The Hidden Muscles: Pelvic Floor Health in PD

In this episode of Parkinson’s EmPower Talks, our guest is Erica Vitek, MOT, OTR, BCB-PMD, PRPC with Aurora Health Care.

Today, we’re talking about pelvic floor health in Parkinson's. This can be a very sensitive topic, but it needs to happen more often in Parkinson's care.

Many individuals with Parkinson's experience bladder changes, constipation, urgency, nighttime bathroom trips, and these symptoms are rarely talked about openly.

The good news is there are some therapies, exercises, and strategies that can help.

Erica’s EmPowering message is, “The pelvic floor is a muscle; we can do something about it. We can help the pelvic floor muscle, training it in a different way to help you to really maximize your quality of life. You are not alone; it's common, we can help it, and track patterns. So, when you go to your clinician, you can have at least some idea of some of the patterns that you've been experiencing, and then we can start from there and take steps to help you get this all taken care of.”

To watch this episode on YouTube: https://youtu.be/b5Qa530Agu0

Resources:
BCIA, look for a practitioner certified as BCB-PMD (board certified in biofeedback for pelvic muscle dysfunction) Consumers - https://www.bcia.org/consumers-find-a-practitioner

Herman and Wallace, look for a practitioner certified as PRPC (board certified pelvic rehabilitation practitioner)
Find a Pelvic Rehabilitation Practitioner Near You - https://pelvicrehab.com/?utm_source=hermanwallace.com&utm_medium=referrral&utm_content=findapractitioner

American Physical Therapy Association
PT Locator | Find Expert Care for Pelvic and Abdominal Health - APTA Pelvic Health - https://www.aptapelvichealth.org/ptlocator

To support more programs like this: https://wiparkinson.app.neoncrm.com/forms/support-parkinson-empowertalks

Wisconsin Parkinson Association 
website: https://wiparkinson.org/
YouTube: https://www.youtube.com/@wiparkinson
facebook: https://www.facebook.com/wiparkinson/
instagram: https://www.instagram.com/wiparkinson/

Transcript

SPEAKER_00 0:02

Hello, friends. Welcome to Parkinson's Empower Talks, a journey of empowerment and understanding for living your best life with Parkinson's. Kick back, relax, and get comfortable. We're here to make your Parkinson's journey just a little bit easier. I'm your host, Daisy Reimer. I'm a nurse practitioner specialized in movement disorders and the president and CEO for the Wisconsin Parkinson Association. The Wisconsin Parkinson Association's mission is to provide hope, community, support, and resources for individuals with Parkinson's and their loved ones. Welcome to Parkinson's Empower Talks. I'm Daisy Reimer, and we're having a conversation that I think needs to happen more often in Parkinson's care: pelvic floor health. Many individuals living with Parkinson's experience bladder changes, constipation, urgency, nighttime bathroom trips, and these symptoms are rarely talked about openly. The good news is there are some therapies, exercises, and strategies that can help. And I have Erica Vitek who is joining me today. And we are going to discuss this further. Erica, can you give us a little bit of background on what you do and where you work and what really kind of got you into Parkinson's disease? I know that you and I have gone back a long way. We I think we've known each other for decades now. And I have to say you're probably one of my most cherished colleagues because just your knowledge and your insight into Parkinson's disease is just amazing. So thank you so much for being here today.

