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Pelvic Floor Dysfunction and Diet

06/03/2014, 11:30am EDT
By Lacey Welch, PT, DPT

The Good, The Bad, and the Unknown

Lacey Welch, PT, DPT

You may or may not notice that when you eat or drink certain foods and fluids, it affects your urinary and bowel function. Sometimes for the better, other times for worse. As I work with women who have pelvic floor dysfunction, dietary education is at the forefront of my treatment plan as it is typically a key component in symptom management. This is especially important for those who have symptoms of urinary incontinence/frequency, constipation, and anal incontinence, not necessarily pelvic pain disorders.


Since the bladder is where excess water and toxins are held and eventually exit, we have to be careful in avoiding bladder abuse by selectively choosing our diet. Otherwise, we may consequently develop frequent urination and incontinence or other conditions more difficult to treat. If we don't provide adequate nutrition for good colorectal health, constipation, irritable bowel syndrome or anal incontinence may ensue.


I implement dietary education usually after the patient returns with a completed voiding log, documenting their baseline diet and bowel/bladder function. This allows me to individualize their education and analyze whether or not it is a major symptom generator. The recommendations I provide are not in the form of a meal plan, as I am not a dietician, they are delivered with caution, as most people have other co-morbid conditions to consider.


The Good


The most influential component of our diet is water - pure water. By pure water, I don't mean artificially flavored water. By pure water, I don't mean carbonated water. By pure water, I mean straight up water, on or off the rocks. It is baffling what little water most people consume. Dehydration is not only detrimental to those with pelvic floor dysfunction, but can also be an underlying reason for symptoms of dizziness or impaired balance. Many of my patients with urinary incontinence feel as though they should drink less water to avoid an incontinent episode or frequent trips to the bathroom. What is misunderstood is that a bladder deprived of water is an unhappy, more irritable bladder. When we dehydrate our body/bladder, we increase the concentration of the urine, therefore irritating the bladder lining and likely causing worsening symptoms of urinary incontinence. As for constipation, the colon must be supplied enough water, and fiber for that matter, for our food to absorb and form into stool, with enough remaining to stimulate bowel motility and regular evacuation. (TMI?) Bottom line, everyone should consume between 32-60oz of water each day or half of our body weight in ounces, unless a co-morbid medical condition contraindicates such. It is good to help set achievable goals for the patient in order to gradually increase their intake of water, avoiding majority of the intake just prior to sleep at night.



The Bad


Unfortunately, much of the food and drink our society regularly consumes consists of major bladder and bowel irritants. One of the most harmful, but seemingly popular drinks we can ingest is diet soda. I explain to my patients that it beholds a quadruple threat - color (tannins), carbonation, caffeine, and artificial sugar (particularly, aspartame). Any food/drink that contains one or more of these four irritants should be cautioned against in those with symptoms of bladder/anal incontinence as they contribute to damage of the bladder lining and disrupt stability of bowel and bladder function. Other dietary irritants consist of acidic/citrus fruits, alcohol, spicy foods, and sugar if consumed in excess. These are just a select few of the more commonly documented irritants to bladder and bowel function that I feel are the most influential in symptom improvement.


The Unknown


There are many foods and drinks that may potentially affect our bladder and bowel health negatively. It is important that the patient be educated on evaluating the response of his or her bladder/bowel function in relation to what they consume, and modify their diet, or not, based on those responses. A helpful website with an expansive categorized food list for bladder friendly and not-so-friendly foods is: It is geared toward those who have symptoms of interstitial cystitis, but I find that it also relates well to those with less severe symptoms of urinary incontinence. As changes are indicated and implemented, patience is necessary due to the time it takes to cleanse the body of irritants and repair damaged tissues. Therefore, a timeline for improvement is difficult to pinpoint due to the varying severity of symptoms caused by diet.


Certainly diet is far from the only factor affecting pelvic floor dysfunctions, but cannot be overlooked when treating such. All of us, as physical therapists, can initiate dietary education to those symptomatic of pelvic floor dysfunction, as this is a noninvasive treatment method we are all qualified to implement. However, if you determine the patient requires more detailed education or you feel uncomfortable discussing this with your patient, it may be necessary to refer to a pelvic floor rehab therapist.


Let this be our inspiration: "Chuck Norris can lead a horse to water and make it drink."


I would love to hear your comments, suggestions or questions, so feel free to contact me. 

Sponsored by Lacey Welch, DPT

Lacey Welch, DPT

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Lacey graduated from the University of Central Arkansas in 2010 with a Doctor of Physical Therapy degree. She then moved back to her roots in Texas to practice in outpatient physical therapy. In 2011, she accepted a position to facilitate the development of a women's health program, which is where her passion lies. She seeks opportunities to educate the community and other healthcare providers on the availability and importance of pelvic rehabilitation and women's health physical therapy. Check her out at: LinkedIn and Twitter. 

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