladder.

Britt (she/her): I'd say the only person that has a small bladder is if you compared like, LeBron James with like Dominique Dawes, Simone

Rachel Gelman: Simone Biles.

Britt (she/her): Biles or something. there is no such thing as a small bladder.

Rachel Gelman: Yeah. So what would you say to someone who feels like, cause I think something we see a lot in practice

Britt (she/her): Yes.

Rachel Gelman: is people feel like they're peeing too often. And I think the first thing I always say or let people know is like, what is actually normal? Cause I think people don't know that, but like

Britt (she/her): Mm-hmm. Yep.

Rachel Gelman: during the day, ideally someone should be peeing every two to four hours. depending obviously on different factors.

Britt (she/her): Yeah.

Rachel Gelman: If someone's working out and drinking tons of water or they're in like a really hot or humid climate, it might be more often. And then at night, we usually say if you're under the age of 65, it should be ideally like you're sleeping through the night. Maybe you're waking up once. If you're over the age of 65, then it bumps up to like twice a night is would be still in the normal range again. give or take different factors, but we're talking about like

Britt (she/her): Yeah.

Rachel Gelman: on a regular basis.

Britt (she/her): Yeah. Yeah, I think the big part of a small bladder is first I let people know that like their bladder can hold like, like a now gene

Rachel Gelman: Mm-hmm.

Britt (she/her): amount of urine. I mean, it shouldn't be doing that all the time, right? But it has the capability,

Rachel Gelman: Yeah.

Britt (she/her): which blows people's minds and that sometimes I'll be like, well, sometimes when you feel like you have to pee, you have this small bladder and then you go and you try to pee and then you have this really high urge, but then nothing comes out. They're like, yeah, that's so weird. I'm like, yeah, it's, it's

Rachel Gelman: It is weird. Yeah.

Britt (she/her): because it's because the information you're getting is not coming from your bladder. It's coming from like the muscles surrounding your bladder, or it's coming from

Rachel Gelman: Mm-hmm.

Britt (she/her): the contextual cues you see. I started talking about pee and now everyone has to go pee.

Rachel Gelman: Mm-hmm.

Britt (she/her): So, It's, yeah.

Rachel Gelman: It happens every time I talk to a patient. When patients are talking to me about their bladder symptoms, I immediately like leave the room and like feel like I have to pee.

Britt (she/her): Yeah, Yeah. Yeah.

Rachel Gelman: And so weird. But I think that, yeah, people also, if you start like training your brain and your bladder to pee more often. So if you are someone who's like, I should, before I leave the house, I should go just in case.

Britt (she/her): Yeah.

Rachel Gelman: Or like, well, I'm already home. People are working from home and they're like, the bathroom is right there. So I just go because it's right there.

Britt (she/her): Yeah.

Rachel Gelman: So you kind of are training. this new kind of feedback loop or training your bladder to empty when it's not actually full.

Britt (she/her): Yeah. And what a full P is, is also important to know. So like

Rachel Gelman: Yeah.

Britt (she/her): we're looking at like at least an eight seconds, like an eight Mississippi P for a full bladder and

Rachel Gelman: Mm-hmm.

Britt (she/her): like a good stream. Because most of the time I'll be like, was it like, you pee a full amount or like, you know, a full bladder that I, yeah. And then I go like one Mississippi, two Mississippi, three Mississippi, four Mississippi, you know, usually they're stopping me on three Mississippi's. So.

Rachel Gelman: Yeah. Yeah. And ideally, you know, urine should be kind of like a light lemonade,

Britt (she/her): Mm-hmm.

Rachel Gelman: pale yellow. So I think that's something that people aren't aware of is like how important hydration is for the bladder. Because I think

Britt (she/her): Yeah.

Rachel Gelman: so many people are like, I'm peeing all the time. So it makes sense then that they think the solution should be like, I'm going to limit my water intake. But It actually can make things worse

Britt (she/her): Yeah.