SPEAKER_01 1:39

Wow, thank you, Daisy. I feel the same about you. And yes, we do go back decades. So uh basically, I'm an occupational therapist. I've been working for over 20 years actually at the same place. So I'm at Aurora Sinai Medical Center, and I'm a full-time clinician. And really how I even got into knowing about Parkinson's is this the field of getting a job as an OT when I graduated was pretty tough, actually. And and Sinai had an opening, and I took it and found out it was a Parkinson's center of excellence. And I was like, wow, I gotta learn something about Parkinson's because I'm gonna be seeing a lot of people. And I was on the inpatient side actually when I first started as an OT. And I really got to understand Parkinson's mainly because of two amazing physicians that I worked with, Dr. Paul Nasita and Dr. Gary Leo. And they were really the driver to my passion for Parkinson's, along with you, Daisy, uh being the nurse practitioner in their practice. And I really felt a connection immediately to Parkinson's and wanting to help because I could really see significant rehab potential and kind of started off as more of an interest in the exercise potential for these individuals. Uh, but it grew. I had a passion for pelvic health and just didn't really connect the dots as to Parkinson's and pelvic health and how it was so important when I was a newer OT. And then when I really got into training for pelvic health, which was only a few years into my career on acute care, I realized wow, I can do a lot, not only for the general population and pelvic health, but there was really a need in Parkinson's and kind of that non-motor symptom aspect of the disease. I was focused on a lot of the motor symptoms with the therapy I was doing and muscle strengthening and changing the way people moved and helping them with balance and posture. But then realizing that really the bladder and the bowel struggles can be real and affect quality of life. And I have taken that to the next level. I have studied this extensively. It is a big passion of mine. I'm in outpatient rehab now. I full-time do LSVT big and pelvic health. Those are my two uh specialties in outpatient. And I've also written a course on Parkinson's and pelvic rehab. It's a two-day course actually for OTs and PTs. So I do training throughout uh anyone that wants to take it really nationally or internationally via Zoom. And that's my course that I just have put all of my passions into. And then I also teach a general like neurocourse on pelvic rehabilitation too. And then I teach LSVT big. I'm a faculty with uh the LSVT global crew, and so I'm really into the teaching realm as well as my clinical realm. And so that's just a little bit more about me.

SPEAKER_00 4:32

I think that's what I was really referring to when I said about how cherished you are. I I when I think of the impact in the state of Wisconsin on training the trainer, you know, training other health professionals between LSVT big and your pelvic, you know, floor exercises and and program. I just think that it's just amazing what you've accomplished in your career. So thank you for that. So, what exactly is the pelvic floor? Like what role does it play in the body?

SPEAKER_01 5:03

Yeah, yeah, great. So let's uh chat about this muscle. So basically you have your your pelvis, like your hips, and the base of our trunk area, so the pelvic bones. And then at the very bottom of that is really the pelvic floor muscle. It's kind of like a hammock-shaped muscle or a bowl-shaped muscle at the base of the pelvis, and it connects to the front bones and to the tailbone in the back. And really, it it has a few functions. It's really part of our core in some ways. It helps us be more stable, uh, but it also really is a supportive kind of shelf. They call it the pelvic floor because it's a shelf for our bladder, our uterus, or prostate in a male uh and the colon or rectum area as well. So it provides that nice stabilization and support there. And then it's also provide providing like a sphincteric function or a closing function when we need to hold back what uh the contents of the bladder or the bowel, but it's also supposed to be able to relax efficiently to be able to go to the bathroom as well. And so it it really is a key part of the function of that whole uh the system of the organs, but as well as just body movement and body support.

SPEAKER_00 6:19

So, you know, obviously it's a very important and an important piece of system in our body. How does Parkinson's affect pelvic floor?

SPEAKER_01 6:28

Yeah, so the pelvic floor is just like a muscle, like your arms or your legs or your balance reaction muscles. So all those muscles that we have like voluntary control over in our system, the pelvic floor is the same way. We have voluntary control of the ability to hold our bladder or to release the bladder, or the same thing with the bowels to hold the bowels or release. And when it comes to Parkinson's, what can happen is the area where the dopamine loss is occurring in the basal ganglia, that area is actually supposed to be kind of an inhibitory switch for the bladder. It's supposed to be when the bladder is storing urine, it is supposed to be helping it store urine to keep it in storage mode. And when the basal ganglia and the dopamine isn't right, and we have lack of dopamine or loss of the dopamine-producing cells, the bladder kind of has like too loose of a leash like a puppy. It can just kind of do what it wants and it just doesn't, we don't have good control over it. And so it starts to act up and cause a lot of problems for people with Parkinson's. And uh also the the uh colon is has dopamine cells in it, and it's supposed to be a mobilizing stool throughout the day, especially after we eat and things like that. And those cells are also affected negatively, as maybe many people have heard that the the colon can sometimes be maybe even the first place. Some things show up like prior to diagnosis, years before being constipation. And so uh we know that the colon just becomes slower, just like the muscles. And unfortunately, then we get backed up with stool and it's more of a constipation presentation. And yeah, you might not even uh think it's it it that you could do anything about it, but we're gonna talk a lot about like what can we actually do about some of these things that yes, we maybe can blame Parkinson's a little bit for some of these things, but we can do something about it.

