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Entries in tissue talk (4)


Tissue Talk: The most estrogen-dependent tissue in the body

You might be thinking the uterus, ovaries, or mammary glands. But no, we're talking the urethra. Yes, that's right, the urethra. It is the most estrogen-dependent tissue in the body for both men and women.

The urethra depends upon sufficient estrogen levels to maintain proper lubrication, which is essential for normal functioning, especially in women. Women lack an internal urinary sphincter. Instead, the urethra must compensate through an adequate bladder neck angle (also called a urethral angle) and a process called coaptation. The urethral angle refers to the angle the urethra exits your bladder. Too small an angle may contribute to diminished flow. More common, too great an angle may contribute to incontinence. Coaptation means that the tissue must open and close in response to external (to that tissue, not to your body) stimuli. In order to do that, it requires sufficient lubrication provided by the mother of lubrication--estrogen.

Several of my menopausal and post-menopausal patients have found that a topical cream has been part of the solution to their incontinence. The cream does not carry the risks associated with oral hormone replacement therapy. You may benefit from the topical if you have low, or borderline, estrogen levels, have bladder issues and especially if your stream is affected (diminished, increased, spurting, etc).


Tissue Talk: The importance of being hydrated

I always tout drinking more fluids, especially water, in order to work the bladder as a muscle, keeping it strong. The other side to this coin is the benefits of hydration. All tissues function better if appropriately hydrated.

While there has never been research to indicate just how much we should drink and there are varied ideas about how to compute amounts to drink, I tell my patients to use their bladder as their gauge. If you are exercising regularly and have gained control of your bladder issue, you know you are drinking enough if your symptoms subside and you are dehydrated if your symptoms relapse. You can also use your time on the toilet as a gauge: Women should urinate for 10 to 12 seconds and men should urinate for 12 to 15 seconds. If you don't make that mark, you need more fluids.

People tend to think more about hydration in warmer weather, when they're more active. But these MN winters are so dry that it is important to think about hydration year round.


Tissue Talk:  tensegrity

Here's a fascinating and creative take on functional structure:

Tensegrity is a term popularized by Buckminster Fuller when he built the first geodesic dome. These buildings transfer loads through tension beams which are connected in triangles. The integrity of this tension system is crucial to the stability of the structure (tension integrity = tensegrity). When a force pulling in one direction is equally opposed by a force pulling in the opposite direction, stability is achieved for that direction only. For complete rigidity of a structure the various lines of force form a series of isosceles triangles. These are called tensegrity structures. Our bodies do not require this amount of rigidity, in fact our function would be limited because of it. However, the linking together of muscles through their connective tissue bonds (fascia, ligaments, and bones) can create momentary tensegrity systems that assist in the transference of force without too much compression through the joints. Exercises, which connect muscles both individually and collectively, provide tensegrity for the direction of load being imposed.

---Lee, BSR, FCMAT, Diane, An Integrated Model of "Joint" Function and Its Functional Assessment, 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.

Proprioceptive Neuro-muscular Facilitation (PNF) tests and treats patterns of movement that utilize all of a joint's movements through all three dimensions. Since most muscles' tendons and their attending structures (fascia, nerves) attach to their nearby joints, taking a joint through its functional patterns that include abduction/adduction, extension/flexion, and internal & external rotation challenges all of the structures' strength, mobility, range of motion and, most importantly, neuro-muscular coordination. The points in the movement that present as weak, ratchety or painful reveal dyscoordination of a system of structures through that particular part of the pattern of movement. This need not show up in testing single muscles in single planes of strength such as is done in kinesiology. And building strength alone will not provide results. The system as a whole must be reeducated in how to behave as a system. PNF provides systemic functional reeducation.


Tissue Talk: neurology of chronic pain

An item I share in my Bladder & Pelvic Floor Health for Practitioners class from Haslam & Laycock's "Therapeutic Management of Incontinence and Pelvic Pain", 2nd edition:

When pain persists, even after healing has taken place [from a trauma], the nerve cell membranes undergo a change in conformation, establishing new receptor sites and the formation of new neural pathways that become embedded into the central nervous system. Once established, the chronic pain pathways are difficult to eradicate. Chronic pain no longer serves a useful purpose, but leads to physical, behavioral, and psychological changes that combine to produce the pain experience.

There are a couple very practical implications here. Firstly, chronic pain causes very real physical changes, even when the physical cause can no longer be detected. Secondly, the longer someone waits to get treatment for pain, the more established will be those physical changes and the more treatments they will require to try to reverse the pathology.

I have had patients who have become frustrated with western medical practitioners who told them that the pain "is in your head". It's an unfortunate (and rather dismissive) way to language it, but sometimes this is to what they refer. The physical cause has resolved; the pain now lives in their neurology. Chronic pain requires both physical modalities and CBT (cognitive-behavioral therapy) in order to be addressed completely. It will not be resolved by medications or surgery.