Rachel Gelman: for a few reasons. One, if your urine is like overly concentrated, it's going to irritate the bladder lining more. And then that actually will make you have to pee more. And also, as we've talked about before, bowel dysfunction, primarily constipation, is such a huge cause of pelvic floor dysfunction, including bladder dysfunction. So you're not drinking enough water. Now you're constipated. And then you end up having these urinary symptoms. So I think that's something we talk about to people a lot is like, if you start limiting your water, you're sending, notice your symptoms are getting worse or not changing. You you want to stay well hydrated as

Britt (she/her): Mm-hmm.

Rachel Gelman: a way to help your bladder and just your overall health, but

Britt (she/her): Yeah. Yeah.

Rachel Gelman: it's going to make an impact.

Britt (she/her): I also think that because sometimes when people, have, they'll have like urinary frequency. So they're peeing like every hour or something or every half hour.

Rachel Gelman: Mm-hmm.

Britt (she/her): And then, they start limiting their water, concentrate some urine, making it, irritating the bladder lining, but also the bladder never gets an opportunity to stretch all the way. So then they start feeling like they can't empty. And it's because they're not getting like, Okay, number one, there's always gonna be a little bit of pee left in your bladder. It just is like, if you wanna push, okay, so don't push when you're peeing, but like, you can always get more pee out. It's always a possibility. So the best thing to do is pee. You still feel like you need to pee. Just take a breath, relax, see if more pee comes out. If it does, great. If it doesn't, doesn't, right? But what happens is when you do this frequency with a low amount of liquid intake, the bladder never gets to stretch out to its full amount. which means you don't get this like reflexive contraction to empty it as well.

Rachel Gelman: Okay.

Britt (she/her): So then people are kind of lacking this and then it kind of creates this big loop and then they start pushing to pee and.

Rachel Gelman: Yeah, yeah. And I think the other thing we hear about a lot, know, obviously pushing to pee, we don't want people doing that. And the other

Britt (she/her): Yeah.

Rachel Gelman: thing we hear about a lot is because when people start down the rabbit hole of like

Britt (she/her): Mm-hmm.

Rachel Gelman: bladder symptoms, the pelvic floor, every time what comes up is Kegels. And the thing that people always have in these magazines or articles is like, how do you do a proper Kegel? As you're peeing, stop the stream.

Britt (she/her): Mm-hmm.

Rachel Gelman: And it's kind of like, if you do that once in your entire life, like that's fine. Like

Britt (she/her): Mm-hmm. Yeah.

Rachel Gelman: I don't want people to feel like they are going to like injure themselves for life. But

Britt (she/her): Yeah.

Rachel Gelman: I think what we know and what we've seen and what we hear is that people start doing that repetitively as they're sitting on the toilet or they're standing to pee, they keep stopping the stream and then restarting it, stopping and starting it as a way to exercise their

Britt (she/her): Yeah.

Rachel Gelman: pelvic floor. And I think... It's interesting that people do that because if you start doing that as an exercise, you're going to be messing with that feedback loop from your brain to your bladder. And

Britt (she/her): Yeah. Yeah.

Rachel Gelman: so then you can start like when you go to the bathroom and you're trying to pee, that loop is now confused and it's going to be like, wait, we don't want to pee, we're supposed to stop

Britt (she/her): Mm-hmm.

Rachel Gelman: or vice versa. When you are trying not to pee, you may have leaking.

Britt (she/her): Yeah. Yeah. And then the other thing sometimes too, is you can kind of develop these like UTI like symptoms, right? Or this bladder infection like symptoms the repertoire of UTI symptoms are many, but they also include things that are just bladder dysfunction, right? So you have

Rachel Gelman: Mm-hmm.

Britt (she/her): like urinary frequency, increased urgency, but then you'll have other things like pain with urination. burning, like with filling, all these different things. And it's actually, unless you have a true test, like you go to the doctor, you pee in a cup, the doctor comes back and says, yes, you have blood in your urine, a high white blood cell count. You have an infection in your bladder, take some antibiotics, unless that happens. There's a high likelihood it's just irritation of the tissue, irritation of the muscles, because the muscles themselves, they're right next to the bladder. They can create all those symptoms as well. They can create pain with peeing. They can create burning. They can create urinary frequency. So.