SPEAKER_00 8:22

That's what we want to know, right? That's what we're trying to do is empower people with that information and give them the tips that they need. So, what are the most common pelvic floor symptoms? You mentioned about constipation, you know, that you see with people who are living with Parkinson's.

SPEAKER_01 8:37

Yeah, so well, let's build a little bit on the bowel issue. So uh, first off, when we when we eat, like the GI system can be affected really from top to bottom in Parkinson's and people can experience swallowing problems, but really even just getting to the stomach, the stomach might empty a little bit slower than average. And if you're backed up with stool, that might be also then uh just be a little worse because now everything's backed up. And as we know, uh, or if you don't know, uh the carbidobolividopa needs to get to your small intestine, it needs to get out of your stomach in order to really work to help movement symptoms. And so it is really important to work with this constipation issue because the medications work so much better when we can get the stomach emptied and get that carbidobolibidopa more efficiently to the small intestine. So that's one um really important thing. And then also just generally another bowel symptom that can be really common is the actual like slowness or difficulty like evacuating stool. Uh, it can be really challenging to get it out. It might feel like it's like right there, but it just will not come out. So I teach strategies to help with that because that can be like a muscle in coordination, but also like a slowness of just everything down there that we can actually uh help with. And then let's talk about the bladder a little, Daisy. So the bladder problems that are really common in Parkinson's are mainly like that gotta gotta go feeling, like the overactivity of the bladder. So the bladder muscle, it's a muscle itself. And when it stretches, uh, it is supposed to be slowed down by the basal ganglia. It's supposed to be controlled as it's storing urine, but it's not not uh uh having that accuracy, that that signal is not uh connected as strong as it used to be. And so when the bladder stretches and fills with urine, it just gives the gotta gotta go signal like really early on in the filling stage. So individuals with Parkinson's might experience like they they have this really strong urge and they go to the bathroom and they hardly go. It's like I have this strong urge and I get in there and hardly get to go.

SPEAKER_00 10:40

I had to get here fast. Yeah, exactly.

SPEAKER_01 10:42

Or getting up in the middle of the night, like this, you know, you maybe your mobility isn't as good in the middle of the night, your medications aren't on, or you just don't feel as stable, and you're rushing in there because you get this awakening and you feel a strong urge, and then like almost nothing comes out. And so uh that can be just that connection and the miscommunication, the uh signals are kind of mixed up a little bit. Uh, and so that is that is very common. And then that causes obviously not only this urgency, but frequency. So maybe you're out and about and you kind of know where every bathroom in the Milwaukee area is, or wherever you might live, right? Maybe you're not in Milwaukee, but wherever it is, you kind of know where the bathroom is. Right, yeah. Right. I had a patient come in this week and she brought a card that was given to her that was like uh the freeway, and the signs were like bathrooms here, bathrooms exit there, bathroom exit here.

SPEAKER_00 11:34

That's what you're saying, right? You're looking for them everywhere you go.

SPEAKER_01 11:38

Right, right. So it becomes kind of like almost like just this habit of you have to always, you know, be be knowing where they are and uh because it's very anxiety provoking. Uh, you don't want to have leakage, which can also be a common thing, is having urinary incontinence as well. And so yeah, it's it's something that we we want to get a handle on so you can live your life.

