“ I have to get up 6-10 times a night due to my bladder” “ Sometimes I soak the bed when I sleep” “ I am afraid to go out because I may leak if I laugh or sneeze” “ Sometimes the urge to empty my bladder is so strong I can hardly get my pants down in time” “ I try not to drink much before I go somewhere so I won’t have to go to the bathroom”
Hello again everyone!
It’s Carlene, (Dr. J) and I am back with another topic I address a lot in my private practice; bowel and bladder challenges. What does an occupational therapist have to do with bowel and bladder issues?
I am glad you asked! Occupational therapists are trained in human anatomy, so we understand the muscles, tendons, ligaments and nerves that make up your pelvic floor. The pelvic floor is the area between your tailbone in the back and your pubic bone in the front (where the zipper starts on your jeans). It also includes the sit bones. If you sit on your hands, you will feel those. The amazing pelvic floor contains 14-16 muscles, connective tissue, bones as well as organs ( bladder, uterus or prostate, vagina or penis and rectum). The pelvic floor has three jobs: elimination, intimacy and support/organ protection. To put it bluntly, the pelvic floor is all about pooping, peeing and sex. But the pelvic floor also serves as a shock absorber when we walk or run. It keeps the organs in place and the bladder from emptying at the wrong time when under stress. However, like any other muscle in the body, the pelvic floor muscles can become weak, stretched, or uncoordinated. This can result in less-than-optimal elimination and intimacy. Therefore, an occupational therapist’s knowledge of anatomy can be very helpful in finding solutions to improve the function of pelvic floor muscles.
Relaxing is Key to Elimination
Did you know that even just changing the way you breathe may help you coordinate your muscles? Many people don’t realize that eliminating pee and poop requires the muscles to relax. When they find themselves straining to eliminate, they are fighting their body rather than helping. An occupational therapist can provide pointers on ways to sit and breathe to promote the relaxation required to fully empty the bowel or bladder. For example, you have a high toilet now because it is a lot easier to get up from, but that new position puts a bit more of a kink in your rectum so it’s harder to eliminate your poop. Did you know constipation can cause your Parkinson’s symptoms to worsen? I urge you to print the attached sheet to help you identify any factors that may be affecting your symptoms. Some simple retraining may be all it takes to reduce constipation or enable you to fully empty your bladder so you don’t feel a frequent urge to urinate. For example, a squatty potty (a stool you can slide under your feet when you sit on the toilet) may help you relax so you can poop more easily.
Daily Habits Matter
In addition to understanding anatomy, an occupational therapist is trained in assessing a client’s daily habits and routines as well as the role anxiety may play in pelvic health. Many people may not realize that bladder urgency issues (feeling like you must go frequently or can’t make it to the bathroom in time) can be compounded by habits and anxiety. Let me break that down. You are planning to go out for the afternoon, but you are afraid you may not be able to make it to a bathroom in time, so you don’t drink any water. It makes sense to limit how much goes in to limit how much comes out. However, what is really happening is the urine you produce is very concentrated because you may be dehydrated. As a result, the urine is more irritating to the bladder making you want to pee more often, not less. The solution is to drink more water. Did you know you need to drink ½ your body weight in oz. every day? For example, if you weight 140 lb., you need 70 oz of fluid a day and 2/3 of that should be water.
Also going to the bathroom too often can become a habit. How do you know if you are going too much? Going pee every 2-4 hours is normal. Are you going more than that? When you go can you count at least 10 seconds of urine flow. If you count 1 Mississippi, 2 Mississippi … up to 10 and you are still peeing then you had to go. If it is less than that you did not really have to go and you may be getting into an unhelpful peeing habit. Do you find that every time you walk by your bathroom you have the urge to go? Do you find that you try to pee before you go anywhere “just in case?” It is important to pay attention to your body’s cues for elimination. If you suffer from urgency, try the following: take some deep breaths and count back ward from 100 by 7 and see if the urge passes, or try squeezing your toes 10 times. You can also try walking more slowly to the bathroom. In other words, see if you can find ways to distract yourself and increase the amount of time between trips to the bathroom until you are on a more normal schedule. See this youtube video from the Davis Phinney foundation for more education from a Pelvic floor therapist.
Simple Lifestyle Changes Can Work
Bowel and bladder issues are VERY common, and not just for folks with Parkinson’s Disease. The good news is there are some very effective lifestyle changes you can make that may not involve taking more medication to manage these issues. A good first step is to pay close attention to both your input and your output. See this short fact sheet and log you can use to get started. An OT or PT who specializes in pelvic floor therapy could be an important part of the solution. Ask your doctor for a referral to a pelvic floor therapist. I am also advancing my training in this important area. I offer a 30 min free consultation via phone or Zoom. Please reach out to me through my website My LiveABILITY if you would like to know more.