Rachel Gelman: Mm-hmm. Yeah. Yeah. It's kind of like those muscles are all wrapping around the urethra. They're supporting the bladder. So if those muscles are tense, guarded, spasmodic, what have you, it can then, yeah, like irritate the little tube, the urethra

Britt (she/her): Yep.

Rachel Gelman: that's trying to exit, and it can be squeezing the bladder in a way that either is like impacting how it's moving,

Britt (she/her): Yeah.

Rachel Gelman: but also your brain can start to misinterpret. what's happening and just kind of be like, well, I guess we should tell this person to pee because I don't know what's

Britt (she/her): Yeah.

Rachel Gelman: going on down there. Or I should send a signal like some burning or whatever

Britt (she/her): Yeah.

Rachel Gelman: to alert them that something's wrong. And

Britt (she/her): Yeah.

Rachel Gelman: so, you know, if people are going in and getting tested for a UTI and it keeps coming back negative, that can be a sign that they should maybe consider seeing a pelvic floor specialist. But I think the,

Britt (she/her): Yeah, good point. Yep, very good point. And

Rachel Gelman: Keep going.

Britt (she/her): no, no, I was just going to say, and some urologists do that. They do refer

Rachel Gelman: Mm-hmm.

Britt (she/her): to it pelvic floor physio. Others don't. They just get tons of antibiotics for

Rachel Gelman: you

Britt (she/her): an unfound

Rachel Gelman: Yeah.

Britt (she/her): bacterial infection that can't be found on any panel.

Rachel Gelman: I know, I know. And it's always like, well, I mean, I think on the flip side, like playing devil's advocate, I have had people

Britt (she/her): Yeah.

Rachel Gelman: who, you know, go in and get special testing. It turns like, they had something like urea plasma, which may not always be the first thing that they test for on some

Britt (she/her): Mm-hmm. Mm-hmm.

Rachel Gelman: like general like urgent care panels.

Britt (she/her): Mm-hmm.

Rachel Gelman: So I do think like it's important to do due diligence if like things aren't getting better.

Britt (she/her): Yeah. Yeah.

Rachel Gelman: But on the flip side, it's like taking just like round and round and round. antibiotics

Britt (she/her): Yeah.

Rachel Gelman: and then you're not seeing changes or in or

Britt (she/her): benefit. Yeah. Long term. Yeah.

Rachel Gelman: yeah long term because sometimes I think we do see people who are like I took the antibiotics and I did feel better for a little bit but then the symptoms came back and

Britt (she/her): Mm-hmm.

Rachel Gelman: I think people aren't aware of the fact that like antibiotics have such a strong anti-inflammatory

Britt (she/her): Mm-hmm.

Rachel Gelman: impact so it's like equivalent to taking a bunch of ibuprofen.

Britt (she/her): Yeah.

Rachel Gelman: And so that's why some people do notice improvement for a period. But then symptoms return because you no longer have that anti-inflammatory

Britt (she/her): Yeah.

Rachel Gelman: response. But there is nuance to it. And I do think before you take antibiotics, getting a test done and seeing if it's a true infection or not.

Britt (she/her): Yeah.

Rachel Gelman: But I think the other thing that is being talked about more and more, which is great because right now you know... I feel like perimenopause and menopause is getting a lot of, is in the spotlight at the moment. Yeah, it's like,

Britt (she/her): Yeah, it is. It's like the Barbie, the Barbie.

Rachel Gelman: yeah, perimenopause and menopause Barbie is really hot right

Britt (she/her): Yeah,

Rachel Gelman: we. I know if Mattel, if you're listening, we'd be happy to help develop your perimenopause, menopause Barbie. But we know that's what's...

Britt (she/her): Yeah, Yeah, yeah. That sweats, then you go like press a button and it starts to sweat or it gets hot, like it's warm.