SPEAKER_00 11:59

It's interesting, you know, you started out talking about the medication, you know, having to get through. And so people who are experiencing where they feel like they just it took a dose, but it's really just not working well. Some of that could be attributed to whether or not their bow is, you know, is is blocked too much and things. I remember one patient in particular at the Parkinson Center that was seeing you. And originally the patient and her spouse had come into our clinic and she was up to the bathroom at least between 11 and 13 times a night. And the spouse was exhausted. He was just he didn't know what to do with himself, and he was so frustrated that she would get there and just go a little bit, and then they'd get back to the bathroom and he like he never really slept. And after she had gone through, you know, pelvic floor exercises, he's like getting up, you know, a couple of times a night seems like you know, just it it was just amazing change in their in their level of function, you know. So this can be really life-changing for people, both with the person who has Parkinson's and the caregiver as well.

SPEAKER_01 13:03

Absolutely. And sleep is so key too, Daisy, right? Like when the caregiver's not sleeping or the care partner's not sleeping and the person with Parkinson's isn't sleeping, the motor symptoms are worse, other non-motor symptoms are worse, and you just don't feel yourself, and cognition might be more impaired. And so the bladder can really kind of rule the roost, if we want to call it that. I mean, it really can. And we want to be, we say, like the boss of the bladder rather than the bladder bossing you. And uh so yeah.

SPEAKER_00 13:31

Yeah, empowered, you know, taking control back. So when along kind of the disease course does this occur, you know, when when do you start to maybe lose that strength in the pelvic floor?

SPEAKER_01 13:42

Yeah, so I mean, I would say constipation, like we talked earlier, might be more prodromal or like before diagnosis and might even sometimes people just attribute it to their body changing or aging or something like that. So it's hard to exactly know. But constipation is one of those known kind of early, early symptoms that might happen that way. And uh the bladder sometimes doesn't happen till a little bit later. Uh, usually early in Parkinson's, the bladder kind of still is acting pretty normal and it's with more depletion of dopamine cells that it tends to act a little bit differently or act out uh and might be more in the the later stages. Um, but no matter when it comes, we can do something about it. So even if you are experiencing, you know, experiencing it before other people might, it's okay. We we really should get on it as soon as we can.

SPEAKER_00 14:30

I would think that being as proactive as possible would be good. I mean, this is like any other exercise for another muscle in your body. The sooner you learn it and the more you maintain it, um, the better the the health outcomes, of course. Right, right. So when people hear about pelvic floor exercises, they often think of like Keggles. You know, how how accurate is that?

SPEAKER_01 14:54

Yeah. So actually I hear that all the time. Well, Keggles was just the guy who developed these, right? So it was Dr. Arnold Keggle, he was a gynecologist, I think way back in like the 40s or the 50s, and he decided that pelvic floor exercises might actually help people recovering from, you know, having a baby or as we age and fixing urinary incontinence. And uh, so that was kind of how it got the name Keggles. Uh, but really it is just pelvic floor exercises. So it's anything that we're doing to try to strengthen, or sometimes it's about relaxing the pelvic floor too. So it's not always about strengthening, but yes, those are the same thing. Keggles, pelvic floor exercise.

SPEAKER_00 15:36

It always seems I I think people oversimplify it though. They think it's just like, oh, I'm gonna tighten up and then let loose, and you know, okay, I can do that on my own, right? But it's a lot more complicated than that.

SPEAKER_01 15:46

And it is, it is, yeah. It definitely is a lot more complicated. And some people actually, believe it or not, have tension in the pelvic floor that cannot be released accurately or or in coordination. Uh, and actually, I almost more see tension than I see laxity or weakness, if you want to call it that. And a lot of times it's because potentially someone has let these symptoms go on for a while where their bladder has been maybe overactive or irritable. And we actually get in kind of a protective tension mode to try to prevent leakage. And then what happens is some people might feel like their muscle isn't actually strong. So when you think about like a tense muscle, it can't really perform, right? If you have like a tight bicep and you're trying to squeeze more, well, it's already squeezed. And so sometimes people will say, you know, I feel really weak, like I just can't squeeze the muscle. And then in our therapy, we discover actually the muscle is so tight because there's been so much protective mode tightening that we actually need to relax in order to get the bladder to respond better. And when the muscle's tight, the bladder actually becomes a little unstable. It kind of gives like spasms and that can cause incontinence or just that gotta gotta go feeling all the time. And so it really is not as easy as just saying, I'm gonna squeeze my pelvic floor, or I've tried that and it didn't work. Yeah, definitely seeking out some help can really pinpoint where the issue really is, and we we can help with that in in pelvic floor therapy.

