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Exercise
Hey guys Rosso Steinberg and welcome to another episode of have the balls to talk about it
So today we'd like to welcome back Lianne Nikki Bella's are our pelvic floor physiotherapist and we're gonna talk about
An interesting topic which some nails have experienced Nick actually brought this up because he's had some episode. It's actually true
I did yeah of men ping too much can't be too much so
let me start with this because it's interesting because when it I like I had it moments in my life and I always wondered I
Never figured out was it stress was because I drank too much water
Because you know, I just kind of went I had it left and I never knew I never did anything about it then okay
So the average person would typically go between 5 to 8 times a day
Does that depend on how much water you drink and I get that question all the time?
This is for someone who drinks let's say around 2 liters of water a day
So someone who is drinking all their intake of fluid evidently if you're drinking 4 litres of water a day
you might go more frequently the bladder and some patients don't realize that I had a couple of patients come in and
They were drinking 8 liters of coffee a day. Ok, and then I I said stop and they stopped and they were cured
So yeah, we're not talking about those patients know for someone who drinks the normal water a normal fluid intake every day
They would go let's say every two and a half to three hours a day
Now if you wake up in the morning, and you didn't go all night
You might go more frequently in the morning and that's okay
But globally you would go between let's say five to eight times in a day and at one point
I remember I was a little bit stress and the thought of it could that also trigger?
Yeah, definitely. There are stretch receptors in the bladder that can be triggered in different ways
Often when the volume gets to a certain point those are gonna go off and give a signal
To your brain and your spinal cord
You know saying that you need to go but there's other
Factors that can irritate the lining of the bladder and give you that you know that urgency that feeling that you need to go now
So stress being one of them anxiety
Certain bladder irritants like someone for example, you mentioned coffee alcohol
spicy food
Anything really acidic that could also irritate the lining of the bladder. Yeah
Yeah Because it could be so what happens is the lining of the bladder gets more
Irritated and you know that gets the muscle around the bladder to want to contract in an involuntary way
so it's going to give you that urgency that you need to go the bladder starts contracting which means it wants to empty very very
Similar to bladder infections, you know a woman that often sometimes men get a bladder infection
irritates the bladder and they're running to the bathroom every
30 seconds so you can see that with caffeine and alcohol not to the same degree typically as a bladder infection
But does that mean that caffeine and alcohol is obvious that we know alcohol is not
You know good for your great for you. Does that mean it's bad for you to drink?
Is there X amount that I should or shouldn't drink or no? I mean it's it's it's you know, most people
Pee more with caffeine and alcohol
But in moderation it I think if it affects your quality of life
And it stops you from doing things in your day to day then you might want to reduce it and see if that changes
So it's very subjective when went from one person to the other
It really depends on how it bothers you, you know, you can start off by eliminating one thing. Did it change anything?
Yes or no?
keep a journal
and see what the differences are with or without it and
People often come up to me and say do I have to be treated do I need medication? Do I need therapy for it?
And I I tell them it's like a headache, you know, you can take a Tylenol if you want
No one died of it of an overactive bladder. Well, so it's a matter of can you?
Know you can't do any harm. Okay, but no one died of an overactive bladder. It's a quality of life issue. Yeah
Yeah, you can take tahno if you want to if you want to live with it and go into a quiet room
Yeah
What happens sometimes is that someone will keep going to the bathroom frequently because they're nervous and they don't want to go for example
When they're working or when they're at the gym or when they step out of their house and the bladder?
Overtime can get a little bit lazy and the sense that the total volume can you know instead of filling up to?
400 it'll fill up maybe halfway and
those you know, triggers are certain are gonna start going off which will
You know make you go more frequently throughout the day and so someone who goes 15 times a day
might need to retrain their bladder kind of like someone who had
A gastric bypass surgery in their stomach gets really small. They eat you onto the food
they get full whereas someone can eat like
You know 10g drain that by if I have to go pee I hold it and that's how I treat it
Yeah, so one of the ways you can train and this is where pelvic floor physiotherapy comes in
You have two sphincters. One of them is a little bit more internal at the neck of the bladder and you have another sphincter
That's below the prostate gland and that is supported by the pelvic floor muscles
And so when you're able to contract these muscles
Fully you have full control of the sphincter and you're able to suppress the urge to go to the bathroom and often
it's just a much, you know a matter of
improving that communication between your pelvic floor your bladder and your brain and
Giving you the education that you need to know that it might not be a real urgency
It might be you know
A fake one in the sense that you went half an hour ago your brains tricking
You don't need to go right away suppress the urge keep doing your stuff so that you don't develop a lazy bladder
yeah, I just want to add one thing because
We're just just to be clear with everyone. We're talking about really the run-of-the-mill overactive bladder
There are other things that can cause people to pee a lot
Diabetes and enlarged prostate infections. So if there's something out of the ordinary in your symptoms
Definitely seek medical help point do you like I always have that question
I think a lot of people - probably they think at what point do you?
say I gotta go see a doctor I was like
Well, if there's any I mean if it's if it's really a problem affecting your quality of life
But if there's any other symptoms that can be more than just the run-of-the-mill if my car changes my pee
Yeah, if urine becomes cloudy if it hurts when you pee I feel like people generally when they're concerned
They're gonna start off by seeing their doctor and they're gonna see what options they have in front of them
You can definitely take medication to help but you can do a conservative approach also
And you kind of way out which one works for you and which route you want to take, but I always suggest as dr
Steinberg mention it could be so many other factors and we don't know what its gonna be
So rule them out before
First and foremost and then you can go and do something a little bit more conservative and then bring awareness of the pelvic floor muscles
There's also there's also people who not just peel up but they actually lose urine urinary incontinence. Yes
We see that extremely commonly in women
But we do see it in men in various conditions and and often they need to be seen by a pelvic floor physiotherapist. So
Can you tell us about that? Wait, what is a year what it was that Huard?