Rachel Gelman: Yeah. And it's like, wait, why did I come in this room again? What was I looking for? Um, yeah, that would be amazing. Um, but I think we, you know, people aren't necessarily aware, and I wasn't aware of this until I started working in this specialty, how the tissue around the vaginal opening, including the urethra heavily depends on

Britt (she/her): Yep. Yep.

Rachel Gelman: estrogen to stay happy and healthy.

Britt (she/her): Yep.

Rachel Gelman: it helps prevent things like UTIs.

Britt (she/her): Yep.

Rachel Gelman: And so if someone's estrogen levels are low, something's happened, maybe it's menopause or perimenopause that's impacting it, certain medications can impact hormone levels. things like having gone through childbirth and that can impact estrogen levels. So then, if

Britt (she/her): Speak it.

Rachel Gelman: our estrogen levels are lower and that tissue now isn't getting enough of what it needs to stay happy and healthy, the urethra can be impacted. And sometimes that means the urethra is now more, kind of almost like protrudes and is closer to the surface.

Britt (she/her): Yeah.

Rachel Gelman: of the vaginal opening, meaning it's more prone or exposed to bacteria, or it can impact sort of like the stability of the urethra itself. The urethra can become more irritated because the tissue lining is thinner. Either way, it all can be a recipe

Britt (she/her): Yeah.

Rachel Gelman: for having actual UTIs, like true infections, or it can mimic the symptoms of a UTI. So

Britt (she/her): Yeah.

Rachel Gelman: usually what I'm thinking when someone's coming in with these types of symptoms is like, Okay, yeah, we're obviously, we want to make sure an infection has been ruled out, but also I want to think about like, is anything going on with hormones in addition to pelvic floor muscles? And you know,

Britt (she/her): Yeah.

Rachel Gelman: it can be the thing I always tell people is it can be all three or it can be two, it doesn't have to just be one thing.

Britt (she/her): Yeah. Yeah. Yeah.

Rachel Gelman: So we're always thinking about these different puzzle pieces that can be contributing to someone's symptom presentation

Britt (she/her): Yeah. it's also very interesting sometimes working with people when you've ruled out all that stuff and it truly is just like some type of rearing. Like that's how they were raised with their bathroom habits

Rachel Gelman: Hmm.

Britt (she/her): or it's like high anxiety issues or it's like, so

Rachel Gelman: you

Britt (she/her): it can definitely be not a physical thing too. It can be like your brain's version of protecting yourself for some reason. feel like protection or hypervigilance and urinary dysfunction. They, Not all the time, but they can often go together.

Rachel Gelman: Yeah, yeah, definitely. Like, I think the example I always give when we're teaching is growing up, my mom was like so adamant that I couldn't have pants or anything with a belt, like belt. was like,

Britt (she/her): yeah.

Rachel Gelman: because she's like, because if you need to go to the bathroom and that belt's in a way, like you're gonna have

Britt (she/her): Ha ha ha.

Rachel Gelman: a problem. And sometimes still to this day, I have this like mental thing about belts that I'm like, no, and it gives me anxiety.

Britt (she/her): Yeah, Yeah. Yeah, yeah.

Rachel Gelman: because I have this fear that I'm not gonna be able to get this belt off and I'm gonna pee my pants. And so even though I know rationally that's not true, but it's like in the, and obviously I can wear belts now and I don't pee my pants.

Britt (she/her): Yeah, yeah. Yep. Yeah, yeah.

Rachel Gelman: But for such a long time, that was a belief I had, because I was told that if I wore a belt, I wouldn't

Britt (she/her): Mm-hmm. Yep.

Rachel Gelman: be able to get it off and I would pee everywhere and it would be a big problem.

Britt (she/her): Yeah, well they just mess us up, don't they?

Rachel Gelman: But I just think it's funny because also then I'm like, I've never asked her, but I'm sure

Britt (she/her): Yeah.

Rachel Gelman: she was probably told that as well. Like, you know, I'm sure there's this

Britt (she/her): Yeah, it is kind of funny.