SPEAKER_00 17:17

So, what does pelvic floor physical therapy actually involve?

SPEAKER_01 17:22

Yeah, yeah. And it can kind of seem like, wow, I'm gonna go to therapy for my pelvic floor for my bladder.

SPEAKER_00 17:30

Right. That's what I mean. It's like Right.

SPEAKER_01 17:32

And most people are like, wow, I didn't even know therapy like existed for this, right? Uh so basically uh the doctor would write a referral or nurse practitioner or physician assistant or whoever you see uh sends a referral, and then you see a specialist like myself. There's many of me out there, and you can see a physical therapist or an occupational therapist. And basically, in those appointments, really what we want to do, at least initially, is really get a history. Like when did this start? Uh, how you know, how long has this been going on and what has been the progression of your symptoms? Was there a particular event uh like that you've had this since you had babies, or you had this because you had a prostate procedure, or what what really is the history behind that? And then we really need to get into the the habits and the patterns and the kind of what's been really going on. We need to know all those symptoms, and then we take that and kind of come to a conclusion about some advice for what to do. So there's lots of behavioral or lifestyle modifications one can make uh that are simple, and we would try to kind of shape the kagles or the pelvic floor exercises to be more directed at that person's problem because there can we we want to make sure that it's really addressing that person's challenge level. And then we have a lot of different tests. So I have a uh what's called biofeedback, and that is really kind of one of the gold standards of testing the pelvic floor muscle. So we can test that utilizing an internal sensor, but if that seems a little scary or invasive, we do have external sensors and I also have ultrasound to be able to actually visualize what the pelvic floor is doing. So we have a lot of options to really visualize and really get in more information so I can give feedback on really what to do to make uh you know the situation better.

SPEAKER_00 19:21

Right. So I I like that it's so personal and that you're actually doing, you know, an evaluation of those muscles with that biofeedback. It's just so it's such personalized advice, which is obviously none of this is cookie cutter, just like the rest of Parkinson's. Right. Yeah. So so in that evaluation, like what could the person? I know you kind of mentioned some of the tests, like, is there anything else during that evaluation that a person should expect during that time period when they're um undergoing evaluation?

SPEAKER_01 19:52

Yeah, so we can really, like you said, individualize or customize. I I like to meet the person where they're at as far as if they're like, you know what, I want to throw everything at this, then you know what? I know how I'm trained in uh doing internal examination. I'm trained in utilizing techniques directly on the pelvic floor with the pelvic floor. But some people are like, you know, I'm not ready for that. I want to try some of these behavioral things first. I want to be conservative, right? So I really meet the person where they're at so that we can, you know, figure that out. But definitely one of the things they should expect is some homework. There is gonna be a little a little bit involved. And and a lot of times actually, I really like to do like a diary, uh, especially with the bladder and and sometimes with the bowels, but really with the bladder, I really want to know like what are you drinking? When are you drinking it? What uh does your volume look like when you go to the bathroom? Are you going only like you know, a couple dribbles every time you get this really strong urge, or are you getting like a really nice volume out? Because that is really a key factor in my advice. If someone is saying, gosh, I go so much, but their stream is a little slower, uh, it actually, you know, not might not match up. So I really want to have them actually measure at home how much is coming out. Tell me a little bit about your urge, how does that match with the volume that you're getting? Uh, and then I can match it up with their dietary habits as well, and pull that all together again and bring a little bit more light to the situation so they can make those changes. Uh, and then there's going to be some exercise homework as well. And that will be patient-dependent. It might be strengthening, it might be relaxation, uh, it might be some stretching. So there may be some other things involved.