Your hairy incontinence in constant content the loss of urine
Why there'd be a drop or a large amount
It's definitely more prevalent and woman
But there is up to one third of men who are affected by this and it could be affected by different ways
So the first one being you know
A stress and continence what that means is that the pressure is so high pushing on your bladder
for example
If you puff if you sneeze if you list something heavy
The intra-abdominal pressure is gonna be pushing on the sphincter and that might lead to a leakage
Okay, so another one could be for example an urge incontinence
So what this means is that the bladder gets excited again for someone maybe who has an overactive bladder
Okay, and then, you know, they're put the hands and running water or they'll take you know a shower
They'll put their key in the door and then certain things will trigger that
Excitement of the bladder and it's a strong urge. They can't they can't
Pee in their pants the bladder is gonna contract on its own involuntarily and they lose that control
Yeah, another type of incontinence would be overflow which happens because you know mainly in men who are a little bit
Older I guess you can yeah
Usually their prostate blocking the bladder and almost completely
So they think that their sphincter is not working
but what it is is their bladders filling up and filling it up and have one liter as well and just
Overflow like a you know, when you take a cup and you pour water starts to drip over this side
Mm-hmm, they're not able to control that. It just comes out it comes out because there's no more room in the bladder
Right. And is that normally for older people?
Yes
because the bladder will compress and and
Essentially block a part of these of the urethra and the urine has nowhere to go
So I thought I'd just I'd mentioned it's gonna you know
fill the bladder and then
along the day
I could be an important medical issue cuz that commanded the pressure and the bladder can actually back up to the kidneys and cost can
You damage Wow, no
incontinence in males or
Urinary leakage in males is something that definitely you should seek help
And I think it's important to mention that a lot of men who've had prostate cancer and had the prostate removed are
Much more susceptible to getting incontinence because through the removal of the prostate they inevitably have to remove the first
Sphincter, so that means that they have to rely 100%
On the second sphincter and the second finger can be damaged during the surgery also
Exactly, depending on how much they've removed, right?
So and they would need to do some reg occation for these muscles and gain strength
gain
Endurance get better control and coordination and you know integrate their pelvic floor expo not their exercise a bit
You know integrate the pelvic floor with in your day to day activities
You know, why is it there? Why do you have a pelvic floor? When should you be using it? And what types of activities?
So for example if I want to go from a sitting to standing position
I'm gonna want to do what's called a perennial locking which means contracting your public floor prior and during
Doing the movements that I don't get any loss of urine
I think it's important for you as a trainer because it's something you can you can work into your routine with
With men when they're training, you know locking in their pelvis like they're doing with the whole core and locking in their neck
So there's while they're doing a rep of something they'd be using like inside everything, right?
It's like you're doing a Kegel which means are doing a contraction of the pelvic floor muscles
So what I like to say
It says if you're trying to hold in urine and gas because you really want you know
the entire public floor to lift and it's a movement that's gonna be tightening and
Almost like an aspiration going upwards and inwards and something very interesting for people who do like to work out is you know
It's very much a part of your core
Okay, and often when we think of core, we you know
We think of our abdominals but they're tied in and they're connected with the inner most abdominal muscle the transverse abdominus
And the diaphragm as well and the muscles that support your back
So these for you know parts of them your core
They really Co contract and synergetic ly work together so that if you're doing martial arts, for example
Or any type of physical activity, you know
You're gonna naturally
Bring in your abdominals and your pelvic floor often co contract at the same time
And if they don't these are often people who are more susceptible to having dysfunctions and problems like urinary leakage
But the common mistake that I see is that when you tell people to do their kegels or they read it
But they squeeze their abdominals only. Yes, and they forget the pelvis. I cannot tell you how many people
Think they're doing what's called a Kegel when in fact, they're compensating, you know with their inner thighs
Especially with their gluts. There's hardly any elevation with the pelvic floor
They're blocking their breath which by blocking your you know, you're not moving the diaphragm
It's increasing that internal pressure, which could lead to more leakage
so they're actually doing the opposite of what they're supposed to be doing and I think
verbal cueing and getting you know someone to really evaluate to see the quality of the
contraction and what it's doing and being able to correct it to optimize the efficiency of the contraction so that when you're integrating it
It'll be working at an optimal, you know, yeah when I tell patients often that they should see if they'll third floor physiotherapists
No, no, I did exercises. No, no
No, you need to see an expert to learn how to do it properly
Then you can do it on your own but you know if you're not improving at all
Or you're not doing any improvement. You're probably not doing it the right way
Keep in mind Nick that these muscles are not accessible on the outside of the body. You can't see them they're hiding inside
and so to get that connection and to
Understand how to relate to them is not easy and people often feel that they're doing it properly
But they're compensating in so many different muscles that the actual real muscle is not doing very much, you know
and then you'll have people say oh
I do Pilates and I do I say yeah great. Show me and then sure enough
They sometimes they do the opposite and they push instead of you know, pulling it inwards. They'll do the opposite. Yeah good
So I hope you guys enjoyed the episode
If you have any questions, leave them in the comment box any comments
Let us know if there's any future videos or topics you want us to cover
and make sure to go visit my website Nick Russo's comm or
Steinberg urology comm on instagram at Steinberg urology
thanks, again the end coming you for having me and remember guys have the balls to
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