Rachel Gelman: Yeah, I've had people tell me that they don't sit on a toilet seat

Britt (she/her): Yeah.

Rachel Gelman: because they were told by their parent that like, you would get. you get an infection or some people were told they'd get pregnant. I've had a few people tell me that they're like, I'm not, I never sit on a toilet seat

Britt (she/her): What?

Rachel Gelman: except for the one in my own home because when I was little, that's what I was told. And

Britt (she/her): Yeah. Yeah. And why is it important to sit on the toilet seat?

Rachel Gelman: because if you're like hovering, And I'm not talking about like, cause people always counter and say like, well, what if I'm camping and I need to do a deep squat? And I'm like, well, that's different.

Britt (she/her): Yeah, yeah, Yeah.

Rachel Gelman: Doing like a full deep squat is different than like when you're in, you know, like a gas station bathroom or something, then you're like, I don't want to put my butt on the seat. So you kind of like hover and you're in this like sort of half squat thing. You can't relax that way.

Britt (she/her): No.

Rachel Gelman: You're holding, you're like squeezing your abdomen. You're squeezing your butt. And if you can't fully relax, that means your pelvic floor muscles probably can't fully relax, which means you're not

Britt (she/her): Yeah.

Rachel Gelman: going to be able to fully pee and get all the urine out. All

Britt (she/her): No, you'll get the spray pee.

Rachel Gelman: get the spray pee or it'll go off to the side and go down your leg.

Britt (she/her): you

Rachel Gelman: it won't feel complete. And the other reason I think that it's different than when you're out camping or wherever you can do a deep full squat is if your brain is kind of anxious about it being like, I sh I can't sit on this toilet. Okay, we have to protect ourselves versus when you're probably out in the woods or wherever, popping a squat,

Britt (she/her): Mm-hmm. Yeah.

Rachel Gelman: you're just like, okay, I'm in the deep squat, I can relax, I'm gonna pee versus in this like, know, wherever you are that you aren't wanting to sit down,

Britt (she/her): Yeah.

Rachel Gelman: your brain is on high alert and we need your brain to be chill and relax so that your, you know, everything can empty effectively.

Britt (she/her): Yep.

Rachel Gelman: So I always say like, hey, first of all, like, your skin is a nice barrier. So if you do sit on the toilet seat, your skin is there to protect you. But I get why you maybe don't want to bare skin on a

Britt (she/her): Yeah.

Rachel Gelman: toilet seat that doesn't look very clean. So taking toilet paper and like making yourself a little makeshift

Britt (she/her): Yeah.

Rachel Gelman: cover is a good idea so that you can actually sit, let yourself relax and empty your bladder.

Britt (she/her): Mm-hmm. Yeah.

Rachel Gelman: Because this hovering thing can be,

Britt (she/her): Yeah.

Rachel Gelman: is not the best or optimal way to

Britt (she/her): Yeah, yeah,

Rachel Gelman: go.

Britt (she/her): Yeah. And I think it's kind of like the same thing where it's like, if it happens once in a while, fine, that's okay.

Rachel Gelman: Mm-hmm. Yeah.

Britt (she/her): But if it becomes like a constant thing that you're just doing all the time, no. And you're trying to rush all the time. No, you got to give yourself like that extra, that extra 10 seconds is not going to make or break a situation. It's not like

Rachel Gelman: Mm-hmm.

Britt (she/her): you're running the whatever race and whatever.

Rachel Gelman: Yeah, yeah. it's not like you're doing CPR and suddenly you're like, hold please, I'm going to go pee. But you

Britt (she/her): Yeah, yeah, yeah, exactly. Yeah. Yeah.

Rachel Gelman: know, when people tell me they're like, but I have a meeting, you know, I back to back meetings. And it's like, well,

Britt (she/her): Yeah. Yeah.

Rachel Gelman: I have a feeling, unless you're like doing something like you're guiding someone through a surgery, or I don't know what you would be doing.

Britt (she/her): Yeah, yeah, yeah.

Rachel Gelman: But my guess is that I just am that anxious that I have such like,

Britt (she/her): Ha ha ha!