SPEAKER_00 21:38

I love that you um ask for the data. And I think that's because, you know, even myself as a clinician, you need that to be able to show people that their actions have caused the change. And that's so reinforcing for them, you know, that okay, you know, I I drank this much water before. Maybe it wasn't enough water. Maybe they're spastic and things. Like that, you know, that occurs whenever you do, you know, don't drink enough water. And a lot of times perspective is I'm drinking enough water, or you know, there there are some kind of take homes that we all have about um just you know, we kind of throw it all into one big basket of I just I go to the bathroom a lot. I think it's probably 10 times a day. Well, if you're going a lot, you're maybe not counting at all, right? And so, like really putting a number to it and then giving them those behavioral, you know, those behavioral tips and changes really just will help to reinforce what you're trying to teach them. So I love that you're being concrete with that. I I've learned myself, even with like budget pressure changes too, that if I really give them um, you know, a specific pattern that we're looking for and some real numbers, then they can see for themselves that these strategies are working for them.

SPEAKER_01 22:50

Right, exactly. And that's a great way to to compare, like, well, what did we look like kind of at baseline? Right. And now you make these changes, and now we can actually like really see it on paper and document that. It's a really great awareness tool too, because sometimes, even just after that first session, and I have someone do a few of these things, they're like, wow, that was like a wake-up call. I just didn't even realize, you know. So it's it's a really great tool. And sometimes, believe it or not, even just that is enough to really turn the corner, and then we can just optimize a few other things. And sometimes it's a quick fix, other times we need to dig a little bit harder, but uh it can be in a really amazing awareness tool.

SPEAKER_00 23:34

So you mentioned like some of those strategies that you use. Like, what are some of the practical strategies that people can start using right away to support bladder or bowel function?

SPEAKER_01 23:45

Yeah.

SPEAKER_00 23:46

I know this is not specific because you're not talking to someone you've evaluated, but just kind of in general.

SPEAKER_01 23:52

Yeah. Well, let's like hit on the bladder first. So, like with the bladder, and and you kind of actually alluded to it, uh, restricting fluids, not drinking enough fluids, uh, actually is is definitely one thing you you want to avoid because the bladder just gets aggravated when the urine is real dark or you know, you're just not cleaning it out, and then you're at risk for bladder infections or UTIs.

SPEAKER_00 24:15

Sometimes that's the first thing you do when you start to have what you feel is an overactive bladder is you cut back on water.

SPEAKER_01 24:22

Exactly, exactly. So, you know, the whole eight cups a day is not always right for everyone. So you want to really see, I tell people to kind of look at their urine color. We want it to be like a light lemonade color, a lemonade color in that range. Uh, you know, it maybe eight cups is too much for you. Your bladder might actually not be able to handle that. And and maybe you're a smaller person or or whatever it might be. And uh, so that that's definitely something to pay attention to is the just right water intake. And then I I help guide that as well, but you can definitely take that and and run with that now. Uh, but then some of the other things with with the bladder is you want to avoid irritants. So things that irritate the bladder, mainly the like the top things, would be caffeine. So coffee, even decaf has some caffeine in it. Uh, there's something called tacino, and it's actually a coffee made from tea leaves, and it is caffeine free. It's uh caffeine-free. So it's just like like a caffeine-free or herbal tea. And so Ticino is available online, uh, possibly in other uh more um fancy grocery stores potentially, but uh you can get it online, and some people really like it and it can eliminate that that caffeine issue if you enjoy your coffee in the morning. Uh does it taste like coffee? Yes, uh, yes. They actually the the old version of Ticino was very bitter, and people really didn't like it so much, but now they have all these flavor options and they've really upped their game.

unknown 25:53

Gotcha.

SPEAKER_01 25:56

Okay. Uh, and then I would say uh also avoiding like soda.

unknown 26:00

Yes.

