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Entries in urinary leaking (6)



Skeletal muscles have tone and strength. The two are often confused because in normal parlance we say that someone who has built their muscle strength, by say, weight lifting or physical activity, is 'toned'. This is not what we are referring to when pointing to muscle function.

'Muscle tone' refers to the work the muscle is doing when it is at rest, while the work that muscles do while working, or exerting force, is called 'strength'.

All muscles maintain some working fibers, even while at rest. This reflects a certain amount of electrical and chemical communication that constantly happens in order to maintain basic functions such as proprioception, balance or just structure. Those muscles that have some responsibility for posture have more slow-twitch fibers and will have greater resting tone. Slow-twitch fibers are the "white meat" of muscle. Like birds who must fly hundreds of miles to migrate, they are working much of the time to keep up some tone for endurance. The need for postural and structural support never sleeps. When some fibers need to rest, others jump in to take over. The pelvic floor is postural and is prone to hypertonicity. Hypertonic fibers are those that do too much work while at rest. A muscle that doesn't rest can't work as well and can produce pain. Most patients who show up at American pelvic pain clinics or complain of urinary symptoms present with hypertonic pelvic floors.

Muscles at work are characterised as strong or weak. Both can be hypertonic (or hypotonic, for that matter--meaning too flaccid at rest). When women are given a vaginal digital exam by a urologist in order to assess for strength, it can be difficult to accurately assess the strength of a hypertonic pelvic floor. If the muscle contracts but doesn't adequately relax afterwards, the physician will feel little difference in tension and proclaim the muscle group to be weak. What the practitioner actually felt was the result of hypertonicity and the jury is still out on the strength or weakness.

A female urologist (one who is trained on female anatomy & physiology) is more likely to be aware of this issue than the more traditional male urologist. Nearly all urologists are male urologists.

I have had patients who become concerned that exercise will worsen hypertonicity. This could not be further from the truth. When we work a muscle, we contract and relax it, over and over. In working the muscle we train the relaxation part of the cycle as much as the contraction. In fact, working the muscle is one way of treating hypertonicity.

For the pelvic floor, there are two more ways that we can aid relaxation of the muscles. One is to give a slight push out, like giving a little push to get a tampon out. It should never be a forceful or strained push; use very little effort and don't expect to feel anything different from doing it. The other way to relax the pelvic floor is to lie in rest pose--on one's back, with knees bent and soles of the feet touching each other. This minimizes the electrical activity from the large muscles of the thighs and buttocks that tends to spill into the pelvic floor. This electrical activity is normal, but too much of it promotes hypertonicity.


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).


The weighted bladder

Research shows that bladder dysfunction is affected by changes in body weight. Even a five pound increase in weight can adversely affect a bladder already experiencing symptoms. The good news? A five pound decrease in weight can lessen the stress on the organ and, hence, mitigate the experience of bladder symptoms.


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.


But I have a small bladder.....

I'm amazed at how often I hear this and that this myth has survived in such an educated society. You never hear anyone say, "I can't do aerobic exercise because I have a small heart." It sounds ridiculous, right? But somehow when people say they have a small bladder, it goes unchallenged.

All species are born with organs of appropriate size for their bodies. My 8# Papillons have very small bladders. But when there has been occasion that I wasn't able to get home for 10 hours, they held it. They are continent through the night. Size is irrelevant; condition is everything.

It is true that the bladder, being a muscle, can atrophy, just like a heart can degenerate into unhealthy condition. The heart degenerated from not exercising and the only way to get it back in shape is to do aerobic exercise. The bladder atrophied from not drinking enough fluids and from urinating too frequently and the only way to get it back in shape is to drink more fluids and to urinate less frequently.

Next time someone laments that they have a small bladder, let them know that there is help for them and direct them here.