Rachel Gelman: so many different things where I'm like, yeah, like,

Britt (she/her): You're like, okay, if it was this, then yes, but if it was this, then no. Okay, this is my boundary. If I'm guiding someone through surgery, okay.

Rachel Gelman: when people are like, oh, I have another meeting or a back to back meetings, I can't be late. I'm like, I guarantee.

Britt (she/her): you.

Rachel Gelman: I mean, I would hope unless like, everyone in the meeting as an asshole. Like, people

Britt (she/her): Mm-hmm.

Rachel Gelman: aren't going to be like, where were you? were 30 seconds late. It's like, I

Britt (she/her): Yeah.

Rachel Gelman: think everything will be okay if you just let yourself have that extra extra time.

Britt (she/her): Yeah, I think that's too... Yeah, I think that's the whole mind shift too with peeing. Like being able, like you said, to actually just take a breath and activate those parasympathetics. The rest

Rachel Gelman: Mm-hmm.

Britt (she/her): just to like... I think that's also a part too of the interplay of your... don't know, protectivism over the bladder.

Rachel Gelman: Yeah. when people are rushing to the bathroom. Why, like when people have that urge response and feeling

Britt (she/her): yeah. Yeah. Yeah.

Rachel Gelman: like if they don't make it, they're going to pee their pants and it comes on really suddenly. What's going on there and how people can kind of mitigate.

Britt (she/her): Yeah.

Rachel Gelman: their urge and that kind of like the wave, if you will.

Britt (she/her): Yeah, wave. Yeah, sure. So back in the day, when we were on the plains and foraging and running away from like animals that would eat us, anytime there was something that we had to run away from, right, it would either be bite, flight or freeze. Yeah, that's our response to that. And our eyes dilate. Our hair stands on end, blood flow gets sent to the extremity. So we're ready to run. And it also activates like our bladder and our bowel to empty. So what happens is if you feel an urge coming on and the urge is growing, usually an urge wave comes up and it comes back down and then it goes away. Yeah. That's the bladder being like, Hey, do we have time to pee? No. Okay. We'll wait till later. What happens? is that if you end up feeling like, I have to pee, or I really have to pee, and then you run, you end up making this urge wave super high. And then you just pee your pants because you're activating the stress system.

Rachel Gelman: Mm-hmm.

Britt (she/her): And you're basically like, anytime you run with an urge, you're going to pee your pants. It's like you are physiologically, evolutionarily like. set up to pee your pants with that. So you have to what we try to do when you have these intense urges that you know are like this urge does

Rachel Gelman: Mm-hmm.

Britt (she/her): not make sense. Like I just went pee 30 minutes ago. Like why do I feel like to pee all of a sudden again? You want the urge wave to come up and you want to try to distract yourself. Do some things maybe like relax

Rachel Gelman: Mm-hmm.

Britt (she/her): your pelvic floor. Think about like counting backwards from a thousand and sevens in French. Like something that's going to distract you. Whatever it is you're going to do that. and you're going to let the urge wave come and you are just going to hang out and you're going to stay low. And when the urge is done on the other side, that's when you decide, do I have to go pee? And if you do, then you can go to the bathroom. But if you go at the top

Rachel Gelman: Mm-hmm. Mm-hmm.

Britt (she/her): of the urge, you're just going to pee your pants.

Rachel Gelman: Potentially. I think there are some times where people make it, still make it.

Britt (she/her): Well, that's the thing to me when someone says, no, I don't pee my pants, but I still make it. I'm like, mm-mm. That

Rachel Gelman: Mmm.

Britt (she/her): that does not mean you made it. Making it means being able to come to the bathroom, open up the door, come in, unbuckle your your buckle, pull your pants down, pull your underwear down. If you're wearing

Rachel Gelman: Mm-hmm.

Britt (she/her): underwear, sit down, take a breath and then pee because

Rachel Gelman: Mm-hmm. Yeah.

Britt (she/her): you are the boss of your bladder. So whenever someone says,

Rachel Gelman: Mm-hmm.