SPEAKER_01 26:01

Uh so not only soda is kind of like uh uh it hits you two hits you two ways. We got this caffeine issue, and then we also have the carbonation. So carbonation is very aggravating to the bladder lining, and so we want to reduce the caffeine and the carbonation. So sometimes someone will come to me and say, you know, they drink like three lacroys a day or something like that. That can also be an issue, uh, that the carbonation just is activating this bladder overactivity as well. Uh, and so when we talk about these little tidbits of advice, it's not that everyone has to be like, oh my gosh, I can't drink carbonation or I can never drink caffeine. It actually is really all about your body, your bladder. So you want to like test it out, kind of like a little elimination diet, right? You might like take it away and see what that does for a day or two. Uh, and it's not that you can never have it, because if you're at home and the toilet's right there and you want your coffee, have your coffee, right? Totally. I'm not ever gonna take that away because I like coffee too. Um, but you know, but if you have a flight at 8 a.m. and you're headed on vacation, that just might not be something you do right before you get on the airplane. And so it's not that you can't ever have these things. It's that maybe you just do that based on what your plans are for the day. And if you really enjoy those things, you can still have them. Uh also, good bowel habits are super important for the bladder. Constipation actually is one of the main causes of bladder aggravation or bladder irritability. And so we really want to keep those bowels moving. Uh, a couple quick tips on the bowels, a squatty potty or a stool for your feet, right? So the proper posture on the toilet can help you relax. So having that stool underneath your feet, being able to lean forward and really relax and breathe and take your time can really be key. Sitting on the toilet about 15 to 30 minutes after eating can really get the gut moving a little bit, kind of using all your reflexes. Uh, and then in therapy, we do some teach some abdominal massage, but even just like deep breathing can help like relax your abdomen and get things moving. And then uh fiber, super important diet, fiber, super important. So high fiber things really helpful. But then, like you and I have been talking about, if you limit fluids but you up your fiber, it actually can cause like a little clash, right? Fiber needs fluid.

SPEAKER_00 28:20

Yeah, uh, so we want to match that up together. I've always said to my patients, have you ever put uh made metamucil and let it sit in a cup on the counter? What is it? What happens? It becomes cement, you know. So if you don't chase it with enough fluid, you're actually backing yourself up more, you know. And I'm I don't like to use the metamucil, but some people can kind of relate to that a little bit more. Chia pudding is is fantastic.

SPEAKER_01 28:45

Yes, yes. I I recommend that a lot. Chia seeds are an excellent source of fiber, flax seeds. Uh yeah, kiwis have been shown in the research, like two kiwis a day, which kiwis are a little pricey, so that would be, but you can vary it up. Variety in your diet is really important too, right? So changing it up a little bit, fruits and vegetables, things with skins, things that can really um kind of give you a little roughage to get the gut moving a little bit.

SPEAKER_00 29:12

You mentioned obviously that you know, drink not drinking enough fluid, you know, can trigger uh more issues with bladder irritability. Are there other like common habits or patterns that might be making symptoms worse without people really realizing it?

SPEAKER_01 29:27

Yeah, I would say just in case going to the bathroom is actually a really bad habit that a lot of people get themselves into. So, you know, if you're going to the bathroom before you go to the grocery store, that's one thing. But if you're going to the bathroom all day long throughout like your whole week, uh, like every time you're like, oop, I'm just gonna go just in case, like all the time, what happens is the bladder actually gets in a habit with that. So the bladder will stretch a little and then you're like, oh, I feel a little something, I'm gonna empty. And now when it fills that little bit of something the next time, you're gonna get a signal. And that's gonna start to become like a regular habit. Uh, and that can be really, really uh challenging to get out of that habit because the bladder has now formed this new habit. But it is retrainable. The bladder is retrainable, the bladder can relearn how to get out of that. But I would say this just in case going to the bathroom would be something you definitely want to avoid. Also with the bowels, uh, try not to just go and sit like for long, long periods of time. It's not really great for your public floor, actually, to do that, both uh in men and for women. So uh it's just too much pressure down there to just be sitting and trying and don't hold your breath and strain. That is a big mistake we can make. Uh, we really want to use breathing to help us to go to the bathroom, because that breath hold straining actually closes the exit, believe it or not. It might feel like you're like really using good effort to try to get the bowels to move, but usually that breath holding straining is just really bad, both for the pelvic floor, like overstretching, but it's like locking things up.