Britt (she/her): but I don't pee my pants, I always make it. I'm like,

Rachel Gelman: yup

Britt (she/her): that's the issue. But you're like, I have to make it. Yeah.

Rachel Gelman: Yeah. That you feel like you have to make it. Mm-hmm. Yeah. like that mantra. I say that to myself a lot actually, because I think you said it. I think you said it when we were teaching once and I was like, I like that. I am in charge. I am the boss of my bladder is a really nice mantra

Britt (she/her): Yeah. Yeah. Yeah.

Rachel Gelman: to have and to tell yourself. But I do think it's interesting how that that wave can come on it's so hard to fight that instinct to rush.

Britt (she/her): Yep. Yeah, yeah, yeah, yeah.

Rachel Gelman: And I tell people like, you really need to like, slow down and do the opposite, which feels so counterintuitive.

Britt (she/her): Yeah. Yeah.

Rachel Gelman: And I also have found one little trick I've told people more recently is

Britt (she/her): yeah.

Rachel Gelman: to either like, curl your toes under.

Britt (she/her): Yeah.

Rachel Gelman: Or sometimes I tell people to think about trying to separate their like, middle and like, guess ring.

Britt (she/her): Yeah. Yeah.

Rachel Gelman: toe, like trying to separate your toes. And people don't realize how like there's such a big connection between the feet and the bladder because the same nerves that go into the pelvis branch off the same nerve that goes to the feet. So sometimes if you can kind of like be sending multiple signals on the same like neural highway, if you will,

Britt (she/her): Yeah.

Rachel Gelman: your brain is like, Whoa, what's happening here? And we're just going to shut

Britt (she/her): Yeah.

Rachel Gelman: off communication for a little bit. So I find that can also be like almost a way to distract yourself

Britt (she/her): Yeah.

Rachel Gelman: count backwards by seven, or I tell people like, think of all the countries that start with the letter C, anything to distract.

Britt (she/her): Yeah.

Rachel Gelman: And if, like you said, if after a few minutes they've done those things and they still need to go, then you can walk to the bathroom.

Britt (she/her): Yeah.

Rachel Gelman: But I think a lot of times that urge sort of goes away and people can wait. you know, another 30 minutes to an hour.

Britt (she/her): Yeah. Yeah. And I think it's also really important what you said before too, about thinking about stage of life as well, because

Rachel Gelman: Mm-hmm.

Britt (she/her): I know all this information and I was changing my son's diaper like a couple months ago and I was like, shit, I'm going to pee my pants right now. And I did like the exact thing you're not supposed to do. I was like, I just grabbed him and I like ran to the bathroom and sat down and peed. And I was like, that was the most intense urge spike I have. ever had in my entire life.

Rachel Gelman: Mm-hmm.

Britt (she/her): But I'm like postpartum, so I'm within that window of like, you know, having

Rachel Gelman: Mm-hmm.

Britt (she/her): low estrogen and my tissue being thin. I'm also perimenopausal, so I'm 40, you know, so I have like

Rachel Gelman: Mm-hmm.

Britt (she/her): all this stuff going on. I've already noticed like, like changes in terms of like, just sensitivity, like things are just bothering me more. And so

Rachel Gelman: Mm-hmm.

Britt (she/her): I was like, wow, now I know like, because some people will come in and they'll talk about, I don't have time, I don't have time between When I feel the urge and when I pee my pants, there's like no time to do that. It's like, I feel the urge and I pee my pants like right away. And

Rachel Gelman: Mm-hmm.

Britt (she/her): I feel like it's like the tissue like needs to be healthier. You need like create space there or something so that you actually have

Rachel Gelman: Mm-hmm. Yeah.

Britt (she/her): a moment to be able to like address that instead of just your body automatically just peeing its pants. So that's why the

Rachel Gelman: Yeah.

Britt (she/her): estrogen is also really important too.

Rachel Gelman: Yeah, we're always thinking about that.

Britt (she/her): Yeah.