SPEAKER_00 31:06

Okay, that's interesting. So if a person listening to this is having problems with their bowel or their bladder, um, or just feels, you know, like there's pressure there or you know, urgency during the night or uh urinary frequency, when should they consider seeing a pelvic health therapist?

SPEAKER_01 31:28

I would love for them to see someone right away because I I don't want them to be afraid to tell somebody about these these symptoms. They're I know they're private issues and it's not something that everybody just talks about readily, but uh really see somebody about it. I mean, we we should we should tell the doctor that you're experiencing it. Let's get a referral and get you in. And and sometimes it's a quick fix and we can make life so much better. So we'll get on it right away. Uh, and I mean, I'd be happy to help, but I know of ways to to find other colleagues as well if you'd like me to mention that. Yeah, absolutely. All right. So uh basically you you really can be like I mentioned earlier, an OTRPT can do pelvic health work and it's beyond the training of your degree. You you have to go to a lot of extra schooling for this, and you don't necessarily need a certification, but that can be the easiest way to actually find somebody that has kind of taken that extra step. Uh, and so there's a biofeedback certification for pelvic floor uh dysfunction. And so that is one way you can find someone. So the BCIA is the biofeedback certification uh international alliance. They just recently changed their name. So they have a specific area you can search for a public health provider that's certified in biofeedback. There's also the American Physical Therapy Association. They have what's called the WCS, which is a board certification in pelvic and women's health specialty. And so you can search someone via that as well. And then also Herman and Wallace Public Rehabilitation Institute, which is actually where I teach my courses, they have the PRPC, which is a pelvic rehabilitation practitioner certification. That's also a board certification. And so you can find someone on their uh website as well to find someone. Now, the other way would be just to even call the clinic nearby where you live and say, you know, I'm I'm looking for this service. Could you please um direct me to which clinic you have a specialist? That can be another way. Uh and you know, within just Aurora, since that's where I work, we have kind of a really nice system where when the referral comes in, those individuals that look at the referral know where we are. So that can kind of help too when you're in a bigger system.

SPEAKER_00 33:43

That's fantastic. We're gonna put all of those links um in the commentary along with this podcast. So if you didn't catch all of that when you were listening, make sure you scroll down and visit the links and we can connect you there. So, Erica, one last question. If you could give our listeners one piece of empowering advice, what would it be?

SPEAKER_01 34:07

I really think it's it's all about kind of what we even just started talking about in the beginning. It's the pelvic floor is a muscle. So you might think of therapy as like we we train muscles for exercise, but it's a muscle. We can do something about it. We can help the pelvic floor muscle, training it in a different way to help you to really maximize your quality of life, make changes to these areas of your body that are private and something that maybe isn't isn't talked about, you're not alone, it's common, we can help it. Uh, and track patterns. So when you go to your clinician, you can have at least some idea of some of the patterns you've been experiencing. And then we can start from there and take steps to help you get this all taken care of.

SPEAKER_00 34:50

I love it. I love it. You know, like we said at the beginning, this can be a sensitive topic for people, but I love that we're sharing this with everybody and um really just encourage people that have that discussion. You know, start with your family, write these things down, try to take notes as much as possible, and then uh look into pelvic floor exercises. That's the key word. Even when you go to your doctor, maybe they don't even know about it because there are clinicians that aren't aware of pelvic floor exercises as a therapy option. So um take that with you. Thank you, Erica, so much for joining us today. You provided a ton of useful information, and I just know that there are going to be people out there that appreciate it and can utilize it. Thanks so much, Stacey. Take care now. Thank you. The Wisconsin Parkinson Association is a grassroots organization funded by people like you. To support more local programming like this, visit wiparkinson.org.