Rachel Gelman: Yeah, I think it's so funny how people assume that if you're in healthcare or certain specialty, that means that you are probably like, have no issues whatsoever. Like

Britt (she/her): Yeah.

Rachel Gelman: I remember a patient once was telling me they were gonna go buy like a cake.

Britt (she/her): Yeah.

Rachel Gelman: And they're like, oh, I would tell you to go try this new bakery, but like, you're a PT, so I know you're probably pretty healthy. I'm like, I mean, I'm not like. not like a monk. Like I

Britt (she/her): Yeah. Yeah, yeah, yeah.

Rachel Gelman: am like a normal person.

Britt (she/her): Mm-hmm.

Rachel Gelman: yeah, I have a lot of these same issues.

Britt (she/her): Mm-hmm.

Rachel Gelman: That you know, we have these episodes where we do

Britt (she/her): Yeah.

Rachel Gelman: the things that we tell patients. Ideally, they should try to not do

Britt (she/her): Yeah.

Rachel Gelman: it's not to say like, you know, you're gonna always be having the most optimal bowel and bladder habits every day of your life.

Britt (she/her): Yeah. Yeah. Yeah.

Rachel Gelman: So, you know, we all have moments where we're like, well, I know I'm not supposed to, but I'm just gonna

Britt (she/her): Yeah.

Rachel Gelman: run over here and pee or like, yeah, hovering over a toilet seat. Like, it's not like we haven't done these things.

Britt (she/her): Yeah, yeah, yeah, yeah, yeah. So

Rachel Gelman: But.

Britt (she/her): we wanna make it better for everyone else, but don't feel bad if you do it once in a while, it's okay. And go see a pelvic floor physio. Yeah.

Rachel Gelman: Yeah. Yeah. Go, you know, I think at the end of the day, if you're unsure when in doubt,

Britt (she/her): Yeah.

Rachel Gelman: maybe get a consult,

Britt (she/her): Yeah.

Rachel Gelman: try to talk to, you know, a professional because

Britt (she/her): Mm-hmm.

Rachel Gelman: the thing we see time and time again. is everyone's like, I know I should do key goals or I already

Britt (she/her): Yeah.

Rachel Gelman: do key goals. And it's kind of like, okay, like, sure, there's a time and a place for that one exercise. because

Britt (she/her): Mm-hmm. Yeah. yeah, yeah.

Rachel Gelman: we have very strong feelings around this idea

Britt (she/her): Yes.

Rachel Gelman: that there's just one exercise to rule them all.

Britt (she/her): Yeah.

Rachel Gelman: there's so many options and so many things to think about.

Britt (she/her): Yeah.

Rachel Gelman: that when people start having bladder symptoms, they look at pelvic floor, they see Kegels, and that just kind of is what people start doing. And hopefully people will start to understand and realize there's so much nuance there that

Britt (she/her): Yeah.

Rachel Gelman: if you can try to at least talk to someone and just get a better sense of what might be a good option for you as an

Britt (she/her): Mm-hmm.

Rachel Gelman: individual versus taking these blanket ideas.

Britt (she/her): Yeah.

Rachel Gelman: And because sometimes there's, obviously there are some blanket ideas that think make sense, like drinking more water. Like we know

Britt (she/her): Yeah. Yeah.

Rachel Gelman: that as human beings, that is something we need to survive. But

Britt (she/her): Mm-hmm.

Rachel Gelman: giving just one specific exercise for every single person with a pelvis isn't really like, it doesn't make sense to me.

Britt (she/her): Yeah. Yeah. Yeah.

Rachel Gelman: When in doubt, reach out. I

Britt (she/her): Hashtag.

Rachel Gelman: love it. I'll make it into a button or a sticker, because I do love a sticker.

Britt (she/her): Yeah, there you go. Yeah.

Rachel Gelman: Well, awesome. When in doubt, reach out. We're going to end on that note, but tune in next

Britt (she/her): Mm-hmm.

Rachel Gelman: time where I believe we're going to be talking about sex.

Britt (she/her): Yeah!